Everybody needs a win sometimes, and these hardworking lawyers hit the jackpot. From jaw-dropping courtroom revelations to jury plot twists, they finally got to say “case closed” in these triumphant moments. After all, it’s not every day that you get to pump your fist in front of a judge. Lie back and enjoy the victory.
Done And Busted
a room with a desk and chairs in itPhoto by Robert Linder on UnsplashI had a client who was accused of taking a young woman's car and then crashing it and fleeing the scene. The girl testified at trial that she had given him the keys that night because she had been drinking and she "would never, ever drink and drive." I just sat back and let her speak, because she didn’t know that I’d already won.
Apparently, she was not aware that I had requested and obtained a copy of her driving record, which showed she received a charge for exactly that—drinking and then driving—after the incident in question. I still remember the look on her face when I handed her the driving record and said, "Except for that one time you got caught a month later, right?"
The look on the judge's face was equally memorable.
A Bump In The Road
I was working as a paralegal. We were defending a claim that had run into tens of thousands of pounds against our client. It was a trailer park where a woman had tripped over a speed bump while walking back to her caravan, and damaged her knee. The fall was genuine. The question was whose fault this was. She claimed it was the trailer park’s fault because she hadn't seen the speed bump due to low lighting, poor marking etc.
Going through the various questions to her, our barrister asked how she knew the speed bump was poorly marked, or something similar. Her response was, "Well, I remember thinking how it wasn't well marked when I was walking up to it." Needless to say, it was a short day in court after that point. I mean, if she saw it in the first place…
Me, Myself, And I
During a deposition. It was a case where two former employees decided to start their own company in a VERY niche market, but decided to make their plans on company laptops they unsuccessfully tried to brick. Now, there isn’t anything specifically wrong about wanting to leave one company and start your own. The problem was how they did it.
They were trying to poach existing clients while still employed, which breached their fiduciary duty, particularly of loyalty. I believe we also went after them for intentional interference with contract, as they weren’t trying to solicit new clients for their business, but rather trying to get existing ones to break their contracts with our client.
Using the company laptop to try to do it just made it way easier to catch them…when the company IT guy found all the emails. Yep. These were not the smartest bulbs in the drawer—but at the deposition, they really let it all hang out. One of the defendants was the one being deposed. She said she “answered to a higher power than the company.”
When pressed on what that meant, she said “herself.” That got reused prominently at trial.
Caught Red-Handed
I was reviewing the transcript of an interview with a child. The child made incriminating statements against my client. At one point, when discussing the allegations, the child used an odd word, but I didn't think much of it. A few days later, I was watching a video of the child interacting with their grandmother, who hates my client, from about a week before that interview. That’s when it all became so clear.
The grandmother used the exact same odd word in the exact context the child later used it. At that moment, it became clear that the child had been coached. It was the first real "ah ha!" moment of my career.
A Total Trainwreck
I was sued for a car crash. While the plaintiff was on the stand, she began recounting the event, and everyone realized the stomach-dropping truth. It was a completely different crash. Different cars involved, different time of day, everything. Upon cross-examination, she revealed that she had FOUR lawsuits running concurrently and couldn’t keep them all straight.
The jury foreman looked at me and rolled his eyes! Her eventual payout from my insurance was a pittance, less than the initial settlement offer before the whole thing went to trial. Her lawyer was shaking with anger when court adjourned. He was one of those “we don’t get paid unless we get money for you” guys, so he lost a lot of money on that one.
Paper Trail
person writing on white paperPhoto by Cytonn Photography on UnsplashI worked on a case involving defective processors. In discovery, we got emails from the defendant’s engineers who had worked on the processors. They were in an Asian country, but the emails were in English because they were going to US executives. As we read them over, one email’s contents absolutely sealed our victory.
One of the more senior engineers basically laid out the exact defect we were suing over, explaining what the problem was and why it was their fault, and finishing with: “This is a big problem, we ship JUNK to the customer!” Needless to say, we hit them over the head with that in mediation, and they settled shortly after.
Nickel And Dime
I represented myself in small claims court. My lease had an exit clause that said if I fronted two months’ rent, they would work to lease my place and return any money that was unused. I checked with the office ahead of time, and they ensured me there was a waiting list for the units, so I gave them the two months and moved. This turned out to be a huge mistake.
They never returned a dime. I talked to the new tenant and confirmed they moved in a week later. In court, the judge was commenting on how he didn’t see anything explicitly saying they would return any unused rent, even though that intent was stated to me a few times. Dumbo from the leasing office piped in with “Your honor, in almost every case we can return some money, but in this case we didn’t have a tenant in the two months after he left.”
So she gave the case back to me and I presented the affidavit from the new tenant confirming the move-in date. Judge awarded me double what they owed. Turns out leasing office dumbos 1 and 2 thought they could lie to me and “return” my excess rent money to themselves. Protect yourself, people! Landlords are jerks.
What’s In A Name?
My mom got pulled over in my dad’s truck. The officers wrote the ticket in my dad’s name. Well, my dad was at work an hour and a half away from where it occurred at the time. Judge threw it out pretty quick.
On The Record
It was my third month of practice, and I was in family law at the time. I was representing a mom in a petition for a restraining order against the boyfriend/dad. At issue in the broader case was child visitation, custody, support, etc., but today's hearing was just on the restraining order. We had pretty good facts but it was mostly based on the testimony of the parties.
My client was way more reputable as a witness, so I was feeling confident. 10 minutes before the hearing, my client shows up. I give her a last-minute prep on what to expect and then she says "I'm glad I'm going through with this. I can't deal with it anymore and he's just getting worse. To top it off, he left me a ranting voicemail on Saturday."
"You have your phone with you?" "Yes." We play the voicemail, and the recording shocked even me. It's a full two minutes of ex-boyfriend screaming stuff like, "I should have killed you when we were together," and, "You were always such a witch. I hope you burn in a fire." I didn't have time to ask her why the heck she hadn't said anything to me about the voicemail before the bailiff called our case.
We sit, and the judge asks if either side has additional evidence, and I ask for permission to play the voicemail. Ex-boyfriend, who didn't have an attorney, didn't object, so I played the whole nasty two-minute rant in open court. Judge goes, "We're going to take a brief recess before I issue my ruling. If the parties want to meet and confer in the hall, they are welcome to."
Boyfriend knew he was screwed. We settled the whole darn case then and there. My client got her wish list in terms of custody, supervised visitation, child support, plus the restraining order, to boot.
The Whole Truth And Nothing But The Truth
I’m a trial lawyer, so I have a ton of these. My favorite was probably a drink and drive case where the officer was in a Buffalo Wild Wing with my client watching a fight on TV. Like, the officer was standing at the bar in full uniform, then when my client walked by him to leave, followed him out. My client was only actually going to his car to grab his phone charger because he was going home with the bartender.
Like, he hadn’t even closed his tab yet. The officer detained him and charged him for opening his car door, then fabricated this story for his report about how the client got in the car, turned it on, and began to pull out of the space to leave the parking lot. He also denied being inside the restaurant—this was all on the stand, under oath, to my face. Well, he had a surprise in store.
I talked to the bartender and got the security tape. It very clearly—like surprisingly good quality—showed the officer standing at the bar, watching my client walk out the front door, then follow him 30 seconds later. The parking lot camera also showed my client barely touched the door handle before the officer stopped him. But the story doesn’t end there.
Eventually, the officer underwent an “internal review” where the board determined he hadn’t done anything wrong. A few months ago, he shot an unarmed man while on patrol. He also trains new officers now and tells young college girls he pulls over to call him “Tommy.” For what it’s worth, bad officers lie under oath ALL THE TIME.
This story is just fun because I got to prove him wrong and save my client from a conviction.
Lies Don’t Pay
man in gray notched lapel blazerPhoto by FILMon on UnsplashA friend of mine was an attorney in New York for a while. He was defending a guy who was asleep in the backseat of his car while intoxicated and a NYS Trooper detained him. On the stand, the Trooper testified that he visually saw "the key in the ignition." My friend gave him like three chances to walk it back. "Are you sure, Trooper, that you actually saw the key IN the ignition?" The guy wouldn’t back down.
"Yes, counselor..." And then my buddy dropped the hammer. "You are aware that my client drives a Toyota Prius?" BAM. My buddy moved for immediate dismissal, and the DA didn't argue. Case dismissed. Nothing happened to the Trooper. As to WHY the Trooper did this? Promotions & Overtime. Imagine you're running the entire New York State of officers. You have about 5,000 Troopers—what metric do you use to gauge how effectively they're performing their tasks?
For the most part, Troopers ride alone. So Trooper #1 drives around all day on his shift and issues zero tickets. Trooper #2 manages to issue, say, five tickets a day and makes an arrest four times a month? You're going to assume that Trooper #2 is "doing his job." An "aggressive" officer is one who has a lot of tickets and so forth.
Also, court appearances are almost always on overtime. Officers’ unions are very specific about overtime pay rates and when they apply. If you're an "effective" Trooper and you write lots of tickets, you're going to be in court a LOT at 1.5 your hourly rate, sometimes 2.0 your hourly rate, depending. So it pays them to be like this.
Me And My Big Mouth
We had no evidence that the woman who slammed into my stopped car going 85mph wasn’t sober…until she indignantly admitted it on tape in her deposition. She busted into my deposition and demanded she go first because I was a “lying witch.” She then excitedly told my lawyer that the report was wrong because it said she was coming from the movie theater when she was actually coming from her friend’s bar.
