New research may show that mild electric shocks can travel farther and be more damaging than the medical community once thought.
There's no way to know for sure, but the 110V shock that changed the course of Patrick Yates' life may have lasted less than a minute. It may have even lasted less than 30 seconds. But its effects have lasted two years, and he'd like some answers as to how it happened, why he continues to experience pain and emotional problems, and if he'll ever get better.
Most days the headaches are so bad that the 24-year-old former high school quarterback can barely function. He eats little and sleeps even less, reduced to catching cat naps during the day because he can't sleep at night. He rarely leaves the house for fear of being caught in public when he has one of the seizures that have become all too common since the shock. When he does go out, he's too embarrassed to wear shorts because of the severe scarring left by sores that mysteriously developed on both of his legs after the incident. And he's become so weak and incapacitated that he can't even do much around the house for his family since they took him in. “It has become a struggle just to lift groceries,” Yates says.
What makes Yates' case so strange is that the intensity and chronic nature of his symptoms are so disproportionate to the shock itself. No one — including Yates, who only remembers briefly waking up and seeing a paramedic standing over him and then finding himself in a hospital bed surrounded by family — knows exactly what happened. The facts that he has been able to piece together with the help of witnesses and his attorney Eric Marye, who specializes in electric shock cases, however, describe an incident that should have done little more than leave him slightly dazed: When a co-worker in the customer service department for Earthlink, an Internet service provider, complained of problems with the computer in his cube, Yates came over to see if he could help. He rested his right hand on a metal part of the co-worker's desk, which had come in contact with a faulty plug and been energized to 110V, but instead of getting a slight shock and yanking his hand back, he was knocked to the ground and began convulsing violently. He was rushed to the hospital where he stayed for the next day and a half. Things have continued to go downhill since.
Yates never returned to work, and since the incident in July 2002, he's made more than 20 visits to various doctors and psychologists in an effort to understand how such a seemingly innocuous shock could be causing him so much pain — especially in parts of his body where the current path theoretically wouldn't have traveled — but his test results have been inconclusive, and his questions have gone largely unanswered. “I got tired of going to emergency rooms,” he says. “The tests weren't showing anything, and no one could tell me what was wrong or if I was going to get better.”
Ironically, the best — and only — explanation for what happened to Yates eventually came from someone without a medical degree. Dr. Michael Morse, a professor of electrical engineering at the University of San Diego, has been studying a phenomenon he calls “diffuse electrical injury (DEI)” since the early '90s when he first served as an expert witness in cases where victims of short-duration, low-voltage shocks were suffering from long-lasting, disproportionate pain in parts of the body that should have — theoretically, anyway — been unaffected by the shock. “Many of the early cases I studied involved litigation, which of course, for the purposes of research are suspect because of the question of secondary gain,” he says. “But since then I've spent a lot of time looking at cases that genuinely don't fit the traditional view of electrical injury.”
Since then, the phenomenon has become one of the focal points of his research. When he continued to uncover cases of people who were suffering from physical and emotional injuries that weren't in keeping with the traditionally accepted set of symptoms for nonlethal, low-voltage shocks, he decided it was more than just a freak occurrence among a few unlucky people. In fact, based on the number of cases he reviews each year, he predicts several hundred shock victims suffer from diffuse electrical injuries every year in the United States.
That number is speculative, in part because members of the general medical community are either unaware of it or deny it exists, as Yates can attest to. Beginning in 2000 and with the help of Dr. Jennifer Berg, a San Diego-based psychiatrist, and Rachel TenWolde, an industrial and systems engineer, Morse embarked on a multi-year, ongoing study of electrical injury patients to determine if a link exists between their shock experiences and the disproportionate symptoms they suffer. The first results will be published later this summer in a paper submitted to IEEE Transactions on Biomedical Engineering, and Morse believes they suggest that even a short-duration, low-voltage shock can have painful, debilitating results for months or even years after the event and that the symptoms are most notable when the contact voltage is in the 120V to 240V range. The questions of why and how have yet to be answered.
Across all demographic lines
In the IEEE Transactions paper titled “Diffuse Electrical Injury: A Study of 89 Subjects Reporting Long-Term Symptomatology That is Remote to the Theoretical Current Pathway,” Morse and his fellow researchers claim that cases of DEI are characterized by symptoms that are disproportionate to the electrical contact. Morse defines “disproportionate” as anything that falls outside the expected results of a typical short-duration shock. “If one receives a short 110V shock, a proportionate response would be that they would suffer no injury other than minor burns at the entry or exit points,” he says.
Also important to the study of DEI is the theoretical current path. In order to qualify as diffuse, injuries must manifest outside of this path, which is best described as the shortest line between the entry and exit points — across the chest in a hand-to-hand contact and down one side of the body in a hand-to-foot contact — but as Morse and his colleagues point out in the study, the theoretical current path is based on literature that's now almost 70 years old. “It basically says electricity follows the linear path from entry to exit, but you know what, I think that's wrong,” he says. “It doesn't adhere to the laws of physics, and it doesn't adhere to the basic laws of electricity.”
Morse gathered the majority of his data via an online survey. Respondents who found the study, which was made accessible through several search engines, were asked a series of questions modeled after a face-to-face, post-shock interview that might be conducted by a physician. It asked for medical history prior to the shock, a description of the event itself, and a list of symptoms experienced afterward.
Morse acknowledges the limitations of an online survey like the one used in his study, but believes that it was actually beneficial because it allowed him and his team to gather data from a worldwide sample — something he couldn't have done otherwise. And he cites several studies that support its validity.
