Operations, Patient Care, Trauma

Lyin’ Eyes: Do we underestimate this finding?

Issue 5 and Volume 33.

You can’t hide your lyin’ eyes,

And your smile is a thin disguise.

I thought by now you’d realize,

There ain’t no way to hide your lyin’ eyes.

By Don Henley and Glen Frey, The Eagles

It has often been said that the eyes are windows into the soul. I’m almost sure that saying was derived from a more elaborate statement by the Roman orator Cicero. But whatever the idea’s origins, anyone who deals with people readily identifies its practical validity. The eyes provide a careful observer with important clues to the thoughts, intentions and emotions that lie behind them.

The writing of this article is framed against the backdrop of an evolving political process, in which various candidates induce American voters to mistake glitter for diamonds. I’m no political wiz, but I’m guessing it’s safe to say the voters got fooled last time that happened. Today, plenty of people are starving for leadership.

To make the big time in almost any culture, a political candidate has to be a damn good public liar. That’s too bad, because dishonesty is probably the last trait you would want in a leader. We haven’t seen many good leaders in recent years.

But think about this, Life-Saver: EMSers get lied to for a living. We know something about people that doesn’t get altered by the artificial staging, lighting and filtration of TV. Lying is unnatural, and if you know what to look for, people’s eyes will usually tell you when they’re doing it.

What do you look for? Look for the partial smile, involving the mouth but not the eyes. A genuine smile lights up the whole face, and it’s unusual for the mouth to smile all by itselfƒor for only part of the mouth to smile. Look for an avoidance of eye contact, or in some people, eye contact that seems exaggerated or inappropriate. When you do see avoidance, it may take the form of someone averting their face or turning away from you altogether. Lastly and most importantly, watch the way they blink.

Normally, we blink about 10 times a minute. When somebody’s trying to fool you, they blink faster than that; in some cases, a lot faster. I don’t think you can set yourself up as anybody’s judge, especially when it’s your job to be their caregiver. So, don’t bet the farm on any single observation you make. But blinking is about as important a finding as any vital sign, like blood pressure or heart rate. It’s definitely worth your attention, especially when you’re trying to explore the immediate history of an event, like the ingestion of a substance or the possibility that someone’s syncopal episode was slightly dramatized.

There are some pathologic causes for excessive blinking. Tourette Syndrome is one. Strokes and other nervous system disorders can also produce the finding; so can common contact lenses or recent LASIK surgery.

We already examine and monitor numerous features of people’s eyes throughout the course of our calls. We depend on the eyes for subtle implications about mentation, pain, fear and dysphoria, intracranial pressure and cerebellar function. Why should we miss whatever else they might reveal?

Police interviewers assign implications to a host of human features in a suspect, like changes in body language, adrenergic changes, slowing of speech, question avoidance, excessive details, and directional changes of the gaze in response to questions. I don’t know anything about those. But my kids taught me to trust this oneƒthem, and about 20,000 patients. I believe it’s a good tool.

I wonder what would happen if somebody were to subject every presidential finalist to an interview by a group of 10-year paramedics. We might be able to save the months and millions of dollars we now spend on political posturing. Who knows? Maybe none of them would get past a group like that.

But you know that part about the soul? I think there’s something to it. And I think there are some patients and family members who know there’s something to it. I think it’s possible, when somebody looks deeply into our eyes and asks us how their loved one is doing, we get evaluated ourselvesƒmore often than we might realize.

What do you think? How do we measure up?