“Did you have anything to drink at your friend's bar?” “Of course.” “How many drinks” “I dunno, they just keep my glass full.” “Did you take any medicine that day?” “Methadone and low blood pressure medicine.” “I see.” The officers had refused to breathalyzer her at the scene because her husband was a fire-fighter who they knew personally.
They told her to go home, sober up, and go to the hospital later. I heard the whole thing but had no proof until she handed it to me. They settled same day.
Justice Is Served
I once had an illegal immigrant client in for not paying his child support, and he was beyond difficult to work with in any capacity. I'm talking, whomever he spoke to from my office, he would demand their phone number, current address, and social security number because he thought he was entitled to it since we're government employees.
He also was just not a fun guy to talk to and was just straight up rude to everyone. So these types of things rarely go to trial and usually, people don't even serve any time as long as they work with us, but not this guy. He was uncooperative the whole pre-trial process and refused to show up to anything unless there was a threat of warrant.
It gets to the day of the trial and he starts giving the judge heck over every little thing, demanding her SIN, address, and phone number, and claiming some weird straw man argument. He cited unrelated contract and business laws (again this is child support), but what finally did it was he called the judge a "stick up the butt witch."
He was promptly found guilty and sentenced to the max time. I literally did nothing but read his payment history, cited how much he was behind, and sat back to watch this guy argue himself into serving six months. It was pretty satisfying seeing him escorted out of the courtroom in handcuffs. Not exactly a strict win for me, but…still a win, to be honest.
V For Vendetta
I’m not a lawyer, but I am a very observant girlfriend. My boyfriend’s car was involved in an accident. He was parked in an area where, during certain hours, you were not permitted to park as it would block semis from being able to maneuver to deliver goods to a steel plant. A girl backed her vehicle into the driver’s side door of his Ford Fusion.
The authorities were called for insurance purposes, and my boyfriend states that it appeared the officer and the girl knew each other, as they were on a first-name basis. He received a parking ticket. It took forever for the insurance companies to sort it out because she didn’t think she was at fault because he was parked illegally.
However, that doesn’t matter to the case. If you hit someone’s car, you’re not going to get off scot-free, so she ended up having to pay for his deductible. And this is where the nightmare began. The local PD, who obviously did know the girl, started straight-up harassing us. My boyfriend received a piece of mail from our magistrate stating he failed to pay a parking ticket.
He was just going to pay it. I looked over the paperwork, though, and found that the vehicle they identified was traded in before the ticket was issued. The ticket indicated a white Toyota Tundra, but the license plate block was not filed out. It was signed, but you could not make out the badge number. We had traded his Toyota Tundra in for a Ford Fusion in December.
The ticket was written in February of the following year. I was furious. So I gather all the evidence for him, and he went before the magistrate. The officer testified that he saw a white Toyota Tundra illegally parked at a certain location that had a parking time restriction and that it was owned by my boyfriend when he ran the tags.
I should note that my boyfriend had had several parking tickets while he owned the Toyota Tundra. That’s our guess on how he got just enough info to write the ticket. My boyfriend presented his evidence and the judge dismissed the case. The judge was heard saying to the officer that he would like to speak to him afterward, and he chastised him for wasting the court’s time. The officer later told my boyfriend that if he had contacted him, they could have “taken care of it” outside of getting the magistrate involved.
Needless to say, we haven’t had an issue since.
Playing House
I tried to sell my home myself, and the buyers wanted a term period for the land contract before getting their own mortgage. I agreed to one year, had a simple contract drawn up and after we both signed it everything seemed fine. I didn’t know how wrong I was. Within 30 days, they present me with their own land contract that was pages long to "protect their investment."
At about page three, it very clearly stated that, "If for any reason the home burns down, purchaser will receive all insurance proceeds." First, I still had a mortgage, and the proceeds would go to pay that off. Second, that's a pretty targeted thing to say. Not lawyers’ terms of the house being destroyed, and it's surrounded by woods and waterways, just "if it burnt down." But it got worse.
Page four stated that this would remain a land contract until my mortgage was paid in full, so they'd never buy outright. I returned it to them with a letter stating those two things were never happening and I wasn't signing. They stopped paying, so I began eviction. Six months later, the lawyer I hired was an idiot, so I'm sitting down with their lawyer myself.
He brings out the contract they'd tried giving me and began talking about their iron-clad case due to the agreement. I asked him one simple question to absolutely ruin him. I asked him to show me my signature. The look on his face when he realized it wasn't there, oh man. After we talked, it turned out he knew them and wrote the contract—without the burn-the-house down stipulation; It seems they added it.
Not only did I "win," I'm pretty sure they lost a lawyer friend.
Done Dirty
a woman in a black suitPhoto by Nussbaum Law on UnsplashI was a volunteer family advocate. I worked with families who were falsely accused of child mistreatment. Part of that job was going to court with them. One day, I was contacted by a family whose children were in foster care because of parental substance use. Except the family claimed that they didn't use, but that no one would believe them.
They had a court-appointed attorney who did nothing but tell them to stop using. I honestly didn't believe them, since I was pretty jaded at the time. Still, I told them to request their case file so that I could review it myself. I was surprised when they called me back and had the case file. I met with them and went through everything.
I noticed the claims of substance use, and court findings of substance use, but there was one huge thing missing. There were no test results in their paperwork at all. I told them to ask for the results. Long story short, the caseworker wouldn't give them the actual results, and the lab wouldn't either. Well, that’s alarming.
So, I tested them myself at a different lab. They tested clean. Color me shocked. There were four months to go until the next court date. Every time the court-tested them, they went right after to the other lab and did a second test. All clean. I told them to tell the lawyer beforehand that if the courts claimed any dirty tests, to ask in court for the test results.
Their lawyer didn't want to. I was starting to get mad. So, on the day of court, I had a stack of clean test results in my bag. The lawyer wouldn't even look at them, and he was openly hostile to my presence and involvement. Court starts. For what it’s worth, I had been in this judge's courtroom before with other families. It wasn’t my first rodeo.
The child protection services supervisor stands up and says that the parents have had 12 dirty screens in the past six months. At this point, the lawyer actually did ask her for the results. Her answer made my blood boil. She said she didn't have them with her. Like, really? Well, obviously at this point I knew exactly what to do.
I got my own results out of my bag and handed them to the mom, who was next to the lawyer. She tried to get him to take them, but he ignored her. I got so agitated that the judge said, "Mrs. Baez looks like she's about to have a stroke. What's going on?" I stood up and explained that we had clean tests taken immediately after the mandated ones that Child Services claimed were dirty.
I briefly explained that the parents had tried getting copies of their results and had been refused, and refused continually. I said that the parents had consistently denied ever using substances and had clean tests to prove it. The judge ordered Child Services to provide copies of all the test results at a hearing in a week. When it finally happened, I was so vindicated.
At that hearing, the case was closed and the children were released from foster care. The family never got an apology from anyone, but they were too traumatized to pursue it. They packed up and moved away within a month.
A Slippery Slope
The plaintiff was being deposed in the lawsuit she filed alleging gender discrimination and harassment. She was claiming her boss had made some inappropriate innuendos and overtures. The defense attorney asked her if when the alleged statements or events took place, was she shocked? “No.” Was she offended? “No.” Was she damaged in any way? “No.”
“So why exactly are we here?” “Well, honestly, I’d rather not be.” Meanwhile, her attorney stared straight down, scribbling notes and doodling. We ended the deposition there and asked her attorney if this was going away now. We got a call later offering to settle for $1,000 and a letter of apology. My best guess is that she was pressured by a friend or family to talk to an attorney, and the lawyers ran with it without really talking to their client.
The Wrong Place, The Right Time
I was prosecuting a convenience store owner for luring a young girl, who regularly came into the store, back to a part of the store to grope, fondle, and kiss her. However, it was the only section of the store without surveillance camera coverage. They were in the backroom for about two minutes and 17 seconds, per the time stamp on the videos.
Of the many arguments the defense put on, one was that there was no way there was enough time for anything to happen. I knew just how to shut this down. In my rebuttal on closing, I asked the jury to imagine what could happen in the room in that amount of time, and I asked them to all close their eyes while I timed out 2 minutes and 17 seconds on my watch, in silence.
After about 60 seconds, two of the jurors started crying. Knew it was going to be guilty right then.
A Friend In Need
My client was riding his motorcycle on a relatively calm street when this guy exited his garage, without looking, and ran over him. In the deposition, the guy brought a witness who was with him at the time in the passenger seat. The whole time, the witness maintained that my client was driving too fast and that there was no time to brake the car.
I asked him the same question a few times in different ways, making him tell the story again. In the fourth telling, he was already a bit frustrated and let it slip: “—Look, I’ve already told you. We were exiting the garage and, as soon as I sat up from getting my cell phone from the car’s carpet—” “—Wait. So you didn’t even see the crash?”
There was no coming back from that.
A Dog Eat Dog World
I filed the lawsuit in January. We exchanged "discovery" over the next few months, and I filed a motion for summary judgment, meaning I'm asking the court to let me win the case without a jury because the case is so obvious. Right before I file this motion, I figure, let's review the discovery materials and see if there's anything I missed.
