Narrated by Dr. Sarah Shah:
Besides learning about run of the mill cases in medical college, it was exciting to see and experience the weirdness of the human psyche and physiology. That was how we met Mazen who was a cocky 16-year-old when he walked into the out-patient clinic for the treatment of his chronic abdominal pain. As was usual with walk-in patients, the attending doctors would expect the students to take the detailed history and do the prelimary examination of the patients. He smiled most of the time and thought it was hilarious that so many young women in white coats were so seriously focused on him. He was very ticklish and giggled all through his baseline examination. We had to ask all the relevant questions from him…How long had he been ill? Did he have constipation? Diarrhea? What and when did he eat last? More giggles (and eye-rolls).
Well, the general history was taken, and though we tried, he did not give us any specific information about his diet or what he ate last. Yes, he did have constipation off and on. He looked a bit pale, and his pulse was a bit fast and thready, but we didn’t think it was significant at the time because he was active and very responsive.
When it was time for the professor to examine him, we all crowded around to hear what was being discussed and most of all what the professor thought about the differential diagnosis of the patient. We were interested, no were desperate to know how he was ultimately going to come to the diagnostic conclusion of Mazen’s abdominal pain. I did notice that the patient was a bit furtive and tries to avoid a few of the pertinent questions.
All of a sudden, just as he was about to be palpated by the professor on his abdomen, Mazen turns on his side, groans and vomits a projectile of fresh blood! We immediately sprang into action and put up an IV bag with saline in one arm and took a blood sample to cross match his blood for an emergency transfusion. But within 10 minutes we were performing high quality CPR (Cardio Pulmonary Resuscitation) on him. Unfortunately, our efforts were futile and he died quite soon after that.
We learnt a major lesson on how to communicate bad news to a bereaved family that day. It was even more excruciating for us since it was our first time, and the patient was so young and full of life when he came to us. How do we tell a family that a young child who walked merrily into the clinic had just died? And we could not tell them about the exact diagnosis at once. Understandably, once we had given the sad news to his family, they were very upset. They wanted to take him away to be buried immediately. But our professor was able to convince the family to have an autopsy done since he came to us with his mysterious abdominal pain followed by his vomiting of fresh blood. We needed to know what the actual diagnosis was so that it could be treated or even prevented if we came across another patient with these symptoms in the future.
Since our study group was present when he visited the clinic, we were all allowed to attend the autopsy as well. After all we wanted to know the conclusive diagnosis as much as anyone else. While waiting for the autopsy to begin, we tried to out-guess each other by tabulating the various causes of bloody vomiting, especially in his age group. We were acting like over-zealous puppies. (Nothing new). The “I know better than you” interns were also there in full force, looking at us medical students with their usual disdain. And as usual we ignored them.
Finally, the autopsy commenced and as usual, the body was opened with the thorax to abdomen Y-incision and was painstakingly examined. We realized that with our speculative pre-autopsy discussions, we had already unknowingly suspected Mazen’s diagnosis when the stomach was palpated before it was sliced open. Examining it carefully, we saw that it had unusual bruising all over it, some fresh and some in their healing phase. There were also unmistakable signs of where it hemorrhaged and most of all, it had some really strange lumps. The stomach seemed quite solid and heavy for a normal organ when it was lifted out of the abdominal cavity. However, once the wall of the stomach was incised, we saw to our morbid fascination that it was filled with sharp metal objects! Razor blades, random pieces of metal, countless needles, and even a small pocket-knife!! No wonder he was in pain and no wonder that he literally bled to death. His stomach was so full that a partial intestinal obstruction had already formed, and it was concluded that the abdominal pain was due to the strong peristalsis (movement of the gut) trying to push the blockage forward. Instead of that helping, due to the strong movements, the sharp edges of the razors had rubbed against the stomach wall where ultimately an artery was severed. That led to Mazen’s fatal hemorrhage.
Mazen had suffered from a rare form of pica, (an eating disorder characterized by a tendency to eat substances that provide no nutritive value) called Acuphagia. This is a condition where people ingest sharp objects willingly. Usually, this type of pica is found in mentally ill patients, but so-called normal people, have also been found to have this disorder.
Although very few cases of Acuphagia have been reported in the medical literature (particularly in adults), most of these suggest that those displaying the symptoms have psychological disorders, (except of course if the behavior is part of an “entertainment” act). Well from whatever information we were able to garner with our brief acquaintance with Mazen, he seemed active and alert, though he did give the impression of being an extrovert, like a class clown. It could be possible that he was showing off to his friends or he swallowed the sharp metallic items on a dare…On the other hand, it could be that he was impressed by some magician in the movies, and his quest for entertainment became his nemesis, and he ultimately died a painful death.
Moral of the story…don’t eat what you shouldn’t. It can kill you.