There is a man living in New York City who once suffered a traumatic brain injury and is now frequently brought into our ED by EMS with a chief complaint of “seizure.” Often providers order labs, imaging and medications, prescriptions he doesn’t fill and make clinic appointments he never attends. He appears disheveled so many assume he is addicted to alcohol and has seizures due to withdrawal.
“Seizure” is the one of the few English words this man knows. He is Polish, as am I, and in speaking with him in Polish, I’ve come to understand the circumstances that have rendered him one of our “frequent fliers.” He is street homeless and often sleeps on sidewalks or park benches. Concerned passersby call EMS to help, but they cannot understand him so he says some of the only English he knows – “seizure” – and they bring him to our ED where miscommunication leads to the usual algorithm.