Romance on the surgical service
Sometimes, an otherwise complicated diagnosis can be made with a simple observation, without requiring many procedures or expensive tests. Witness the case of Benji:
One day, a neighbor frantically knocked on my door and told me that she could not arouse her 6 year-old son, Benji. I raced over to the house to find Benji lying on the couch, and indeed it did not seem possible to awaken him. A preliminary neurologic exam revealed nothing wrong. I then raised Benji’s arm above his face and let go. Now, when a person is really unconscious the arm will hit his face. However, if he is faking, the arm misses, since the patient does not want to hurt himself. Benji’s hand missed.
I then announced to Benji, that since I could not wake him up, I would have to give him a big shot in the behind with a needle that he would not feel since he was not awake, and that I was going out of the room to prepare the shot. I left the room with Benji’s parents and came back about a minute later. Benji was gone. He was hiding behind the couch.
So arriving at a complex diagnosis is not always difficult when there is a pearl that shows the way.