Case 3 - Jason Bird

Jason Bird was a 47 year old man who was admitted to a cardiac intensive care unit despite having no health care card-- he claimed he had lost his billfold to a mugger a few hours earlier. He came to the emergency room of a Midwestern hospital late on Saturday night, complaining of crushing sub-sternal chest pain. Although his electrocardiogram (EKG) was markedly abnormal, it did not show the changes typical of an acute myocardial infarction (MI). The cardiologist on call, noting his ashen pallor and obvious distress, ordered him admitted and then waited for the cardiac enzyme results.

The following day, Jason's EKG was unchanged and the serum enzymes showed no evidence of heart muscle damage. His chest pain continued. He complained loudly that he was being ignored. The cardiologist urgently requested a mental health consultation. Jason was a slightly built man with a bright, shifting gaze an a four day growth of beard. He spoke with a nasal Boston accent. His right shoulder bore the tattoo of a boot and the legend "Born to Kick Ass". Throughout the interview he frequently complained of chest pain, but had no difficulty breathing or talking, and he showed no signs of anxiety about his medical condition.

He said he had grown up in Quincy, Massachusetts, the son of a physician. After high school, he attended college for several years, but found he was "too creative" for a profession or conventional job. Instead, he had turned to inventing medical devices, and numbered among his successes a positive-pressure respirator that bore his name. Although he had made several fortunes, he had lost nearly everything to his penchant for playing the stock market. He had been visiting in the area, relaxing, when the chest pain struck.

"And you've never had it before?" asked the interviewer, looking through the chart.
Jason denied that he'd had any previous heart trouble.
"Not even a twinge. I've always been blessed with good health."
"Ever been hospitalized?"
"Nope. Well, not since a tonsillectomy when I was a kid."
Further questioning was similarly unproductive. As the interviewer left, Jason was demanding an extra meal service. Playing a hunch, the interviewer began telephoning emergency room physicians in the Boston area to ask about a patient with Jason's name or peculiar tattoo. The third try struck pay dirt.

"Jason Bird? I wondered when we'd hear from him again. Hes been in and out of half the facilities in the state. His funny looking EKG-- probably an old MI looks pretty bad, so he always gets admitted, but there's never any evidence that anything acute is going on. I don't think that he's addicted. A couple of years ago he was admitted with genuine pneumonia and got through a week without pain medication and with no withdrawal symptoms. He'll stay in the ICU a couple of days and rag on the staff. Then he'll split. He seems to enjoy needling medical people."

"He told me that he was the son of a physician and that he was a wealthy inventor."

The physician at the other end of the line chuckled. "The old respirator story. I checked into that one when he was admitted here for the third time. That was a different Bird altogether. I don't know that Jason's ever invented anything in his life. As for his father, I think he was a chiropractor." Returning to the ward to add a note to the chart, the interviewer discovered that Jason had discharged himself against medical advice and departed, leaving behind a complaining letter to the hospital administrator.