I was going to write a haiku, but now I’m just going to write about Haiku, the e-record mobile app.

Just the other day, I was looking up a patient who had been mentioned during rounds as new to the ICU. Reflexively, I opened the “My Patients” tab, and at the very top, I saw the name Holly Hartfield. Not the person I had meant to find—but because Holly was someone I distinctly remembered from a few weeks ago while I was part of the Pulmonology consult service, I paused.

Holly was a frail older lady, with short curly brown hair, bright blue eyes. When I first saw her, she was lying in bed and didn’t look particularly comfortable. She was adamant she hadn’t had too much trouble with her breathing until “this.” The monitor said she was taking something like 25 or more breaths a minute – hardly able to get through a full sentence. A nasal cannula was coiled around her face. With every exhale she would purse her lips. Her voice would creak a little when she spoke. Her hands would tremble a little whenever she gestured. There was something very gentle about her.

With her incurable lung disease, we didn’t have more in-house treatment to offer. Her condition was stable. She had been improving back to her baseline… So, before she got sick from anything else in the hospital, we definitely wanted to send her on her way.

Except Holly was scared to go home. She told us: afraid of finding herself suddenly unable to breathe again, especially living alone as she did.

With any talk of sending her home, I watched her breathing get faster and faster. When she couldn’t catch her breath, she would gasp for more air, fasterandfaster.

“Close your eyes. Imagine yourself on a beach…” said the attending physician in his deep mellifluous voice, attempting to calm her down. I thought of warm sand and frothy waves sweeping a shoreline. And I watched Holly’s SpO2 blink higher and higher on the screen. Her respiratory rate settled.

(As we walked out of the room, though, I thought I saw it starting to creep back up…)

For the next few days, we visited her to convince her it would be best if she went home and followed up with a specialist for her kind of lung disease – he’d definitely take great care of her!

And finally she did leave.
And then she came right back.

Although I wasn’t “following” Holly during this re-admission, I quickly learned she had suffered a terrible gastrointestinal injury that landed her in the ICU.

This time, a breathing tube was in place. I can’t remember for what we were consulted. I do remember that, once again, we didn’t have much more therapy to offer her, at least beyond what she was already receiving. I more vividly remember the surprise of seeing how sick she had become. Just like that.

I prayed to the universe for her recovery.

Days, maybe weeks later, I realized I had never formally exchanged more than an introduction with her. I was 99.99% sure she wouldn’t remember me at all. Nevertheless, seeing her name appear on my phone screen made me smile. So I pressed to open her chart.

“Deceased Patient Warning: You are entering the medical record of a deceased patient.”

My options for this pop-up were: “Cancel. Continue.”

I had never seen this “feature” on Haiku before. As if encountering a digital noti cation of her death weren’t already shocking enough, heart-wrenching enough, the choice of the word “warning” felt more accusatory than considerate. It seemed as though some- thing, somehow was upset with me… For the next few days, I would tap on her name, see the pop-up, and close the app. Why was I doing this to myself? Was I double-checking, in a way, trying to af rm that she was, in fact, deceased? Why not just open the chart? Even by accident? Perhaps in wanting to nd out how she might’ve died, I was crossing some line? What kind of trouble could I possibly get into by doing so?

A classmate would later explain to me that we are allowed to open the chart for educational purposes.

But I still haven’t.

Deborah Yu is a medical student at URSMD. In her spare time, she wonders about her pirate-self in a parallel universe, swing dances, and reads Murakami. She thrives on creative projects and efforts to engage the rest of the world in the medical humanities.

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