And what do you know, the other side made a massive mistake on literally just the fourth out of 100+ questions that I asked. It's a dog bite case, and every single time I asked about the bite, the response says something along the lines of, "We admit to this and that, but we deny that our dog was involved in any dog attack." Just one moment won me the whole case.
Question 4 asks whether they admit that their dog was not leashed on the day it bit my client, and they simply answer, "Admit." Meaning, they admit their dog was not leashed, AND they admit that their dog was the one that bit my client. That was the ONE thing that was genuinely in dispute. They tried to argue at the hearing that it was a mistake and they only meant to admit to the lack of a leash.
Nonetheless, the judge held them to their word, most likely because the other evidence made it clear it could only have been their dog, anyway.
Cuts Like A Knife
man wearing police uniform selective focus photoPhoto by Fred Moon on UnsplashI knew that officers had beat up my client and framed him. They described a knife in his possession that “caused them to fear for their safety.” Oddly, they never seized it. We won the court case and then filed a civil rights case. While deposing an officer, he described the knife in detail. No more than three minutes later, he slipped up and claimed his partner told him my guy had a knife, but he never saw it himself.
I told him, “That’s not what you just said,” and saw him panic. His lawyer panicked too and asked to see me outside. When we got in the hallway, I withdrew my settlement demand, and the case settled for a substantially larger amount within 45 minutes.
Know Thyself
This was a custody case I was prosecuting. The dad went on about how he has changed his life around and worked through the AA program. I asked him what step he was on, and he proudly proclaimed, “Three.” I then asked him what step three is, and he had no idea. I then asked him what step two was. Again, no idea. Parental rights terminated.
What Lies Beneath
At a restraining order trial, it was essentially my client's word versus his, regarding an assault. He did a good job dressing up and acting very appropriate during most of his testimony. But in an instant, his perfect façade fell apart and revealed evil. He was asked a series of open-ended questions, and you could see him getting tenser.
He then said something to the effect of, "That freaking witch coming up on me. What was I supposed to do?” As soon as he said, it a look came over his face and the judge's face, and everyone knew the ruse of the respectable young gentleman had failed. I won.
Nothing But Net Profits
We were in a five-week jury trial on a civil case. Big business dispute. About 15 witnesses later, the plaintiffs call their last witness, their damages expert. The guy talks about his damage analysis, which was about the lost profits my clients allegedly caused this company. The whole time, the guy has a PowerPoint slide up, which shows his damages figures.
But as lawyers know, it’s just an aid for the jury and not actual evidence. The examination comes and goes, and the plaintiff passes the witness to us. I look at my boss. He looks at me. We know something he doesn’t know. The witness literally never read his damages number into the record. There was no admissible evidence, because even though he showed the number on the screen, he never said the number, nor admitted it into evidence.
We didn’t ask the damage expert a single question. Plaintiff rests. We move for a directed verdict, asking the court to rule as a matter of law when there is no evidence, that they had submitted no evidence of any monetary damages. We won. It was more than $10 million. Simply because he didn’t read the number. That was it.
The Letter Of The Law
I was the client in this case. In my divorce trial, my ex-wife has spent about two hours explaining to the court what a jerk I was and all the horrible things I had done to her and my children, claiming that I was unfit to be a parent. Two solid hours...Lie upon lie. Just six months earlier? My wife had snuck into my house—she's the one who moved out—and went on my computer to type me a love letter.
"Oh, you're so wonderful! You're such an amazing father, a great provider, and a great husband! You've done so much for the community. Please don't leave me!!! " That's the gist of it. Well, she didn't print it or sign, it was just a file on my computer left on the screen for me to find. So our challenge, after all her testimony to the contrary, was to get her to admit she wrote this letter. I told my attorney—ask her! She won't be able to lie if she's sworn in.
Plus, I thought she was going to feel incredibly guilty about all these lies. So...he handed her a printout. He had one too. He started reading it, then he asked her to continue the reading. She started to cry. He asked her, “Do you remember writing this letter?” Her face was shriveling. She looked at her attorney and said, "I'm sorry Sandy.” This is what actually did her in.
Then she looked at the courtroom and said "Yes, I wrote this." There was silence for a few moments. Then the judge said, "Attorneys—in my chambers! Now!" My attorney told me later: "The judge understood that when your wife said, 'I'm sorry Sandy,' that meant that her attorney was aware this letter MIGHT be brought up and that she had instructed her client to lie."
The judge was F U R I O U S. Back in the courtroom, my attorney went down the list lie by lie. Did he really do this? Did he really do that? When you say he was doing this, wasn't it really that? Etc. Then he had her read the entire letter again. After that, my divorce went from me being 1/2 inch away from losing all custody to getting full custody. Made for TV or what?
Do You Even Lift, Bro?
person holding silver iphone 6Photo by Solen Feyissa on UnsplashThis was a good one. The plaintiff was saying he couldn’t work and had back injuries after a minor car accident. I found a video on Facebook of the plaintiff squatting 300 pounds the month before his deposition. So, I sent the video to his attorney after the deposition, and the case immediately went away. He also adamantly denied being able to work out or doing any lifting during his deposition. It was all a big lie.
Child’s Play
My husband was in the middle of a paternity case once defending himself. His ex was trying to take basically full custody of their son and only give him visitation two days a month. Her reasoning was that he wasn’t involved, didn’t go to doctor appointments, didn’t take the kid to school, etc. My husband asked her, “When was the last time you told me about his doctor appointment?”
She thought for a second and said, “Never.” He asked, “Would you have let me take him to school if I had asked?” Again she thought for a second and said, “No.” Needless to say, they got 50/50 time-sharing with joint custody. They were not married when the kid was born, and where we live that means the dad has zero rights.
His ex didn’t want him to be involved because she hates him, so he was forced to take her to court just to be able to take his son to the doctor and to school. If he had simply done those things in the past she would not have let him, and he had no rights. He once kept his son past what she told him he could, and she threatened to call the authorities and report him for kidnapping.
Oops, My Bad
My girlfriend had a very minor nose-to-tail and a rookie officer who happened to drive by booked her on some massive charges and fines. She went to trial, and her lawyer tore apart the officer. In the report he filed, the officer ticked her ethnicity as African—she's white and European. He also put the wrong date, the wrong street name, and didn't get the other witness details.
The prosecution and officer argued that she had signed the witness statement, so while a few things were accidentally filled out wrong, it reflected what happened. Her lawyer asked the officer to show the court her signature on the statement. He looked at it and went white as a sheet. He looked back up and said, “Oh, I must have forgot it.”
The prosecutor and a few officers who went to the trial for some reason all let out audible groans. The judge adjourned for 10 minutes, and the officers still wanted to press on, but the judge threw it out immediately after recess. He also gave the prosecutor an earful for taking such a ridiculous case to trial and acting like it had any chance at all.
Owning Up
We had some huge issues with a landlord—trying to enter without letting us know beforehand, not answering to fix issues, very aggressive when talking with us—when he decided to sell the place. He didn't check with us about the visits and just showed up randomly with potential buyers. We told him to get lost, and he eventually left but called us the same evening to threaten us.
We sent emails to remind him of our rights as tenants and he answered by threatening us some more, IN AN EMAIL. We eventually end up in small claims court, and he fabricates a story about how we are terrible tenants and we try to discourage buyers. We just showed the judge the emails as well as the open complaint to the authorities we filled a few days earlier.
The judge couldn't believe it and gave the landlord a formal warning, plus gave us three free months of rent. In the end, the guy just used a real estate company to sell the place. All went smoothly and we still live there with lovely landlords that aren't completely bonkers.
Think Before You Speak
I watched my lawyer have this moment last time we were in court. My ex mistreated my kid, so I withheld visitation and hired a lawyer. I offered supervised visitation with a plan to integrate regular visitation once he completed anger management and parenting classes as well as had six months clean of all substances. I thought this was reasonable.
When he was on the stand, he mentioned that he had been taking prescription medications for 10 years. This was supposed to illustrate that he’s been on meds for a decade and never had a problem being a “good” dad. My lawyer asked what medications, and he listed off a bunch: medications like methadone, Klonopin, Vicodin, OxyContin etc.
She asked why he began taking those particular medications. His reply dug his grave. He said, “Well, I messed up my back last year riding my quad.” She asked him to repeat himself. He said it again. The look on her face was amazing. She said, “So, you’ve been taking large amounts of medications for 10 years?” He said yes. She said, “10 years of major medications due to an injury that happened two years ago?” Done.
Not Very Sportsmanlike
man in green 5 American football jersey holding ballPhoto by Keith Johnston on UnsplashWhen I practiced insurance defense, I was handed a file to take over of a slip and fall. The guy tripped on a hose and tore his ACL. My partner had taken the guy’s deposition already, so I read the transcript. It took me only a few lines in to know we’d won. I'm a Michigan football fan, and I’ve watched every game for 20 years.
This guy testified that he was the starting safety for a certain rival for certain years. Also that he graduated with a double major that doesn't exist at that school. I immediately knew this was false. My partner didn't understand. I dug deeper, and found out he lied about so much stuff unrelated to the fall for no reason.
Eventually, I found high school records from football injuries of head trauma, knee injuries, oh and a slip and fall injury a few months after ours. He also testified he rehabbed an ACL surgery after one month. We immediately settled.
