People pretend to be unconscious for all sorts of reasons. I've been to countless numbers of patients who for one purpose or another are pretending they are out for the count. I call this being funconscious because its not serious. There are some classic scenarios we see regularly - like the argument or domestic dispute that results in someone taking a little break from the day, the shoplifter whose booty stuffed handbag got the attention of store security, the drunk person who has sobered up just enough to realise that they made a complete fool of themselves and now have vomit in their hair and no taxi money. The bloke at the airport who just got told he’s missed his flight and now collapses to the ground with some bad fake seizure activity and then the usual eyes clenched shut, I’m really, really unconscious stuff follows.
You end up getting a good nose for picking the real deal from the Oscar winning performance. You get no points for picking the bloke who has flown through the air over the bonnet of the car and now has a head like a dropped watermelon. He will almost always be the real thing. It’s the unconscious person in the absence of all obvious reason for being unconscious that is where it gets interesting. There are a number of mnemonics in ambulance for remembering the broad groups of reasons people might be in an altered conscious state or unconscious. What these mnemonics show is there are literally hundreds of possible and potential causes. So we always default to the possibility that this may be real even when we know its not. There that should keep the do-gooders quiet.
I've been to little kids who "wouldn't wake up" who just turned out to be so heavily asleep that even picking them up out of their cot, gently shaking them and taking them out to a bright lounge room full of anxious new parents didn't phase them. I wish I could sleep like that. I can even kinda sympathise with grandpa who was so sick of his wife's constant nagging that he went to his happy place.
There are a few of things you can do to check for purposeful movement (which I wont go into here) and needless to say that the body's involuntary responses and reflexes will often undermine even the most determined efforts on the part of the prostrate (note the subtle but important difference in spelling) punter to stay unroused.
There are stories in every city of those who are true masters of the funconscious episode. These are the ones that everybody knows are putting it on. They are the repeat performers, the true Oscar winners who despite every trick in the book including painful stimulation and invasive airway manoeuvres that would make most of us gag and bring up lunch, are able to lie there and not give the game away. These are the ones who will suddenly recover at hospital, demand the toilet and tell the nurse to give them back their smokes. We sigh and say to each other – I knew she was faking it.
I always give people who are faking it the opportunity to ‘wake up with dignity’. There are always those people who have had such a crappy day that they are now lying there wishing very hard they were somewhere else. Whether you agree with it or not, these people do deserve an opportunity to muster some strength to re-face the day. Give people the opportunity to “recover” with their composure intact and they will often do it without vigorous prompting. There is a risk if you make people feel and look foolish that they will not respond well.
I remember an unconscious schoolgirl who was being teased in the playground and had fallen over in front of her tormentors. The concerned staff couldn’t wake her and the growing crowd was only making it worse. We cleared the area of kids and teachers and whispered to her that it was ok to wake up now. Amazingly she did.
Well, I'm off to become unconscious now for at least the next 8 hours...