How I learned to hate paper medical charts…
I chose Oregon Health & Science University for my residency. Susie’s health was declining so we chose Portland to be near her family.
A few weeks into internship at the Portland VA, I was summoned at 2 AM to “pronounce” a patient. Being my first time, I was very careful to check for vital signs and confirm the chart matched the patient bracelet before signing the certificate. Paged again at 3 AM, I was told it was also my responsibility to call the family. Trudging back to the ward, I took the chart handed to me and called the number on the next-of-kin form. The daughter was shocked, but I did my best to console her. After another fitful hour of sleep, I was paged again to find the daughter had arrived and now confronted me with her declaration that “my father’s not dead!” My own heart stopped — had I missed a faint heartbeat? She led me to a different patient room, where a father wondered why his daughter seemed so surprised to see him.
At my 3 AM call, I’d been handed the wrong chart, with the same, common last name. The daughter was so happy to find her Dad alive, she didn’t lodge a complaint, but I was deeply mortified. I already disliked the messiness of paper medical charts, but this took my aversion to a new level. It probably set the stage for my 30-year career endeavor to bring medical charts into the computer age.
A novel form of doctor/patient communication
In my senior residency year, we had a patient in the VA ICU with Guillain-Barre Syndrome, a rapidly progressive paralysis that ascends from the legs upward through the body. With meticulous care there can be a full recovery over many weeks, but the “locked-in” phase of complete paralysis can be psychological torture. We could only guess at what he wanted or needed and his suffering was undeniable.
When his family visited, I asked them about his experience as a WW II veteran. When they reported he was a submarine radio operator, a light bulb blinked on in my brain. I asked him if he knew Morse code, and he blinked once for yes, but trying to blink his eyes in Morse code quickly exhausted him. So I examined him to see what other muscle strength he had left, and found he could still clench his jaw slightly. I donned a glove, put one finger between his teeth, and asked him to try sending Morse code that way. Immediately he squeezed out HOW DO YOU DO. THANK YOU !
I built a crude Morse code key using tongue depressor sticks, a switch, and buzzer. With this he could send clean Morse code, and became quite chatty with me! A Morse code chart over the bed helped the nurses understand him, though he had to send very slowly. Finally able to express his needs, he made it through the locked-in phase to a full recovery.