The Proof Is In The Payment
I represented an elderly Indian couple who didn't speak English very well and owned a rental property. They had a tenant at the time who had not paid rent in over six months. They had tried to evict her on their own, but when they got to court, the tenant produced some hand-written notes that they had given her the year prior thanking her for payment.
Sadly, they had failed to date the notes. So of course, the tenant added recent dates herself. The tenant also produced a partial certified check receipt, but most of it was illegible. Anyway, because of their poor English, they had difficulty understanding the questions and giving intelligent answers, so they lost the initial case.
They hired me to help address all of the various lies that the tenant was putting forth. Anyway, we re-filed. I had my clients pull the banking records, so we could show the date that the certified check was actually deposited into their account. The plan was simple: Let the tenant make the same arguments and then present the banking statements showing the deposit date. My clients also found a photocopy of one of their notes that was undated, unlike the copy the tenant presented the last time.
Well, when the judge finally understood that the things the tenant had presented occurred the year before, his cheeks turned bright red and he asked the tenant, "What year did you make this payment?" The tenant started saying something like she couldn't be exactly sure when...and the judge cut her off again in a very loud voice and said, "What year?!"
Needless to say, the clients got their eviction granted. But here’s the best part. When the tenant arrived at court, I watched as she got out of her car, walked to the back, and pulled out a wheelchair. She then proceeded to stay in that wheelchair until the case was over. Once the judge left the courtroom, she folded-up the wheelchair and carried it to her car, mumbling that she "hates lawyers."
That was a very satisfying day.
Walk A Mile In His Shoes
I got robbed in my home. Long story short, he would have gone behind bars anyway, but the kicker is that the shoes he wore to court were the same shoes he took from my house. The judge asked if I wanted them back. I said yes. The judge made him take them off in court and walk back in socks. Donated the shoes, it was more about the principle.
Bare With Me
I had a ton of these when I used to do Family Law. Once, my client's husband was alleging that she had been high and in her birthday suit in public. As I'm crossing him, I get him to admit that she was in fact changing out of her bathing suit at the beach and covered by a towel at all times. But it was his exact words that were so unforgettable.
He says: "Well, she was naked...under the towel." I come back with: "Just like you're naked under your clothes right now?" Even the judge chuckled.
The Invisible Man
I had a client charged with battery. The alleged victim didn’t really support the prosecution’s case, and in any event, was reluctant to testify. They still had another witness though, and she said that my client was hitting the alleged victim, so it wasn’t looking great for me, to be perfectly honest with you. But then it all changed in an instant.
The prosecutor and I were talking before court started, hanging out by the courtroom doors, when the witness walked in. She looked right at my client, who was sitting not five feet from me, then scanned the room and said, “Where is [client name]?” The prosecutor and I looked at each other for a minute, and then he said he needed to check on something.
When I saw him a few minutes later, he told me he was dismissing the case.
Mistaken Identity
man in black shirt sitting beside woman in white shirtPhoto by Saúl Bucio on UnsplashWhen the petitioner’s attorney called me my brother’s name when I was on the stand. My brother is a jerk and I don’t associate with him anymore. However, he has a lengthy, sordid history and it pops up on traffic stops occasionally. So I was in court over custody of my oldest child, and her mom’s attorney was trying to paint me as a hypocrite for being an addict.
I (truthfully) denied it all on the stand, when the lawyer said, "Now James, I must remind you that you are under oath, and by denying this, you are committing perjury." I stared him in the face and said, "My name is Bill, James is my brother." Even the judge laughed at him, and the only reason we didn't bring it up sooner—we knew he submitted it as evidence but had no idea why—was because I really wanted to know what he was up to with it all.
Let’s Go To The Tape
I got into a car accident after another driver crashed into my car. The driver was such a jerk, talking tough, blaming me, saying that he knew a bunch of lawyers, and here's the kicker—he threatened that he was going to take me to court. I'm a laid back dude in contrast, and I was cordial to him. We went to the station and made our statements to the traffic investigator.
I didn't have a dashcam at the time, but a day later I got a copy of the CCTV footage that was looking directly at the scene of the accident. I showed the investigator the video, and he was absolutely stunned by how wrong the other guy was. At that point, I told the investigator the truth: I was an attorney, and I'd decide if I wanted to take the matter to court.
The following day, I got a call from the guy who hit me. Apparently, he said he also saw the CCTV footage, and he had called to settle things. I was just shocked because this dude who was previously Mr. Alpha Male did a total 180 and was suddenly polite and respectful. Amazing what an impact video has, especially when you’re at fault.
I Regret My Actions
My grandfather was a small-town Georgia lawyer, and he told of a time he was representing an insurance company in a civil suit after a car accident. The plaintiff claimed to have received “whupneck” from the accident, supposedly caused by my grandfather’s client. Pop asked him what exactly he meant by “whupneck.”
The plaintiff, wearing a neck brace, proceeded to answer: “It’s when you can’t move your head like this” and then he shook his head back and forth. The judge promptly dismissed the case.
The Five Finger Discount
I was a witness on this one. It was a shoplifting case. During cross, the examiner asks the accused—based on his testimony during his detainment—“you listed [place he shoplifted] as your employer. Why?” His response: “I make so much from them every year, they might as well pay me.” The public defender just about collapsed.
Catch-22
I’ve got a good one. When I was interning at the court for a judge, I observed a pre-trial hearing for a murder case. The defendant allegedly slew his grandmother because she wouldn’t give him money, then stuffed her in a closet. Horrifying stuff. During the hearing, the defendant’s lawyer, prosecutor, and judge went through some typical procedures.
Then the judge asked the defendant if he had anything to add. The defendant smugly said, “Yes, actually, I don’t think I’m mentally fit to stand trial according to article X.” The judge let him finish, then looked him straight in the eye and said: “The fact that you just told me this shows me you’re perfectly fit to stand trial.” Better luck next time.
This One’s Going In The Burn Book
person holding black samsung android smartphonePhoto by Solen Feyissa on UnsplashI was an attorney for an insurance company defending a lawsuit where the plaintiffs were two girls who claimed they were irreparably harmed and their lives would never be the same because severe back injuries kept them from being active. There was just one problem. They forgot to set their Instagram accounts to private.
As it turned out, the accounts were full of pictures of them riding jet skis, dancing, and pictures of them at the gym. The underage drinking pictures were just icing on the cake.
Delayed Reaction
A gas station chain had one of their station’s gas tanks leak and pollute a church playground. They then tried to say they weren't liable because the pollution didn't start seeping up through the ground until years after it happened. Yeah, swing and a miss on that one, boys.
Mother Doesn’t Know Best
It was day two of a child custody modification trial. The opposition and her attorney were and are crazy. Their allegations were so weak that I told my guy, “Screw it. Let’s go for custody ourselves.” I’m cross-examining mom about her proposed custody plan for dad in some detail and I ask her, “Would you accept this for yourself?”
She snaps back, “Absolutely not!” I ask, “Why not?” “Because I’m a MOTHER.” To his credit, my guy kept a straight face the entire trial and never once got angry. Her petition was denied outright. Ours was accepted by the court. If the mom or her lawyer hadn’t been such pains to deal with, my guy probably would have agreed to some small reductions in his custody just to keep the peace.
Instead, the judge gave us nearly everything we asked for.
Don’t Believe Your Eyes
This was actually fairly recent. I was in a deposition of a fact witness to a fatal automobile accident. The defendant’s attorney had called the deposition, and over the course of an hour and a half or so, elicited a lot of testimony that seemed to place my client (the slain man) partially at fault, which would impact the money the family got.
After sitting quietly for an hour and a half, I asked fewer than a dozen questions. The last of which was about the specific location of my client when he had first seen them. Based on the witness’s answer, it was clear that my client couldn’t possibly be at fault. I sent a follow-up letter that same day and the case was settled within the next two weeks.
Power To The People
I’ve been up against plenty of lawyers as a union chief steward. Years ago, we had an arbitration related to healthcare costs. The company spent the better part of a year trying to break us from pursuing the case. The day had come for our arbitration. The lawyer we were up against was actually Paul Newman's nephew, if you’ll believe it.
Anyway, it was my turn to take the stand. His first question to me was presenting the grievance as evidence and asking me what step it said it was on at the top of the page. Our grievance process is a two-step system, progressing to arbitration if it's not settled. So I said, "Second step." Then he smugly asks, "And where is the first step?" To which I replied, "The first step is a verbal discussion. It goes into writing at the second step." He looked hurt, but persevered anyway. He had no clue what I was about to do to him.
A few more questions in, he asked, "If the entire company got base level insurance, instead of a premium option, that would satisfy the contract?" He was hoping I would argue that the base level insurance wasn't sufficient, because he was trying to paint the picture that we were just trying to get premium insurance at a base level price.
I responded with "Yes." He looked dumbfounded. Asked me, "Yes?" I said again "Yes, that would satisfy the language in the contract." He kind of looked at his other papers he was going to submit as evidence, then muttered, "No further questions." I knew at that moment that they had brought no real arguments to the table.
We got our answer from the arbitrator six weeks later, during a contract negotiations meeting. It was insanely satisfying watching them read the email during one of the sessions, and the immediate shift in demeanor from their side of the table. They got real quiet. We were awarded 100% of the arbitration. Full back pay for all employees who were being overcharged, and reduced rate for the premium insurance.
