22 June 2013


A patient was determined to be brain-dead, meaning her brain had no activity. By law, the patient was now dead. The family decided to have her organs to be harvested for transplantation. An anesthesiologist was called in to evaluate the patient ahead of the organ harvesting.

I found this line in the anesthesiologist's write-up of that evaluation:
Risks and benefits of General and Regional Anesthesia discussed with patient.  Questions answered and patient wishes to proceed.
A brain-dead patient who talks? I'm sure.

There are major problems with the switch to electronic medical records. Because of onerous and shortsighted regulations by the government and private insurers, our notes have to be chock-full of useless documentation. Time constraints necessitate us to use pre-fabricated computer templates that automatically fill out lengthy portions of our notes. The doctor is supposed to go back and change the portions of the computer-generated note that are untrue or do not apply.

In reality, the notes are rarely checked carefully enough, and crazy things routinely slip into the notes (like brain-dead organ harvesting patients who ask questions about the anesthesia, or pediatric patients who are 133 years old). The notes also become so lengthy and unwieldy that they are difficult to read. After all, they are written more by computer than by man.

In attempting to document everything, we end up documenting nothing, because our clinical notes are becoming worthless. Thanks to the increasingly bureaucratic nature of medical practice, the accurate and thoughtful medical record is becoming a thing of the past.

12 June 2013

Death and disease

Note: This post describes a patient's death. It has content that many would find graphic and upsetting. Please use discretion.

11 June 2013


A young patient came into the trauma bay with part of her face blown off. Someone had shot her point blank with a high-velocity round from an assault rifle.

It was horrifying inspecting the damage one human being was willing to inflict upon another. But seeing the evisceration of the delicate anatomical structures in this patient's face furthermore felt like a personal affront. As I've come to know the human body, I've come to appreciate it as a elegant, beautiful specimen. Examining this patient was like beholding a Monet painting that someone had torn off the wall of a museum and then smashed a hole into with their knee.

Gunshot wounds are more than just murderous. They are profane.