A Troubling Notification
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A Troubling Notification Amir A. Razmjou1
Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This piece discusses an internal medicine trainee’s attempt to process the untimely death of a patient seen in primary clinic by suicide. More specifically, it explores the role mental health may have played in the patient’s care, and the possibility of the symptoms which were labeled as functional having been manifestations of underlying psychiatric illness. The piece also attempts to explore the unique challenges facing veterans within the healthcare system. Keywords Medical humanities General internal medicine Psychiatry Suicide
‘‘…died…’’ My eyes caught on to those four letters while routinely scanning the notifications in the electronic medical record for my primary care patients at the Veterans Affairs (VA) hospital. ‘‘Jones 1234, died on 02/02/2020.’’ That was the reminder sandwiched between a normal set of labs, and a medication refill reminder. Shocked, I hesitantly attempted to click on the reminder, only to see it disappear, as if the purpose of the notification was accomplished. Those who have worked at the VA and are familiar with CPRS (the electronic medical record system of the institution) are likely not surprised by this. However, this piece is not about the functionality of a now outdated (though surprisingly sturdy) electronic medical record system, but rather the story of my patient’s death within the VA system, and my attempt to process it thereafter. & Amir A. Razmjou [email protected] 1
Department of Medicine, UCLA-David Geffen School of Medicine, UCLA Medical Center, 757 Westwood Plaza, Suite 7501, Los Angeles, CA 90095, USA
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Cult Med Psychiatry
After painstakingly searching for ‘Jones’, what I remembered to be his first name, and an educated guess on his approximate age range, I managed to finally enter my deceased patient’s chart. I had last seen Mr. Jones two months prior. In the interim, there was a note documenting his meeting with a social worker, where he was inquiring about potential VA benefits for more secure housing. The most recent note in his record was also by this social worker, stating that after multiple missed calls and appointments, the veteran’s home was entered by authorities. When they entered his apartment, Mr. Jones was found on his couch, dried blood over his head, and a gun in his hand; date and time of his death was unknown. I had met Mr. Jones and established care with him early in my first year of internal medicine residency, soon after he had returned to the home after active military duty. He was tall and athletic, with a medical history only significant for a distant history of polysubstance abuse. During the interview, he shared that he thought he was ‘‘drinking too much’’, but that it had not caused problems in his life. He elaborated that his drinking habits largely revolved around insomnia he had been dealing with intermittently for many years. Mr. Jones also brought up a history of recurring testicular pain for se
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