The Ringer
boy kissing her daughterPhoto by Limor Zellermayer on UnsplashI sort of have an opposite story, in that the lawyer knew when he lost one. When I was about four years old, I was ill one day and the only option my parents had to take care of me was for my dad to take me to work with him. My dad was an attorney, so it just so happened that work was the courthouse where he was arguing a case that day.
My dad knew the judge and I was allowed to lay down on a bench during arguments from the two attorneys present, my dad and opposing counsel. I was a pretty well-behaved kid I guess and was quiet, and just sort of laid down on the bench and stayed silent. I have vague memories of the incident, but nothing really defined.
As my dad tells the story, the judge grew “bored” at one point, looked over to me, waved and gave me a smile, and commented on how well behaved I’d been during all of this. Dad said it was at that moment the opposing counsel knew he’d lost the argument and subsequently the case. Dad joked about needing to take me to court more often.
Friends In High Places
I got a hidden shout out from a federal judge in a ruling that I consider to be one of the high points of my career. Here’s what happened. Before a hearing for an emergency injunction, I was watching the hearing before mine. At the end of that hearing, the judge accidentally used a pun, and could not stop laughing. She was literally crying.
I decided at that moment I was going to intentionally use a pun in my hearing. I did—I accused the opposition of engaging in a “shell game” by diverting some federal funds to an egg industry trade group. The judge called me on it, but laughed heartily. My client won. A major newspaper reporting on the case said the judge “winced” at my puns but agreed with my arguments. False!
When the written ruling was issued, the last sentence said that an injunction was issued for protection against “any plans they may be hatching.” Undeniable shout-out.
A Mother’s Love
Not mine, but my mom’s story. She was fighting for custody on behalf of the father, trying to prove that the kids were living in subpar conditions with their addict mother in spite of the ample child support he had provided. It was a tough case because courts are so hesitant to pull kids away from their moms, and they have the upper hand.
Then the mom burst out that she had been feeding the kids cat food as proof that she wouldn’t let them starve. Needless to say, the judge didn’t take that as a good reason for the kids to stay with their mom.
Photo Finish
I took my old landlord to court when I was in college. She had taken my security deposit over false allegations: They claimed I "trashed" the place, not knowing that I took pictures and video when I moved in and out. Their "evidence" was a VHS quality recording of going through a perfectly clean apartment in better condition than it was when I moved in. Oh, but it got better.
They opened up the top of the stove and found a single piece of elbow macaroni under it, holding it up triumphantly. That was the crux of their "defense." The judge was not amused, and I got all my money back plus my lawyer fees and the filing fee. She then fought against her own lawyer to avoid paying him like she should have.
Money Back Guaranteed
Years ago, I had to do something at an outlet mall in a bad part of town. It took me about 20 minutes and then I found that my car had been towed. Ubered to the tow yard, and the giant sign says “cash only.” Had to call another Uber, drive to the ATM and back, and pay them $300-some bucks. Got a horrible hand-written receipt that, believe it or not, was itemized.
I went home, Googled, found that they violated the law in three separate ways: They towed illegally, illegally refused to accept credit cards, and had multiple charges that the law called “unreasonable.” So I got my revenge. I took them to small claims court. The judge began by asking the tow yard owner about his relationship with the property owner and how the decision was made to tow my car.
"Oh," the slimy tow truck dude answered, "My cousin works there, if he says tow, I tow. It's a hundred percent fine!” The judge's eyebrows begin to rise. "But," the dude continued, "BUT what I detest the most, your honor, is this JERK claiming I don't take credit cards. I'm a businessman! I take credit cards all the time! He's a low life who does not have any credit cards, that's why he wanted to pay cash!"
I was having a "HOLD IT" overload, and the judge saw me smiling and hopping in my seat and patting my manila folder of receipts. "Do you actually not have any credit or debit cards?" the judge asked me. I pulled out my wallet and showed him, and then I pulled out the clincher. It was a time-stamped photo of the "CASH ONLY" sign I took the day of, and another one I took the morning of the hearing.
The guy mumbled something like, "Okay, you got me there" and then had nothing but, "Huh, I didn't know that" when the judge asked him about the legality of each unreasonable itemized charge. Anyway, each violation pays double the total tow charge, and since there were three, that's how I made $1,800 on a $300 investment.
Think about the last time you were sick; the ritual of checking WebMD, thinking you have a life-threatening illness, then finding out it was a harmless rash that was causing you all that stress. Regardless of the symptoms, we’ve all been there—but what of the unlucky few who actually did have some sort of ill-fated, isolated illness?
A Bad Bridge to Cross
red and white massage chairPhoto by Atikah Akhtar on UnsplashIn dental school, I had an emergency patient come in complaining of sore gums. Upon examination, I found a massive calculus bridge (google it for pictures) behind her lower front teeth. She only had about 3 remaining lower teeth, but they were all connected with a whitish brown mineral deposit that was about the size of a golf ball. She had never had her teeth cleaned and she was probably 55 years old or so.
I basically performed an emergency cleaning. She could speak so much better afterward. Of course, I had to play it off like it was normal, but in my years of practice, I still haven’t seen a case that bad again. Get your teeth cleaned people. Even if you can’t afford every 6 months, once a year, or every other year is a heck of a lot better than never.
The Neighbors
An elderly lady came into my practice asking if there was anything she could be given to help her sleep, as the Irish terrorists in the flat below were keeping her awake at night. She was reassured that terrorists were not planning to blow her up, or Cannock (a small inconsequential town in the West Midlands) for that matter.
On the second visit, she insisted that they were going to blow something up soon and expressed paranoid thoughts. A full mental health review was conducted by the GP and the community psychiatrist. She came up clean. That's when we contacted the police, a couple of days later the flat below our patient was raided and found to be full of explosive equipment and real IRA members.
"How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?"
Just a Nibble
When I was on peds ID, we had a young girl come in with a rash on the bottom of her feet. She was also having headaches and joint pains. We spent close to an hour interviewing the girl and her mother. Her history was essentially negative. Finally, as a last-ditch effort, I pulled out the weird questions you ask in med school.
I asked if they had any unusual pets, as we had already ruled out normal pets. They said actually they did just return a pet rat for biting her. They thought that this wasn't really relevant. Bam! Rat bite fever.
Pill Problem
I'm not sure if this counts as a rare diagnosis but it was a neat one. This fellow was at dinner with his wife and some friends when "all of a sudden" he slumped forward into his entree and went unconscious. I saw him as a hospitalist in the IMCU. Despite being unconscious, his labs and vitals were all stable and he appears to be adequately protecting his airway.
The wife was initially understandably distraught and not able to offer the best of histories, but as the patient gradually began to wake up, I was able to put together a few facts. The patient had pancreatic insufficiency and thus needed to take six pills with pancreatic enzymes before each meal. He also had a prescription for Ambien. They were both white pills...you can figure out the rest. He recovered fully without any long-term effects.
Hoofbeats
I diagnosed a patient with acute intermittent porphyria. He had a history of psychiatric admissions with depressive symptoms associated with nausea (though not much in the way of pain). I saw him as a medicine consult for the psychiatry service and ordered urine porphyrins just for completeness as it apparently had never been tested before. Lo and behold, they come back positive.
There is this old adage in medical school, "When you hear hoofbeats, think horses not zebras." Which while perhaps relevant to a medical student, is actually the opposite for what is needed from a skilled practitioner. The common stuff is easy...practically reflexive. In our case, a better adage would be, "When you hear hoofbeats don't just assume it’s another horse." Too often physicians just hear the hoofbeats and ignore the black stripes.
A Staple Food Source
man in blue dress shirt sitting on yellow chairPhoto by Mark Williams on UnsplashI worked as a mental health tech to get through undergrad. A 15-year-old female in the adolescent ward claims to have swallowed a staple. Eh, but whatever, as I’m taking her down to x-ray, I tell her about the dime I swallowed when I was a kid. It happens. Well, turns out she underestimated the number of staples by around a hundred.
Every printout given by the therapists had been a swallowed staple. She had gotten staples from the other kids. The x-ray of her abdomen looked as if it were a weird staple-y snow globe. And yet, somehow, she was back to trying to take psych ward staples a week later. Never did figure out how they removed them all.
No Face
Baby born without a nose and with non-functioning eyes. Diagnosed with Bosma Syndrome. It was kind of crazy, I saw the baby a few months later and it was doing fine. Children with Bosma Syndrome grow up without any cognitive disabilities, it's very interesting.
Spinal Tap
I am an anesthesiologist now, but was a doctor in charge of a small rural hospital in India about 20 years ago. An elderly lady was brought to the hospital by an irate husband who felt she was faking an illness. She would lie in a room all day with doors and windows shut and complained of a headache. She refused to do housework or look after the kids. Other doctors who had seen her before me had treated her for pain with no improvement.
I examined the patient; who complained of severe headaches and just wanted to lie down and refused to open her eyes. I admitted her to the hospital and performed CSF tap (A needle into the lumbar spine to get a sample of fluid surrounding the spinal cord). As expected, it was tinged yellow (Cerebro-spinal fluid should be clear). These days we have CT scans to diagnose sub-arachnoid hemorrhage (bleeding around the brain); but it was a difficult diagnosis once upon a time.
One in a Million
The morning report was a good one today. We had a 59-year-old male come in with lower leg swelling. Within 3 days he becomes confused, febrile, and stiff. We put him in the ICU, thinking he had meningitis and got some CSF cultures and started antibiotics. Two days later, the cultures were still negative and he wasn't improving.
