Friday, April 13, 2007

The Muse In The Machine

But, lest you think my hospital is run by ICD-9-obsessed, soulless bureaucrats, it has allowed the installation into our "EMRs" of "Voice Recognition Software" which, from time to time, seems to inspire the program to break into postmodern verse --

Bowser Graininess

i saw her in the low
and he is in the hospital
and painful he is in the
with a blue hue breaking from the globe

and we were here now
and he could be any birth control pills
and is no
is a but
nothing anything is possible

and will go from the

(This poem -- or poEMR, if you will --may be the first recorded example of new subgenre of Flarf which henceforth shall be known as EMflaRf .

This, along with Bro. Bartleby's De Profundis Clamavi button, is giving me the courage to soldier on.

Wednesday, April 11, 2007

On Ordering A Throat Culture, Or Scut Monkey Redux

If I haven't been blogging much lately it's partly because of a new entity that has taken over my professional life. It is called the "EMR," short for "Electronic Medical Record." It has utterly changed every aspect of how the clinic functions. For better ? For worse ? I'll let you decide.

The Old Way:

Me: Nurse, please do a throat culture on Mr Jones !
Nurse: OK ! (swabs throat, checks off "throat culture" on lab requisition, affixes labels, sends to lab.)
In the meantime, I extract a prescription pad from desk drawer, write prescription, hand to patient.

The New Way:

Me: Nurse, please do a throat culture on Mr Jones !
Nurse: OK ! (swabs throat, affixes label on swab, hands swab to me.)
Me: Mutter under breath and go to the "Electronic Medical Record"
Click on Mr. Jones' desktop "document."
Go to side bar.
Click on "CPOE & AP_CCC."
On CPOE & AP_CCC screen click on "Problem List"
On Problem List screen, click on "New Problem"
On "Find Problem" screen click on "reference list"
On reference list screen type "pharyngitis" in little oblong box
Choose one of several dozen "pharyngitis" entries and their accompanying ICD-9 (billing!) code
Hit save on this, "find problem" and "new problem" screens, which close, returning one to
Pull down new problem list menu and hope "pharyngitis" is there.
If it is, click on on "new order" button
Pop-up box tells me it cannot find "custom-list-CCC"
close pop up box
Stare at "new orders" screen
highlight "pharyngitis" on problem list (forget this and you're screwed -- no tests anymore without officially linked ICD-9 approved diagnosis !)
Find correct pull down menu among several and go to, "laboratory"
scroll SIDEWAYS to "microbiology"
hope desired test is on the EMR's parsimonious and weirdly arbitrary list of tests
(why, for example, does it include "parvovirus test" and not "shoulder xray" ?????)
otherwise go on confusing little side excursion after clicking "laboratory, other"
click on throat culture
click on "sign order"
click on "OK" (sometimes twice, God knows why)
wait 10-15 seconds as printer decides to print lab slip
sign lab slip and hand to nurse
hit "change medication" button (or is that "new medication" button ?)
stare at confusing screen
click on "new medication"
stare at another confusing screen
click on "reference list" (sometimes twice, God knows why)
type "penicillin" into oblong box
search among dozens of types of penicillins for correct one
hit "save" on a series of screens, which close and bring you to
confusing prescription screen
fill in several little boxes with dosage, instructions, duration, refills
remember to tell the machine what to do with the prescription (print, fax, fax & print etc etc etc)
hit save
find self (sometimes) back on "CPOE-A&P-CCC", sometimes on "medication" screen
If on CPOE click on "change meds" (or is that new meds)
If on "medication screen" hope "print" button is highlighted
if so, click on it
hope machine has not decided to fax
take prescription from printer
sign, write in DEA number

Realize, with bitter resentment, that the time spent doing these things would other wise havebeen spent writing the progress note that will now need to be written at the end of the day because THERE ARE 6 MORE PATIENTS WHO JUST SIGNED IN -- EEEK !

Remember, with horror, that the Mr Jones also had a fungal rash and wants some fungal cream.

Click, weeping, on "CPOE-A&P...."

Wednesday, April 04, 2007


The Palm Sunday liturgy took me by surprise. It included a little Passion play with assigned roles, and we in the pews would play the crowd. I read along as the band of actors at the front of the church spoke their parts , then said -- no, shouted -- my own lines. Crucify him ! Crucify him ! And I suddenly understood the absolute abyss of repentence to which Lent calls us,

repentence for the evil that enslaves us, the evil we have done, and the evil done on our behalf.

Blood thirst is not new. Just listen to the prophet Amos: For the three transgressions of Gaza, and for four, I will not revoke the punishment; because they carried into exile entire communities...For the three transgressions of the Ammonites, and for four, I will not revoke the punishment; because they ripped open pregnant women in Gilead in order to enlarge their territory...For the three transgressions of Israel, and for four, I will not revoke the punishment; because they sell the righteous for silver, and the needy for a pair of sandals -- they who trample the head of the poor into the dust of the earth, and push the afflicted out of the way... Ethnic cleansing, atrocities of empire, economic oppression: the thirst for blood is unslakable. What slakes the counterthirst ? The cup of salvation.

As if the one deluge were not enough, there is a counterflood: tears. They answer blood in an endless call-and-response: the blood of sons and daughters, the tears of mothers and fathers, wave after wave, red then clear then red again.

And a dream of water: Then the angel showed me the river of the water of life, bright as crystal, flowing from the throne of God and of the Lamb through the middle of the street of the city. On either side of the river is the tree of life with its 12 kinds of fruit, producing its fruit each month; and the leaves of the tree are for the healing of nations.

And then there is the counter dream, the cauchemar: aqua mortua oozing down the gutters, trash-bearing, toxic efflux of our violence and wastefulness. In the midst of this, Lord, when I find someone's cross in my dirty, unwilling hands, grant me the grace to carry it, if only for a while;

teach me to recognize and honor saintliness, even as I sin;

and help me turn toward, not from, affliction,

and to find a place beside, beneath, not over, others.

There are too many words in the world, and many of them are mine. Words that justify war, torture, oppression, theft, aggression. Clever words, ironic words, piercing words. Gaseous words, even pious words, that serve only to inflate the self. Sing, then, not say:

Let all mortal flesh keep silence.

Or just watch as the soldiers strip Him and cast lots for His clothes,

and nail Him to the cross,

where He dies, forgiving them. (Forgiving them !)

Then remember the opening words of the parable He once told:

Unless a grain of wheat falls into the earth

and dies

Then, sit silently and wait.