When you come to the ER stating that you can't move your legs. That they feel paralyzed. That this happened a week ago after twisting wrong. That this got better after slipping and falling on your buttocks. That it got worse again after slipping, again. That the ED to ED ambulance transfer of 100 miles at 3 am for a stat MRI showed only old scarring from previous disc surgery. That your spine surgeon who was consulted by phone says they fired you for persistent narcotic shopping. That you say you are awaiting a second opinion that your spine surgeon ordered in a town 60 miles away. That you say you can't pee but have normal rectal tone. That you show signs of malingering on physical exam. There are certain things you can't fake.
When you have all this, the clues point to malingering. And the history and physical is backed up by that $2000 middle of the night MRI that has normal written all over it. The fear of "Am I missing something? " are overwhelmed by the feelings of "How could this not be malingering?" With all this available data pointing towards nonphysiological weakness I am forced to conclude that your complaints are either supratentorial or they are an intentional misrepresentation of the truth.
But the nail in the coffin? The sign that cinched my diagnosis? Your husband. His performance deserved an Oscar. He lay there for 30 minutes. Sleeping. Not once raising his head off the countertop. Not once opening his eyes. Not once acknowledging my presence. Not once showing even a hint of concern about your paralysis. Your husband could care less that you are paralyzed. That, my loyal Happy readers, is the strongest sign I could have ever asked for. It means more than all the questions I could ask. All the poking and proding I could do. All the objective data I can spend money for. What is this magical sign?
The Sleeping Husband Sign.
A test so wonderful that it can predict the lack of acute major illness 100% of the time. The perfect tool for ER medicine. Not much in medicine is 100% sensitive and specific. The sleeping husband sign is your best friend. And it doesn't cost you a dime.
Plan: Discharge from ER