His wife then says this whole event seems similar to her husband’s (the patient’s) mom. She had Creutzfeldt-Jacob disease and passed from it. It's a 1 in a million (literally) diagnosis and our tests are still coming back for it. Really rare case most doctors will never see.
The Living Dead
I had a lady come into the ER listed as “Multiple Medical Problems”. This usually means diabetes and the issues stemming from it, or maybe bleeding issues from another disease or maybe odd blood tests results at a clinic. I hadn’t seen the patient yet, but the doctor came to the nurse’s station asking who had room 15. I jumped up and followed him into the room.
I walked in and saw what I thought was a corpse. Then the patient’s eye swiveled over to look at me. She truly looked like one of the people they found in a concentration camp. I could see every bone, and her body was twisted in a decorticate position with her jaw locked open. Then the smell hit me: rotting flesh and body fluids. I struggled to keep a neutral face and not gag.
I tried to place a blood pressure cuff on her arm and her skin just started flaking off in my hands. I gagged. The doctor started removing her clothes to examine her. Her feet were black to the ankles. Her hip bones were poking through her skin and were black. The skin around her ribs was worn away to oozing muscle fibers.
Her calves were incredibly swollen and the skin was splitting like ripped pants. I removed her Depends, and there was excrement coating her entire genital area. Then the doctor went to remove a large bandage on her lower back. Her entire sacrum was exposed and the bones were BLACK! The skin around it was a black liquified mass.
It smelled like nothing I’ve ever smelled. I can’t even describe it. The doctor told her family I would clean up her ulcers and wounds in preparation for surgery (liar, no surgeon would operate on her). I had no idea how to clean dead bone tissue and liquified skin (they don’t cover that in nursing school). When I went to clean her sacral area, all the liquified skin separated and oozed all over the bed. I really struggled to keep myself together.
Afterward, I needed a moment in the supply closet to cry it out for a second. I had no idea the human body could break down so much without dying. I still think about that woman sometimes, and what led to her living like that. It still breaks my heart. My guess is that she had some sort of traumatic brain issue or a stroke.
Family members were taking care of her, and I think they were treating her absolutely horribly. I think as her skin deteriorated, she developed terrible pressure ulcers that never healed. The swelling was probably due to starvation and a lack of protein in her diet. I’ve had nightmares about her face since then. Once, I dreamed she crawled into bed with me.
I freaked the heck out and ran into the hallway. My toddler walked out after me, rubbing his eyes, asking why I ran away.
Catching Zebras
zebra standing on wheat fieldPhoto by Jeff Griffith on UnsplashMy first rotation as a medical student was psychiatry. I was really nervous, and made a flashcard for each psych condition and a list of diagnoses to consider. One of the patients being discussed on rounds was psychotic (think: KGB is after me!) but was otherwise put together. He was really into doing art and was very, very religious.
I looked at my flashcard for psychosis and casually mentioned that we should consider temporal lobe epilepsy, which presents with religiosity and exaggerated artistic ability. An EEG showed that he had it. I've caught a few zebras since, but that was my favorite.
Cat Calling
A six-month-old baby was not getting bigger and dropping off the growth charts. The baby wouldn’t move and cried all day long. I couldn’t figure it out. I was making preparations to transfer the baby to the university hospital for admission. One of the clinic nurses commented that the baby's cry sounded like a cat. Ding, a bell went off in my head.
Cri du chat syndrome or cats cry syndrome. Very rare. I looked it up on UpToDate and the baby had a high probability of having it. I referred her to genetics and they confirmed it. The attending called me and marveled at my clinical skills. I chuckled and told him the nurse diagnosed it. Good news, the baby had a small deletion of the 5p chromosome and managed to stay somewhat healthy and functional.
Socrates’ Demise
We had a young fellow come in who worked as a landscaper. He showed up in the ER with severe GI distress. The diagnosis was almost entirely from history. Apparently, he forgot to bring lunch so decided to munch on some "wild carrots" he found while he was out working. I Google "wild carrot dosing" and quickly figured out the diagnosis (this was in the this was Northeast USA by the way). I will give you a hint...a certain Greek philosopher also had an affinity for the substance...it was hemlock. AKA: Not good for you.
He recovered fine, though he did get a night in the ICU for observation.
The Worse of Two Evils
We had a good case a few years ago. An otherwise healthy, 40-year-old migrant worker from Central America started coughing up blood intermittently. Everything suggested tuberculosis: History (they were from an area with lots of TB), chest x-ray looked like tuberculosis, illness script looked like tuberculosis...but his tests for it (sputum/quant gold) were all negative.
I decided to test his urine on a whim to rule out pulmonary-renal pathologies. Ding, ding, ding! Blood. Lots of blood. The patient never noticed it, and his kidney function was superb, so this was a tricky diagnosis. Turns out he had granulomatosis with polyangiitis (Wegner's). Kind of a sad story, because TB is largely curable, but with Wegner's he'll be on chemo for a very long time with this disease. I'm glad we caught it before irrevocable damage to his organs, though.
A Bad Prognosis
As a third-year medical student, I had a patient come in with four years of worsening balance issues and garbled speech. She had gotten a crazy work up at an outside hospital system with every sort of imaging possible, biopsies of random sites, and a number of very expensive tests. She was at our university hospital for the first time.
When I first entered the room, I reached out to shake her hand, and from her wheelchair she had to raise her head at me because she couldn't look up with her eyes. This was the first red flag. I also asked her if she had the sensation where one of her limbs would move without her controlling it, and she said yes, suggesting something called Alien Limb Phenomenon.
I diagnosed her with Progressive Supranuclear Palsy with features of Corticobasal Degeneration, a very rare disease on the spectrum of Parkinson's plus syndromes, and my supervisors agreed. Unfortunately, it was a bad prognosis, but the family was consoled by the fact that at least they had a name for what was happening.
Hard to Miss
person in blue denim jeans lying on bedPhoto by National Cancer Institute on UnsplashA woman came in with severe opiate withdrawal and some shortness of breath. Because she was so insistent about how miserable she was, everyone sort of wrote her off as drug-seeking. The morning I rounded on her, I decided to do a thorough physical exam. Lo and behold, she has a hard non-mobile clavicular lymph node...it was so big that it was impossible to miss if you just did the exam.
Immediately we got a chest x-ray and then a CT scan. There was a perihilar mass. After a biopsy, we learned it was small cell carcinoma (lung cancer).
A Hard Revelation
I was visiting a friend’s house when I was introduced to his dad who had no medical issues. He was a hard-working farmer, but looked a bit too thin. Something told me there was something not quite right, and so I asked him if I could examine him. I promptly discovered hard lymph nodes in several areas. Further investigations revealed he had disseminated cancer. He kicked the bucket less than a year later.
The Meat of the Issue
A patient came in with an itchy rash that would not go away for weeks, and a new swelling of the mouth and tongue. She had "hives" all over her body and the only thing that had helped was repeated steroids. She was a mid 40s female who worked with dogs, so we assumed that she had a new allergy to pet dandruff, fragrance in a shampoo, flea medicine, or something along those lines. We discharged her home with an appointment for the dermatologist to do a biopsy of the lesions. But that wasn't the last we'd see of her.
Later that day, she turns back up in the Emergency Department with swollen lips, increased rash, and trouble breathing. She started having these problems 15 minutes after eating a roast beef sandwich. Someone on the team remembered that she works with dogs and asked if she'd had any recent tick bites. Sure enough, she had been bitten by a tick a few weeks ago and identified a picture of a Lone Star Tick.
Turns out she had developed an allergy to red meat after a bite from that tick. This allergy is called an alpha-galactosidase allergy, and is a reaction to a carbohydrate carried on the outside of cells (think like the carbohydrates on red blood cells for ABO blood type) by all other mammals except humans and monkeys.
The tick had bitten one of these and kept some of the protein in its digestive system, and then after biting her, her body developed antibodies to the carbohydrate, causing her to have a new allergy to meat.
Unexpected Guests
Ordered an abdominal ultrasound on a refugee from Iraq via Syria, expecting to find gallstones because she felt full easily after eating and was having pain in her right upper quadrant. Instead of gallstones, there were two, 7 cm cysts in her liver. Hydatid cysts from a tapeworm.
More Than Meets the Eye
As a fourth year during my rotations, I noticed my patient had a vertical subluxation of her crystalline lens during a dilated eye examination. The part of the eye that develops a cataract later on in life was shifted significantly up. She had severe myopia and astigmatism (-14.00 - 5.00 x 180 OU), and her 6'1" tall body along with disfigured teeth led me to believe she had Marfan's Syndrome.
She had never heard of it, never seen a cardiologist, etc. A few lab tests confirmed. She can live a normal life; she just needs some meds and education. She had very long fingers that jumped out at me and braces on her teeth. As an optometrist, I focus on glasses and contacts, but I see (no pun intended) and treat an unbelievable number of systemic diseases that manifest in the eye or retina.
My Old Mother
woman wearing eyeglassesPhoto by Todd Cravens on UnsplashOne of my favorites is when we had an 85-year-old man in for cellulitis or something, and everyone was documenting he was confused—in part because he kept talking about his mother; his mother was going to be so worried, he had to be discharged to take care of his mother etc. He became agitated and was actually getting ready to be dosed with Haldol because he was insistent he was going to leave to take care of his mother.
