He is small for an eight-year-old boy, made even smaller by the big trauma room gurney beneath him. Two skinny, sunburnt legs stick out from a pair of much too large, frayed, hand-me-down cutoffs. Green grass stains cover the skin of both knees. His bare feet are filthy, farm boy filthy. The kind of filthy that comes from playing in the cool dirt of an old barn floor, from running through uncut fields of wheat alongside the combines, and from climbing the giant hay bales that dot the rolling hills this time of year.

Two hours ago he was just another shirtless boy in a cowboy hat playing in the wheat.

His mother stands across from me. She is perhaps thirty-two. She has sandy blonde hair, just like the boy on the gurney. I can’t see her face because it is buried in her husband’s chest. She is completely silent but her whole body shakes, trembling like an old John Deere combine with something stuck in its blades. Her husband pulls her tight, his arms wrapping around her, trying to protect her from this place, this moment.

The two of them clutch to each other, here, in my emergency room.

At the head of the bed the ventilator chimes and puffs and clicks along as it pushes air into the boy. It pushes air into lungs that collapsed and now have chest tubes draining them. Lungs that cried out just loud enough to stop thirty thousand pounds of combine from turning the boy into chaff with the wheat.

The boy’s arm twitches. The nurse next to me blinks back tears and adjusts his IV.

A case like this is a bomb that detonates in our ER, in our town, in our lives. The shockwaves right now are spreading as neighbors call neighbors, as friends call friends, as family reaches out for family and parents run to check on their children. I know I will not be the only one unable to sleep tonight.

The father stares at his son on the gurney. His face is filled with questions for which I have no answers. How can this happen? How can something we love, something so full of life, be so fragile, so vulnerable, so easily cut down and taken from us in the blink of an eye?

He does not know it yet but he is now standing in a new life. A life that will always be different from the one he woke up to this morning.

I step over to the computer to order some more sedation for the boy while we wait for the helicopter. Taped above the screen is a brand new sign. It is a decal of five gold stars. It seems so out of place at a moment like this. The last few weeks the hospital has been putting them up everywhere. They are there to remind us to give ‘five-star’ service- to tell our patients how much we appreciate their business and hope they will choose us for their future healthcare needs.

They are to be called customers now, not patients, we are told.


I tear it off the screen and wrinkle it in my hand into a ball, squeezing it tight. I shove it in the pocket of my white coat.

Twenty-two minutes later the whine of the helicopter engine fills the air as it prepares for takeoff. I stand outside with the father, watching the big blades spin up to speed in the late August light. Inside the helicopter there is room enough for only one parent to go with the boy. One hundred and three miles away a pediatric ICU bed is waiting.

The helicopter lifts off and a cloud of late summer dust fills the air. The father does not move as the debris cloud swirls about his head. Instead, he stares at the window on the side of the helicopter, the dark outline of his son just visible to us both.

We watch the helicopter rise above the pad and rotate slowly. It climbs a little further, hesitates in the air, and then races off above the wheat fields, the grains below bowing from the thrust of its blades.

I take out the five-star decal from my pocket, unfolding it carefully. I tear it in two and press the larger half against the brick wall behind us. I scribble my home phone number on the back.

“Let me know,” I say.

The father takes the paper and nods, still staring at the shrinking outline of the helicopter. At last it disappears over the mountains in the distance. He turns to me but his eyes are empty now. He is already departing, already arriving at the next place. We shake hands and he walks slowly off to his truck. He’s got a long, quiet drive to the city ahead of him.

I look down at what’s left of the ripped up decal in my hand.

The image of the boy burns bright in my mind. I know I will carry this day with me for a very long time.

I make a fist, crumpling the decal.

I respectfully disagree with those who want us to call them customers, healthcare consumers, or business opportunities.

The people we care for are sons and daughters. Mothers and fathers. Husbands and wives. They are neighbors, friends, and sometimes even colleagues.

They are people like you and me in a moment of need.

They are patients.

©Philip Allen Green

Please Choose One

Please choose one:

The three words blink in front of me on the computer screen.

Please choose one:

 Patient is
Male Female

I click “Female.”

I watch as the auto-template feature fills in the paragraph for me based on my choices.

Patient #879302045

Patient is: thirty-eight-year-old female Status: postmotor vehicle accident. Please acknowledge you have reviewed her allergies, medications, and past medical history.

I click “Yes.”

Have you counseled her about smoking cessation?

I click “No.”

A little animated icon of a doctor pops up on the screen. His mouth begins to move as if speaking. A speech bubble from a comic strip appears next to it.

“Tip of the day: counseling for smoking cessation is important for the patient’s health and part of a complete billing record.”

The animated doctor smiles and swings his stethoscope like a pocket watch.

I click “Acknowledge.”

A new screen appears.

