The epic of Narcissus
A medical miracle becomes a medical student in an updated fable for hospitalists.
There are some things you should never read. If you find your sister's diary laying on her bed, with an easy little lock to pick, leave it unopened. I speak from experience. If you pick up your lover's phone and there's a text from a name you don't recognize, best leave it be. And if the leaves in a teacup appear to spell out your immutable future, rinse them away. I repeat, there are some things you should never read. Luckily this column is not one of them.
The baby of this epic tale was a medical miracle. Neither physicians nor family believed he would live, except his persevering and undeterrable mother. From dextrocardia to dermatitis, malabsorption to myopathy, it seemed nothing was in the right place or worked as it should. He spent his first three months in the neonatal ICU and half his early years in and out of the children's hospital. If there was an infection, he got it, a syndrome, he had it. Yet despite the odds, the fates were not ready to cut short his string of life. Despite experiencing everything from minor trauma to near death, he graduated from college (thanks to a full academic scholarship) and began medical school at the university where he had received all his care.
His chart, which began its own peripatetic journey in paper form, was one of the thickest in medical record history. The yellow sheets of progress notes and blue of lab, X-ray, and path reports were folded into 48 separate plastic folders that filled an entire 12-foot shelf. Many clinicians had marveled at the medical miracle of his survival. When he was admitted, which was often, scores of students and regiments of residents would pore over the aging sheets filled with a variety of handwritten notes, from the fairly legible to the most chickenish of scratches.
The future Dr. Narcissus had, against all odds, grown, and so had his record. About the time he started college, an electronic record system was installed at his hospital. As cuneiform tablets had given way to papyrus, the paper chart became a body electric. The mountains of written notes that had been gathering dust became megabytes of data. Copying and pasting had created a lengthy but repetitive narrative of his complex medical journey. What had been an ever-evolving and riveting saga was now a ponderous but predetermined problem list, which moved from note to note as can only occur with an electronic record.
When he started medical school, he'd gotten the usual admonition against viewing his own medical record, though several hospitalizations into his first year he was sure his classmates had perused it. He persevered and avoid reading it. But one day his old nemesis, the complex medical history, reared its ugly head. He was suffering from blurry vision and went in for an exam. Looking at a photo image of his retina in the ophthalmologist's office, he chanced to glance over at his problem list. The phrase that stuck in his head was “usual childhood illnesses.” There was nothing usual about his childhood illnesses.
And so he began to read his own chart. The electronic record was fascinating, but repetitive. He knew what he had to do. He requested his paper record be pulled, all 48 volumes. On his first day off he went down to the infrequently visited records office. Sitting in its own little cubicle was the entirety of his history. It was glorious. No patient had a history like his, filled with scintillating syndromes, medical misadventures, and fantastic pharmaceuticals. He couldn't stop reading.
He started at the most recent volume, number 48. This relatively slim packet ended with his admission for anaplasmosis with pancytopenia from a tick bite. He'd had his share of unusual infections. It was like a primer: Ancylostoma, Babesia, and cutaneous larva migrans. Every organ had been diseased at one point or another, even his pineal gland. The more he read, the more fascinated he became. He couldn't put the chart down and moved straight on to 47, his admits for psittacosis and acromegaly. He looked at his phone and saw unanswered messages. It was already dinnertime, but this wouldn't be his first all-nighter. He pulled volume 43.
It was a long weekend, and he was due to start a new rotation in the morning, infectious disease. He was all too familiar with the variety of organisms from bacteria to viruses, fungi to spirochetes, that could infect a human body. He'd had them all. He kept on reading, as there was nowhere else he could learn so much. It was beyond fascinating. He just couldn't stop now.
When he didn't show up Monday morning, the medical school administration went to check on him. They knew how sick he could get. His apartment was empty, and his phone went unanswered. They checked his computer sign-on and could see that he had reviewed his own records. The assistant dean went down herself to the records room and saw the cubicle filled with his paper chart. The records clerk remembered the pallid young man poring over the chart. He was never seen again.
Hospital policy called for reshelving records after seven days. When the time came, the clerk slowly loaded the plastic folders onto a cart and replaced them in the stacks, one at a time, counting to 49 as she did.