June 21, 2018
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Discharge patient to heaven

By Dr. Erik Steele

Part of my work is to sift through the stories of the dead to find lessons for the living. I sit down in front of a pile of medical records about patients whose hearts stopped or almost stopped in the hospital, read the story of the “Code Blue” effort to save them, make sure everything was done that should have been, and look for ways we might do a better job with the next patient in crisis.

It is a sad task, because most of the patients in the pile never made it. The most frequently checked box on the Code Blue review form is beside the word “Unsuccessful,” and discharge was not to home. Despite the drama and heroics, despite the best efforts of passionate and dedicated health care professionals, no one ever would go see Hollywood movies about all of this because the endings usually would stink.

Over the last 20 years, I have read more than 2,000 of these Code Blue records, each a story of the effort to save someone’s Mimi, someone’s child, someone’s dearly loved something. They come to me each month; if I put the task off, the pile just gets bigger and bigger, calling to me to read the stories, sign the records and put them all to rest. Until this, I never knew a pile of paperwork about the dead would take on a life of its own.

Reading through the records is like juggling with bags of hammers; you know it’s going to hurt, and it’s just a matter of when. I think I am doing fine, happily in denial that there is a human being on each end of this endeavor, wading through the details with my doctor’s armor on, keeping my interest clinical, and then wham! — some story finds the chink and the human tragedy behind the paper comes through.

This patient was only 3 and died despite a two-hour effort of 50 people to save her; that one was a young woman the same age as my youngest daughter; this one is named Alice like my mother, etc. Sometimes it’s just an image; a 55-year-old out on his motorcycle, cooling in the wind, maybe feeling like a 20-year-old for a bit, when it all ended in the flash of a crash with a pickup truck and an ER trauma code. Then it’s just painful reading details about the unexpected death of someone who reminds me of me and my own mortality.

The dead conspire, you see, to make us somehow treat them as the people they were, as a woman named Mabel and not Case No. 42626, as grandfathers and not 72-year-old heart patients, as someone’s son named Casey and not a headlined murder victim.

I sometimes must find my solace in small things in the record, like a beachcomber looking for bits of sea glass or a child searching the gray sky for bits of blue. At the end of the record about an infant’s care, I find written the ER doc’s personal wish, “May the child rest in peace,” and think of how much it would mean to me as a parent to have my child cared for at the end by someone who would put that heartfelt thought into a dry, clinical note. Another doc dictates “May God rest her soul” into the discharge summary of a 60-year-old female who died in the hospital. Indeed, and it was kind of you to ask God to do that, Doc.

There is also comfort in knowing that sometimes among all the clinical hay I find the needle of something we could do better someday in the future when another patient needs the Code Blue team. Perhaps the emergency team could be assembled more quickly, some new piece of equipment could make the breathing tubes easier to insert, staff might need more education about a new way of doing things, etc. Then I get to do my job helping the team do their job better, and someday, there might be one fewer chart in the pile of patients discharged to their heaven.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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