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Dying to Be Sick

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For the most part, people don’t want to be sick and don’t want to be in the hospital. However, I’ve learned that there is a small minority of patients who are desperate to be sick. It’s amazing what lengths they will go to.

One woman came in complaining of a bloody nose.  It was enough blood that she was admitted. The patient was on blood thinners which can often cause bloody noses.  She stated that she was on blood thinners because of a problem with clotting. By her count, she’d thrown 5 clots to her lungs (called a PE or pulmonary embolism) in the last few years.  Because you can die from a PE, she was put on blood thinners to prevent further clots. She also had a filter installed in one of her major vessels to prevent further clots from getting to her lung– a somewhat invasive procedure.

The physician caring for the patient started looking at old CTs and other imaging.  Turns out the patient had never once had a clot show up on any imaging. Her blood work also showed no signs of confirmed clot. Digging a bit deeper the physician noted that the patient used to work in the medical field and would know the symptoms of a lung clot: sudden onset of shortness of breath, chest pain, sweating, cough, anxiety, and even “impending sense of doom.” This woman had talked her way into a filter in her blood stream, blood thinners, and multiple hospital admissions with no objective sign of anything wrong with her at all.  After paying closer attention we discovered she would only get nose bleeds after she had been left alone in the room long enough to cause one herself.  They re-tested her blood and discovered that she was still secretly taking blood thinners, perhaps to keep the nose bleeds coming.

She was one of my first malingering patients and I couldn’t figure out why she would be doing such a thing.  Turns out she was a mother of a small child and her husband was serving in the military in a war zone.  She asked the doctor to write a letter for her saying that she was too sick to care for her child and needed her spouse to come home.  I felt terribly for her.  She felt that she needed her husband back so badly that she would risk her own life with unnecessary medications and procedures.   Unfortunately for her, the doctor had picked up on her true motive and couldn’t write the letter for her.  She left immediately. My guess is that she went to another hospital to try again.  Because of the way privacy laws are, her physician would not and could not try to notify other physicians of the ploy.

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