It’s 10 p.m., do you know where your doctor is? I chuckle to myself, recalling a familiar public service announcement of the past meant to remind adults about the whereabouts of their children. I know exactly where I am at this typical hour, sitting in front of a glaring computer screen trying in vain to clear out my inbox in our practice’s electronic health record (EHR) and “win the game” by getting to zero remaining tasks. This is not an easy feat since there will be something that has to be left unchecked to address the next day. Still, I try my best to whittle down the list as much as possible. The system automatically moves my cursor to prior read messages at the bottom as I get closer to the end of the laboratory results marked as read. I came across labs from one of my patients who died over a year ago. His photo sparks a memory of our time together when I was treating his cancer and enduring relapses with him and his lovely family.
The EHR offers many tools designed in theory to make note writing more efficient, consolidate test results, communicate electronically, and ultimately assure billing charges are entered. It is well known that EHRs are a common source of disrepute among clinicians, contributing to burnout. Putting these criticisms aside, from another perspective, the EHR also represents an anthropological vault of stories of patients since the past that may never be known outside of the memories of loved ones and the clinicians who cared for them. These stories echo in silence beneath our fingers, telling some of the most intimate parts of individuals’ histories through our notes as we care for new patients.
When I first met him, what struck me about my deceased patient who arose at the end of my tasks was his eye patch. One of the benefits of modern EHRs is that they often have headshots for added identification. Perhaps less than an epic idea, this photo goes from color to black and white when patients become deceased. Like holding the first rung of a collapsible ladder, seeing patients’ faces can unfurl a larger memory of their being, as highlighted by fellow oncologist Dr. Mikkael Sekeres.
A distinctive feature, such as unique facial grooming, a scar, or hardware, can be especially memorable. These mental and physical images stimulate our memories as powerful as the five senses contained in our faces. My patient also had a pleasant stutter that contrasted with his unwavering confidence in fighting his cancer. He and his wife loved each other very much, and she always showed up to his visits. She had a pet name for him, and I had to resist using it instead of the standard professional salutations. As his disease became more refractory to treatment, before his passing, I had the privilege of getting to know more of his family, each one as caring as the next.
One of the challenges of being an oncologist is never forgetting the anguish of losing a patient, particularly because we develop strong relationships with our patients during difficult times in their lives. When a patient passes, my practice sends a sympathy card, and I make a difficult call offering my condolences, wishing I could have done more and that we had additional time together. Loved ones of the deceased had a lot going on at that time, such as funeral arrangements, estate affairs, and mourning. But on my end, after making those phone calls, it is just me, my memories, and the EHR telling me to move on to the rest of the tasks accumulating in my inbox.
Even though the EHR warns me that a chart is closed because a patient has passed, I can still leave a telephone note. I make it a point to document the respects I pay over the phone and leave a few lines about something unique to our shared experience, a positive attribution, and a memory that will endure. Looking at the photo, which is now subdued without color, ready to persist eternally in black and white somewhere within the echoes of the EHR, I feel better knowing that my message in a bottle may bring peace and comfort to those who may find it in the future. Closing the note, I write, “He loved his wife dearly and was never hesitant to face his disease head-on.” After this, I close the encounter and return to the eternal task of clearing out my inbox, addressing the needs of the colorful array of charts giving me the purpose to move on.
Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein.
