Acute Incarceropathy

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OLYMPUS DIGITAL CAMERAThe chest pain patient was escorted back to a treatment room by not only the triage nurse, but also by a police officer. The patient was crying in pain. Agonizing pain. As the officer removed the handcuffs, the patient slowly and deliberately climbed onto the cot.
“I’m doctor WhiteCoat. What brings you to the emergency department today?”
Through her tears, she rolled her eyes and tilted her head toward the police officer.
“I see that, but why did the officer bring you here?”
“I – I – I am having PAIN! Pain all OVER!”
“The nurse said that you were having pain in your chest.”
“There, too! I have a complicated case of Behcet’s Disease. Any time that I have too much stress, I get a flare and all the joints in my body become inflamed.”
When she said that, the police officer rolled his eyes.

I dutifully performed an exam. Everywhere I touched, the patient would yelp … except when I touched her chest with a stethoscope to listen to her heart. Complicated Behcet’s disease must only respond to the galvanic response to another person’s fingers coming into contact with one’s skin. None of her joints felt warm or inflamed, either. Just pain all over. No eye irritation. Between breaths, she stuck out her tongue to show me the ulcerations that had “just popped up in the past hour.” She definitely did have ulcers in her mouth. However, the ulcers had obviously been there for a long time and had obviously not appeared just since her stressful event. For a complicated case of Behcets, she wasn’t on any immunomodulators. She had never taken them in the past, either.
Then came the EKG.
While the tech stuck the leads to the patient’s chest wall (which caused her absolutely no pain, mind you, because there was obviously no galvanic connection), the police officer pulled me aside.
“Is this going to take much longer? She’s got several warrants, and she got caught stealing a purse from a woman’s stroller in a department store. We’re not going to be able to release her on bond this time. She only started complaining of pain once she got caught.”
“Hopefully not …”

The EKG was normal.
The patient apparently knew it. She began to bawl louder and complain of more pain all over her body.
The nurse explained “The doctor ordered you Toradol. Toradol is a wonderful anti-inflammatory medicine. It should help quite a bit with your pain and inflammation.”
She was discharged to police custody shortly thereafter.

Technical diagnosis: Acute exacerbation of complicated Behcet’s Disease with underlying aphthous ulcers and general myalgias.
Secondary diagnosis: Acute incarceropathy with generalized incarceritis.
Plan: Release to police custody.

Since she was in police custody I had to fill out a form stating that she was medically stable. I made sure to add that she should not be subjected to any unnecessary stress while in lockup.
That made the officer chuckle.
“We’ll make her stay very stress free, doc. Very stress free.”


This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

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