Note, the standard is to play along, tell the patient something like "Oh, we already called your mom, she knows you're here" that sort of thing, but he wasn't buying it. Finally, the nurse asks him if we can call his son to make sure the patient's mother is being taken care of (really, just to placate the patient), and the patient agrees. We call the son, the nurse explains the situation, and the son informs us that the patient's mother is indeed alive at the age of 101, but that he is staying in his father's house assisting in her care.
Poor patient was legitimately worried about his mom, and we all thought his infection (or just old age) was causing him to be confused!
On a Hunch
ED referred a guy to me who had a platelet count of 2. The guy looked bloody sick with abdominal pain, petechial rash, feverish, diaphoretic, and he was a bit confused and drowsy too. I talked to my boss who said to give him prednisolone and he'd see him tomorrow, but I was convinced this guy had a really rare condition called TTP (Thrombotic Thrombocytopenic Purpura) and so I called the major hospital in my area and sent him to their ICU for a procedure called plasma exchange.
I ordered a test called ADAMTS13 to prove the condition, and still have a paper copy of the result (he had none of this chemical) because it's the best diagnosis I've ever made, it helped save his life!
Growing White
Menkes kinky hair syndrome. I was called to see a 3-month-old boy with hard-to-control seizures. His most remarkable exam finding was his hair: he had been born with a full head of black hair (he was Hispanic), but at the time I saw him, the first 3-5 mm of each hair shaft was nearly white, with an abrupt color change, still black on the tips. The hair was a giveaway for this disorder, almost no need for confirmatory testing, but the admitting team had already ordered whole exome sequencing.
This was not a fun and exciting diagnosis to make, more a sinking feeling upon discovery of the hair (neurodegenerative disorder due to a defect in copper metabolism that is irreversible once symptoms appear), but it was interesting to see at that transitional stage. I had only seen older boys with Menkes before, once the hair was already pale and brittle all over. Usually the hair has changed long before the diagnosis is made.
Ignoring the Issue
I'm an anesthesiologist. This happened when I was a resident. It changed me for life. We had a 29-year-old male in for finger surgery. We had an uneventful induction maintained on Sevoflurane. Within 20 minutes we started to have rising ETco2. I called my attending after trying to hyperventilate the patient (She was a young Harvard trained peds anesthesiologist).
She comes in and asks me what I think is going on. I tell her things seem strange. She tells me to chill. Five minutes later, the ETco2 is over 100 and I'm freaking out! I call her and tell her this is MALIGNANT HYPERTHERMIA (easily fatal reaction to certain anesthetics caused by congenital aberrant sarcoplasmic reticulum receptors).
She says that I'm being ridiculous when I tell her I'm afraid this is the real deal. My pages get ignored by her. The patient’s temperature starts to rise. I'm bugging out and call the board runner (supervising Anesthesiologist for all the operating rooms). He's old. He knows me well and trusts me. Comes in, looks at the monitor—and his face went white.
Needless to say, we save the patient after many dozens of vials of Dantrolene. Six months later I'm made to do an M&M and the young Harvard attending insinuates I did something wrong in front of the department. Most of the rest of them come to my aide. She leaves the job shortly thereafter. I will soon be at her fellowship.
Weird.
Flippant Flipping
I didn't diagnose it, but I have a patient with primary Ciliary Dyskinesia with Situs Inversus, aka Kartagener syndrome. The cilia in the body don't move well, and this mainly affects the respiratory cilia/lungs, although it also causes infertility, related to the cilia inside the fallopian tubes and the sperm tails not working well.
Situs Inversus is when the organs inside the thorax are mirror images of normal, the heart is on the right side instead of the left, etc. I was looking over this patient's old medical records and one of the radiology reads of a chest x-ray said, "There has been interval development of dextrocardia. Since this is physiologically impossible, the film has been flipped."
Probably the original film the radiologist had been comparing to had been incorrectly flipped to look "normal," maybe by someone who assumed there had been an error. Another chest x-ray report just read: "The film has been flipped" and then went onto the rest of the interpretation.
A Quick Diagnosis
person holding baby feetPhoto by Omar Lopez on UnsplashI once saw a child with mosaic trisomy 8. It was a complete mystery why he had speech apraxia, and the geneticist I was working with took one look at his feet, saw that they had super deep creases lengthwise, and ordered a karyotype with mosaic trisomy 8 in mind. Sure enough, he was right. I was amazed how spot-on he was predicting that.
Caught in Her Throat
Primary doctor here. Had a two-year-old refugee child (whose parents couldn't communicate well) who swallowed a button battery and it was stuck in her throat. For clarity, I didn't know it was a button battery, but something just didn't feel right, so I sent her to the ED. If she had gone perhaps one more day, she might not have made it—it had already destroyed a good amount of tissue in her esophagus and was apparently somewhat close to perforating.
I feel like it would have been very easy to just say she had a sore throat from an illness, particularly with the language barrier. I'm glad that something felt weird to me—she didn't look that bad, but was just holding herself and breathing weirdly.
Rare and Terrible
Wolman Disease. A genetic disease that affects about 1/200,000 kids, terrible outcome. It leads to calcification of the adrenal glands, which is how I picked it up on a chest x-ray on-call (I'm a radiologist). The kid had failure to thrive and a big spleen so I brought it up. He got further testing which confirmed the diagnosis.
Bottom line, don't forget to look at the adrenals or ribs on peds x-rays!
Dr. Google
Probably Stiff Person Syndrome. Technically it was paraneoplastic antibodies causing a case of mild stiff person-like syndrome, but it was basically a lady who had glutamic acid decarboxylase antibodies which caused her to be really stiff. How'd I figure it out? Well, she was really stiff and it was very odd. I was out of ideas and literally googled "stiff person" and got the result of a disease I'd probably heard mentioned in passing in med school but is so rare you forget about it: Stiff Person Syndrome.
Yes, it's real. I thought it was a joke at first—but it's all too real. Ordered the test, it was positive. Later, after more research, I learned that you can have similar antibodies and symptoms with paraneoplastic syndromes, so I did a scan, and found a lung tumor. Boom. SPS is really rare. Paraneoplastic syndromes are less rare. She was somewhere in the middle.
Miracle Porridge
I made a clinical diagnosis of fairly early-stage necrotizing fasciitis (the infamous flesh-eating bacteria) in West Africa which was pretty cool... The patient was a young adult male who was writhing and screaming in agony as he was carried in. He spoke a tribal dialect and I spoke ugly French, so it was basically impossible to get any information out of him or the friends who brought him in.
I laid him on the table and did a rapid trauma assessment. When I stripped off his shirt, I saw a small patch (maybe 4" x 6") of blackened tissue below his left nipple along the side of his ribs. It looked like a chemical burn to me at first glance. I realized that some of the skin had torn off the area when I removed his shirt, and when I touched the lesion to examine it, I could feel the skin separating from the tissue below it.
The technical term is "desquamating." It had a horrible odor like spoiled meat/rotting garbage mixed with 100 degree west African heat and 100% humidity. Putrid. His temperature was over 40C (104+ F) and his O2 saturation was terrible. The rotting garbage smell indicated anaerobic bacteria, the skin peeling off indicated connective/soft tissue involvement, and the disproportionate pain (relative to the size of the lesion) is a hallmark of necrotizing fasciitis.
I ran back to my room and grabbed the Oxford Handbook of Tropical Medicine (highly recommend if you work over there in medicine) to double-check because I had never seen a case of flesh-eating bacteria in person before and didn't want to screw up the diagnosis and move things in a different direction if I was wrong. Sure enough, everything matched up and the chief of medicine stopped by to confirm the diagnosis. He basically said, "Oh yeah we see these fairly frequently, people get a cut or a bug bite and then rub dung or dirt into it and the infection takes hold."
The craziest part was the outcome. In the United States, patients with necrotizing fasciitis in one limb frequently die or suffer amputations of both arms and both legs—even in the best ICUs. Here we were in the middle of West Africa at a remote bush hospital and this guy has it on his chest, which pretty much wrecks the standard aggressive surgical approach since you can't exactly amputate the chest.
We loaded him up with high dose IV ampicillin a few times a day and his wife forced him to eat multiple bowls of porridge...miraculously he made a full recovery and left smiling 10 days later. I'm convinced it was the porridge.
Wearing Your Heart on Your Sleeve
pruning topless babyPhoto by Jakob Owens on UnsplashI diagnosed a little girl at birth who had Ectopia Cordis. It's a birth defect where the heart is located outside of the chest or thorax (yet it's still underneath the skin). It only happens to about 5-7 per one million live births. Warning, if you plan to search up "Ectopia Cordis," the images available may not be for the faint of heart.
Say No to Drugs
Today I took care of a man who believed he had been bitten on the abdomen by a baby rattlesnake that had fallen out of his ceiling vent, crawled up his abdomen under his skin, up his throat, and was currently coiled and rattling in his brain. Diagnosis: methamphetamines. Just say no.
Against All Odds
Five years ago, I spent six months working in a small rural Zambian hospital in the medical ward as part of a volunteer/outreach program. I have done mostly family medicine, and some surgery in my early days, but decided to mix life up a bit. The hospital was typical third world—a few basic medications, rudimentary clinical tools, a small lab on site which was usually broken.
