Pt is a young, well nourished, slightly hysterical woman with an undesirable body fat distribution, complaining of recurrent spontaneous combustion. At time of exam, no combustion was apparent. Pt kept holding up tattered, scorched tennis shoes and insisting that they had been on her body the last time she had unexpectedly burst into flames. Outwardly, her husband corroborated her story, but he looked nervous, and was perhaps under duress to do so. He carried a bucket of water with him. I wondered if he was an undiagnosed diabetic, given the amount of water he carried on his person, though oddly I never saw him drink from the bucket.
Explained to pt that what she was experiencing was undoubtedly a hot flash, which is normal for women, because of their hormones. Pt claimed to be twenty three years old with regular menses. Explained to patient that you can go into menopause at any time. Pt demanded hormone testing to confirm menopause. Informed patient that hormone testing in women is never useful, because I am unable to interpret it. Pt was referred for psych consult and given a pamphlet titled, “So you’re a hypochondriac”. A small stipend of Ativan was allowed, so she wouldn’t exhaust her husband with her notions. Husband was handed a domestic violence packet, and told he could always reach out to the office if he felt unable to manage her on his own or feared for his own safety.
At two month follow up, pt reported no improvements with the outpatient intensive therapy program. She has reportedly been difficult in her therapy group, where the lead psychiatrist noted that she unexpectedly burst into flames, and her head spun around backwards.
Upon my reading of the psychiatrist’s note aloud, pt shouted in an shrill tone, “See! I told you so.”
Explained to patient that her spontaneous combustion is psychosomatic or “functional” and is the result of anxiety and depression, and it will stop as soon as she is able to get her emotions under control. Prescribed a recklessly high dose of SSRIs, to be escalated if she continues to complain of physiological problems of any kind. I even patted her and squeezed her thigh, so she would feel validated, and like I had heard her concerns.
Husband demanded an MRI for the neck spinning thing. He was provided another pamphlet titled “So your wife is insane, and Ronald Reagan shut down all the seaside asylums”.
At four month follow up, patient’s husband entered carrying a fire blanket. He claimed he would throw it over her whenever she experiences a “combustion episode”. Recommended discontinue use of fire blanket as it would only encourage her delusions.
Dx patient with fibromyalgia, functional neurological disorder, and feminine notions. Pt complained that she doesn’t experience fatigue, she “just keeps exploding into flames, and recently sometimes speaks a made up sounding language”. Explained to pt that confabulation is a symptom of anxiety and depression. Increased dosage of SSRI to slightly beneath the LD 50 from rat studies.
At six month follow up, pt was newly released from hospital where internist’s notes state she repeatedly caught on fire, spoke nonsense, walked upside down along the ceiling, and suffered recurrent non epileptic seizures (the sort only crazy women have, and which are always caused by anxiety and depression, men only have epileptic seizures). The internist was foolish enough to test for encephalitis, the acute porphyrias and Pheochromocytoma. I know better. There are no zebras, there are only hysterical women. Husband brought a flask of “holy water from the Catholic Church” with him to the appointment, claiming he would douse her with it when she became unruly. Advised him to discontinue using holy water, and just allow the patient to burn herself out. This will teach her that being on fire is ok, and that it is a consequence of her anxiety. Once she realizes as much, her anxiety will stop, and the spontaneous combustion will resolve on its own.
At eight month follow up, patient walked into the room and began speaking in… perhaps whatever language my wife’s extremely buff gardener speaks. It all sounds like nonsense to me. She feigned a fall to the floor and began shaking. I lifted her arm and dropped it on her face. She immediately burst into flames. Her husband covered her with a fire blanket and made a verbal appeal to god. Dx’d patient with problematic womb, PNES, and conversion disorder. Again, recommended discontinuing using the fire blanket, although I do not like repeating myself.
Husband became disgruntled and started shouting. Wife was taken from the room by a nurse. Husband was privately informed that lobotomies are still performed in some parts of the world. I offered to have his wife seen at the “functional neurological disorders clinic”, where they will teach her to stop bursting into flames by strengthening her mental resolve, and having her practice NOT bursting into flames. Husband recommenced screaming. Psych referral sent for husband.
At eight month follow up, patient claimed to have self diagnosed with demonic possession by googling her symptoms. Informed pt that demonic possession is extremely rare and statistically, she doesn’t have it. In fact it’s so unlikely that she would have it, that it’s not even worth ordering the test. Her symptoms aren’t severe enough for demonic possession, and also her symptoms are inconsistent with demonic possession, which typically presents with projectile vomiting. Her symptoms are much more consistent with hot flashes and anxiety, which she is already being treated for, so it’s not worth ordering any more tests. She is being appropriately medically managed, and if she thinks she knows better than a doctor, she should just take care of her own issues. Pt demanded referral to a priest specializing in exorcism. Refused referral. Increased dosage of SSRI. Pt lost to follow up.
Ponds, Pebbles, and Porphyria 
Leave a comment