BALTIMORE, MD – A third-year medicine resident at Johns Hopkins University, Geno Smulison, completely exhausted from a busy inpatient teaching service this month and struggling to stay afloat with two interns off today, decided at 7:55 PM he had only one option to get all of his notes done and leave before midnight: write about all 15 patients in 1 progress note.
“You can’t argue with that form of efficiency,” said supervising attending Donald Thomas. “Unorthodox? Yes. But as long as all the information’s there.”
“The patients complain and don’t complain about chest pain, shortness of breath, fevers, and cough,” writes Smulison in his subjective, while thinking about a burrito or maybe ordering in pizza for dinner.
“Everyone has pain, but no one has had a bowel movement. They collectively had a tough night. Some are feeling better, some are feeling worse, and some are the same. One of them had hemoptysis.”
“I mean, he covers all of the complaints,” said Thomas. “No problem from my standpoint.”
Smulison continues onto his objective, dreaming of a nice long hot shower, assuming the water wasn’t shut off for forgetting to pay rent.
“Vital signs range from normal to abnormal,” writes Smulison, his handwriting a little sloppier. “This includes fevers, hypotension, marked hypertension, bradycardia, tachycardia, and hypoxemia. Physical exam reveals obesity and cachexia. There are many lymph nodes. Three nasogastric tubes. Many heart sounds and murmurs, or lack thereof. Patients are dry, volume overloaded, and euvolemic. Lungs are clear with wheezes, crackles, and occasional accessory muscle use. Abdomens are soft, tense, hard, flat, distended, quiet, hyperactive, with and without rebound and guarding. One positive Murphy’s sign. Foleys are sometimes present. Many are appropriate, many are inappropriate. Neurologic exams are highly variable. Someone has a wound with a dressing.”
Smulison added: “Labs note some interesting stuff.”
Smulison wraps up his note, thinking of maybe setting his alarm for 6:30 AM, though that might be pushing it, but you know what, why the hell not?
“Assessment and plan,” Smulison eagerly notes, sensing the finish line is near. “These are 15 patients of numerous ages and backgrounds presenting with a constellation of symptoms and signs concerning for either something acute, subacute, acute on chronic, or none these at all and are merely placement versus drug-seeking. In general, they’re getting better, though 1 went to the intensive care unit. Continue current management, which may or may not include labs, imaging, invasive procedures, consultations, medications, transfusion, and a family meeting. Transfer the transferable. Discharge the dischargeable. Intensify bowel regimens.”
Triumphant, Smulison signed and dated the note.
“Bravo!” lauded Thomas, as he proudly agreed and co-signed his resident’s remarkable meta-note. “I’m really impressed. He pulled it off under very difficult circumstances.”
Copies were made of the note and the meta-note was placed in all 15 charts. As word spread of Smulison’s brilliant performance under pressure, his medical colleagues met him with a standing ovation as he exited the premises.
Smulison walked out of the hospital at 8:15 PM.
Sources close to GomerBlog reveal that he is leaning towards pizza tonight, maybe pepperoni. However, Smulison has yet to confirm or deny these reports, citing this as a “personal matter” and requests that the media respect his privacy in the matter.
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