Dot Phrase

Today, the EMR has replaced that thoughtful activity with a series of short cuts and phrases that can be quickly populated into a note, which is ultimately used to justify hospital and physician billing. Certain phrases must be present to attain the desired level of billing. As a critical care physician, I can easily meet the highest mark with the phrase, “respiratory failure.”


 The baby’s blue eyes are wide open but she’s not looking at me, she’s looking through me, unable to fixate with a normal gaze. Beads of sweat cover the bridge of her dusky nose and her pupils are dilated. Her small hands tremble and don’t quiet with my touch. The monitor suspended above her bed [...]


As I walked toward the PICU with coffee in hand, I reach into the pockets of my freshly starched white coat. I have my cell phone, the attending phone and lip-gloss. I pause on the bridge connecting Texas Children’s with The Pavilion for Women and contemplate my to do list for the patients under my [...]

Professional Attachment

Recently, an intern started to tear up as I was leading morning rounds. Our team had just examined a child nearing the end of his life. The outline of his protruding ribcage revealed his labored breathing. He was curled into an unnatural contractured state due to the stiffening of his muscles courtesy of his progressive [...]

Burn Out

What do you tell a respected colleague and friend when the tragic death of their patient is more than they can stand? One of the best intensivists I know shared with me the heart breaking story of withdrawing medical care on a toddler run over by a car. The child's catastrophic injuries left him close [...]