No resuscitation tools whatsoever. HIV, TB and malaria were rife—it would not be uncommon to encounter a loss per day despite our best efforts. On one of my first days there an unconscious person was carried in by a mob of locals. I could smell him before I saw him. He had been in a house fire and his skin was cooked—completely black around his chest, face, and over his legs.
He was still breathing on his own and maintaining his airway but we had no doubt he had inhaled a lot of smoke. With no way to intubate or provide oxygen we merely had to hope that he didn’t swell up and close off and deal with the rest of the burns while he was unconscious. Two colleagues who worked in the hospital came over urgently.
We all kept our cool externally and got the nurses to translate to the man’s family that we were going to do everything we could to get him better. In reality, all three of us knew his chances at survival were in the single-digit percentages. We decided that due to the extent of his burns we were going to have to do an escharotomy (cutting the burned skin to prevent it contracting and stopping him from breathing).
Turns out I had the most surgical experience so despite having never done one before I gave it a go, hoping for the best. We got an IV into a neck vein and got fluids going. The local nurses dressed his burns. We gave him whatever pain relief we had. He was unconscious for a couple of days but eventually came to.
Each day we were expecting his kidneys to pack up but to our surprise, gradually he got better. He was with us for just over four months recovering. He came out severely scarred but he had beaten the odds and survived.
A Rare Talent
I've diagnosed anti-NMDA receptor encephalitis in a patient that was thought to be withdrawing from an unknown illicit substance. Then, not two months later I had another patient with the same disease. I was talking to a neurologist recently and he thought it was a condition that is far more common than we thought it was, but still a pretty good catch for an internist.
I've caught a few conditions that were rarer, but it's nice to talk about one that's treatable.
Improvise. Adapt. Overcome.
I'm PhD, not MD. The weirdest to me was a bloodstream bacterial infection that looked sensitive to antibiotics in the clinical lab, but the patient could not be cured. We got samples of the bacteria and turns out it was "tolerant" to antibiotics in a biofilm (heart valves) but not sensitive in the clinical sense. Opened my mind as a microbiologist to how insanely adaptive bacteria can be, and how they're more a population than individual cells. The most interesting paper I ever published, and unexpected.
Subtle Symptoms
man reading papers in front of computerPhoto by National Cancer Institute on UnsplashNot super rare but sort of diagnosed/missed Myasthenia gravis. I was an intern in the emergency department. A woman presents with the classic vague symptoms of fatigue and weakness. Notably, her father had very recently passed. Full blood panel was normal, her examination was almost completely normal but I did find she had proximal weakness (her upper arm strength and thigh strength were poor but her hand and feet and shins etc. were normal).
I presented to my superior and we decided to send her home because we couldn't diagnose her with anything and we can't admit someone to hospital for fatigue. She was upset that we couldn't help her. After she left, I couldn't shake this terrible feeling. I asked my superior, what about Myasthenia Gravis? Well, too late now, besides the testing takes weeks.
She represented a week later (I didn’t see her). She was admitted this time and seen by a physician. More tests were ordered and eventually she was diagnosed and treated for Myasthenia Gravis. I saw her 6 months later and she remembered me, she was doing much better and wasn't upset that we missed the diagnosis.
It can be very hard to diagnose some things because of how non-specific the symptoms are. In this case I had a feeling she had a real disease especially with her proximal weakness but there wasn't much we could do about it.
Jaw-Dropping News
I'm not sure if I count because I'm a veterinarian, but I saw trigeminal neuritis in a dog. Basically, the dog can't move his lower jaw, but it's not stiff or painful or anything, it just hangs slightly open. It looks like the dog has just received some unbelievable news, basically. It goes away on its own in 2-4 weeks, but the dog can't eat or drink very well, so you have to syringe feed them, do elevated food bowls, etc.
Benadryl to the Rescue
I had a patient transferred to our hospital for a STEMI (major heart attack). When they arrived, I noticed they looked a bit red and asked them, other than the chest pain, what symptoms they were having. The person said that they had been having a rash for a few days as well as nausea, vomiting, and diarrhea. Those symptoms go along with a condition called scombroid poisoning which you get from eating old, dark meat fish (tuna, mackerel, etc.).
I asked the person if they had recently been eating fish and sure enough, they had been eating salmon for the past few days. Assuming they had it, I treated them with Benadryl which fixed the rash, nausea, vomiting, and diarrhea. They were taken by the cardiology service to get a cardiac catheterization (how you find clogged blood vessels in the heart) for the heart attack and the results came back normal (no vessel occlusion).
Best I could tell, the condition stressed their body and made them tachycardic/hypotensive which made their heart work harder. The increased demand on the heart + an already weak heart led to the heart attack. Also, was pretty awesome to see the EKG go from showing a clear heart attack to normal after being treated with Benadryl!
Face-palm Parenting
I'm a nurse and I work in a pediatric ER. A young woman brought her baby in to be seen for vomiting. I ask her to put the baby on the scale. While on the scale I notice a strong odor of bug spray so I asked about it. Her response made my blood run cold. Mom: "A roach crawled into her mouth so I sprayed a little Raid in there." She said it in a matter of fact tone, like it was no big deal.
Queue up calls to the police, CPS and a 1:1 sitter for the child and the mom. When all was said and done the baby was fine and turned over to her grandmother so no worries there. I have no idea what happened to the mother. I don't believe she was intending to hurt the child. I think she was just completely ignorant.
Non-FDA Methods
We had a case a couple of years ago that still gives me chills whenever I think about it. A younger girl goes to her family doctor in a small town outside of the bigger city where I live. She had persistent headaches, which just started a few days prior. No past medical history of anything similar or really at all about her that stood out as relevant.
Unable to diagnose or treat her headaches (which were rapidly growing more severe), she was sent to our hospital (X state's Childrens' Hospital) for evaluation. We ran her through the typical gauntlet of testing for common causes, CBC/CMB/CT/MRI etc. still with no clue. Nothing came up on blood cultures either. At this point she was in the PICU rapidly deteriorating, with high fevers and periodic losses of consciousness.
After eliminating all the horses, we had to start looking for zebras...and quick. We collected a CSF sample for culture thinking it might be one of the rarer forms of bacterial meningitis. While this was cooking (cultures usually take at least a few days) we tried again to get any other possible info from her parents...that's when we learned the whole story.
For the first time, they mentioned that they had visited a local waterpark a week or two before the girl’s symptoms started...and this was in the middle of summer. For any Peds doctor, or especially ID doctors in the room, those words made their hearts sink. Sure enough, the cultures came back, positive for Naegleria Fowleri, the pathogen responsible for Primary Amoebic Meningoencephalitis (PAM). Which up until that point, I don't think there was a documented case of a patient being diagnosed with PAM who survived.
It’s the incurable brain-eating amoeba that lives in warm stagnant water and can enter through the cribriform plate at the top of the nose if the patient gets water up there...which happens all the time at waterparks. Anyway, long story short, we basically cook up a (very non-FDA-approved) drug cocktail as a sort of Hail-Mary attempt at fighting this infection, as nothing else in any other case had ever worked.
In addition to this, we basically stick her in a Mr. Freeze chamber, lowering her body temp to below what N. Fowleri can usually survive. Unfortunately, most people can't survive it either. But for some reason, (though in an induced coma the whole time) she steadily improved. When we took her out of the deep freeze and allowed her to wake up, it was incredible...
She was alive with no apparent neuro/cognitive deficits, and the new cultures showed no growth of N. Fowleri. It's not too hard to figure out where this occurred, as it may still be the only successfully treated case in the US.
Like Flipping a Switch
man in white dress shirt wearing black framed eyeglassesPhoto by Usman Yousaf on UnsplashI can't remember all the details though so bare with me. I'm at a big tertiary hospital, and had an elderly veteran brought to us one day after being found unconscious in a park. He had alcohol in his system and a quick look at his records showed that this was an ongoing problem with him. He was a sweet old man who was very grateful for our help, up until day 3 of his hospitalization. That's when things took a dark turn.
He developed pneumonia-like symptoms and became somnolent for a few days. Then, out of nowhere, he became very inappropriate—he begins grabbing the nurses and repositioning them, touching himself, and constantly licking his lips in a disgusting manner when anyone even looked at him. He went from a sweet old man to a deviant almost overnight. We even had to wrap his hands up in bandages to stop him from touching himself and others. Oddly though, he hit on anyone and everyone (women and men) except for me. I guess I wasn't his type.
We ended up diagnosing him with Kluver-Bucy syndrome, caused by HSV encephalitis (herpes). Symptoms include hypersexuality and hyperorality. It's pretty rare and I haven't seen it since, but as you might imagine, it left a lasting impression on me. He improved with treatment though, and was incredibly embarrassed after finding out what he had done.
Factitious Disorder
When I was an intern, we had a 22-year-old man with persistent abdominal pain, all studies negative. His symptoms were unexplained. His mother was constantly at his bedside, and his medical history, which was extensive according to his mom, included multiple hospital stays with no definitive diagnosis. I noticed that he would frequently take ill after meals, which his mother brought from outside the hospital.
It eventually became clear that he was a victim of Munchausen by proxy. His mother was making him ill. I'd had a patient with Munchausen's when I was in medical school (she was injecting her own waste into her IV), so I was particularly tuned in. Both cases were very sad.