Morse's research queried the subjects for any symptoms existing prior to the shock. The pre-existing symptom set (modeling a non-injured sample of the general population) was used as the control for comparing post-shock symptom occurrence to pre-shock. He's confident that the study demonstrates a pattern of diffuse symptomatology that can be attributed to the electric shock. “I think that we've definitely discovered a different type of injury,” he says. “The medical community just hasn't yet designed the technology to quantify it.”
The results are a mixed bag. More than 87% of patients who were shocked by 110V but didn't lose consciousness still suffered from muscle aches three months after the event in the areas of the body where the current would have theoretically traveled (Table). Almost two-thirds experienced weakness in their joints, and more than half were generally fatigued. As for psychological problems, nearly two-thirds of that group had trouble sleeping and reported being more emotionally sensitive.
The severity and frequency of physical symptoms decrease for those who lost consciousness for less than a minute and experienced limited remote effects (those outside the theoretical current path), but half still suffered from general weakness, muscle aches, and chronic pain. Psychological problems also diminished some for this group, but half experienced memory loss.
Seemingly, the combination of symptoms becomes more complex as time spent unconscious increases and effects manifest farther from the current path. Those who lost consciousness for more than a minute and experienced pain at a maximum distance from the theoretical current path didn't endure a marked increase in physical symptoms, but the frequency of psychological problems increased dramatically. Nine out of 10 complained of short-term memory loss, and nearly three-quarters claimed they were more forgetful and easily confused. Morse and his colleagues speculate that although the percentage of respondents who manifested physical effects remote to the entry and exit points was lower, the high frequency of psychological symptoms suggests electric shock can have diffuse effects because in all cases the brain was outside the current path. “It occurs across just about any demographic line,” Morse says. “I want to know the answer to all the unanswered questions.”
A second opinion
In the past decade, Dr. Neil Pliskin has treated more than 200 electric shock patients and has yet to answer those questions either. Pliskin is the chief of the neuropsychology department of psychiatry at the University of Illinois' College of Medicine in Chicago, and although his research may support Morse's findings that electric shock can have demonstrable effects on the brain, he's not sure it proves the existence of DEI. “Have I seen people who have had electrical contacts that have not directly involved contact to the central nervous system yet who manifest central nervous symptoms?” he asks. “The answer is ‘yes.’ But I have to be honest, I'm not a big believer in the notion of diffuse electrical injury.”
Pliskin's biggest complaint about the study lies with the manner in which the data were collected. He's concerned by the level of self-report necessary to complete Morse's online survey and believes it could ultimately skew the results. “You have almost no verifiable information about what type of exposure they had or whether they actually had an electrical injury,” he says. “So the notion that there's a [definable set of symptoms] and that it's specific to electrical injury in an uncontrolled sample of people who are basically telling you how they feel just isn't persuasive to me.”
Pliskin has conducted his own research on the subject, but he's a little more hesitant to draw definitive conclusions. He recently completed a study that compared the brain function of 48 electricians who had been electrically injured to that of 29 healthy electricians and found that when things like IQ, age, and education level are taken into account, the electrically injured patients were statistically more likely to suffer from psychological changes that affect attention span, speed of thinking, and general performance. “We hypothesize that these differences, in fact, reflect organic changes in central nervous system function,” he says. “What that is due to is less clear at this point.”
Despite the differing conclusions, both doctors' research demonstrates the fact that established theories concerning current paths through the body may not be as accurate as once thought. “The problem is that a lot of people — myself included — who look at things like current path in the human body do so by treating the body as more of a passive electrical element,” Morse says. “That may generally be the case, but there's nothing that says that as current is passing from Point A to Point B it's not having some effect on the biological functioning and the electrochemical nature of the body.”
Pliskin is even less sure. “The questions raised are, How far does the electricity go?, How does it travel?, and Does it really make it up into the central nervous system when you're talking about a hand-to-hand contact?” he says. “Speaking to you as a psychologist and not an electrical engineer, the answer is, nobody knows.”
In the hopes of better understanding how and where electricity travels in the body, and in turn better understanding how it can affect areas not involved in the contact, Morse has begun a project to map the current path in small parts of the body using mathematical modeling. He's currently working on the wrist. “What I've discovered is the current goes largely where we think it goes, but it also goes into areas of the wrist that we might not have expected,” he says. “And I'm convinced that somewhere in that modeling there's at least somewhat of an indication of why this does not appear to follow the theoretical current path.”
If DEI does in fact exist, understanding how and why it happens could also legitimize it and make it easier for people like Yates to prove their symptoms are real, no matter how outlandish they seem. Morse compares DEI to mild traumatic brain injury (MTBI), a condition that 20 years ago also met with skepticism from the general medical community. Much like Yates has experienced for the last two years, patients who, prior to the '80s, sustained mild head injuries and subsequently complained of chronic headaches and memory problems were believed to be faking or suffering from a psychiatric disorder brought on by stress. MTBI has since been proven to be a physical condition that affects brain function. Morse says he's confident that DEI will one day also be accepted as something more than a figment of its victims' imaginations.
Being taken seriously by the medical community would be little consolation to Yates. Once athletic and active, he spends most of his time now wondering when and if his headaches will go away and whether he'll ever be able to go out in public again without the fear of suffering a seizure. Ideally, he says he'd like to go back to working with computers, hanging out with his friends, and doing the Web design work he used to do on the side before his accident. “Basically, I just want my old life back,” he says.
Sidebar: Prescription for the Pain
If you've been shocked and continue to suffer from pain, confusion, and other problems noted in Dr. Morse's study, there are resources for coping with them. Visit the following Web sites for more information:
The Electrical Trauma Program — etrp.bsd.uchicago.edu
Lightning Strike & Electric Shock Survivors International — www.lightning-strike.org
You can also participate in Morse's ongoing study on DEI by filling out the survey at: http://home.sandiego.edu/~mmorse/electricalinjury3.shtml