Please choose one:

The patient’s current emotional state is best described as:
Distraught Calm Agitated

I turn away from the computer to look at the patient. She lies curled in a ball on her side. Her bare feet stick out from the sheets and are halfway off the gurney. I notice she wears a turquoise-blue toe ring. She stares straight ahead. She plays with her patient ID band, twisting it round and round with her other hand. Makeup is smeared around small brown eyes. She stares blankly at the wall behind me. I clear my throat. She doesn’t blink. I clear it louder. Still nothing.

I look back to the computer. The same screen is still there.

Please choose one:

The patient’s current emotional state is best described as:
Distraught Calm Agitated

I turn back around.

Blond hair is matted to the right side of her face where tears have dried it to her skin. A thick strand of it hangs across her eyes, and I wonder if it annoys her. I watch as tears re-form in her eyes and run sideways across her face. A teardrop starts to grow on the side of her cheek. More tears start pooling until finally they fall from her face onto her tear-soaked pillow.

Her chest rises and falls at a rapid pace. She is breathing fast, almost panting. It is a raspy sound. I bet if she spoke right now, her voice would sound raw, the kind of scratchy raw that comes after too much screaming. But she doesn’t speak. She just lies there breathing with a thousand-yard stare fixed to her face.

The computer dings.

Please choose one:

I click “Distraught.”

The computer takes me to a new screen.

Please choose one:

Patient’s primary reason for being distraught:
Emotional Physical Other

The patient starts moaning. I look over. She makes a guttural sound—just loud enough for me to hear—that is part wail and part cry.

I click “Emotional.”

That selection triggers a new screen with new choices.

Please choose one:

What is the reason for patient’s emotional problem?
Intoxication Psychiatric Neurologic

Hmm. I look at her and try to decide which to choose. She is in a hospital gown. Her clothes were cut off with the trauma shears when she came in. She still smells like gasoline, blood, and burnt plastic smoke. It burns my nose sitting this close to her, and it makes my eyes water.

There’s dried blood mixed with car oil and dirt on her chest. There is a lot of it. It covers her shoulders and the top of her breasts like a red patchy shawl, yet she is not injured. She has been examined and x-rayed and CAT scanned from head to toe. Her body is fine.

The computer dings again impatiently, prompting me to choose one.

Please choose one:

What is the reason for patient’s emotional problem?
Intoxication Psychiatric Neurologic

I click the “Next” arrow at the bottom of the screen to try to advance the page without choosing one.

Page incomplete; you must choose one.

My mouse circles the screen hesitantly. I guess I will click…“Psychiatric.” In a way, emotions are psychiatric, I tell myself.

My choosing “Psychiatric” has opened a new screen.

The patient shifts on the bed. I look over. A glimmer on her head, reflecting the fluorescent lights above, attracts my attention. I lean in closer. There are shards of broken up windshield glass scattered throughout her hair. Some are brown from dirt—from where she lay on the ground—some are stuck to her head from blood, and some are scattered on the sheet below her. The shards twinkle on the bed like little stars.

I frown. The nurse was supposed to clean her up. I wheel backward on the doctor stool across Trauma Room Two to the door. I lean my head out through the curtain.

I look around. I spot the patient’s nurse. She is sitting on the other side of the ER, working at a computer. I know she is trying to enter data from the patient’s visit to get her charting done. “Well,” I think, “maybe someone else can help us.

I scan the ER. There are doctors and nurses everywhere down here, yet all those I see sit at computers with their eyes chained to the screens and scowls on their faces while they click and type, click and type. I bet the hospital could burn down around them, and they wouldn’t notice.

“Hey!” I yell.

No one even looks up. The clicking and typing continue.

An old man standing in the doorway of another patient room makes eye contact with me. He scowls as he surveys our ER. He shakes his head in disgust. I blush and duck back into the room behind the curtain.

The computer dings twice now, prompting me to hurry up. I remember that my patient throughput time is monitored, reported, and compared to the national average. A timer has appeared at the bottom of the screen, letting me know that I am four minutes and twenty-eight seconds behind the average ER doctor throughput time.

The numbers keep climbing. If I spend too much time on one patient, I will get a letter from administration for not meeting my throughput quota. I wheel back up to the computer.

Please choose one:

Because you chose Psychiatric, patient was offered:
Counseling Medications Inpatient Care

A sob racks my patient’s body, interrupting me again. She shifts in the bed, leaving crumbling clumps of brown dirt on white sheets. She is absolutely filthy. I wonder how long she lay in that field before someone found her. She still stares at the wall, unresponsive.

I look back at the computer. I didn’t offer her any of these things. Maybe I should lie and click counseling so that I can finish her chart.

I click “Next.”

Page incomplete; you must choose one.

Please choose one:

Because you chose Psychiatric, patient was offered:
Counseling Medications Inpatient Care

I try Alt+Tab. No luck.

Page incomplete; you must choose one.

I give up and click “Counseling.”

Another screen.

Please choose one:

Patient responded to counseling with:
Excellent Improvement Some Improvement No Improvement

I click “No Improvement.”

The little doctor figure reappears on the screen. He’s holding up his index finger, and a light bulb appears over his head as if he’s just had a fantastic idea that he can’t wait to share with me.

“Dr. Tom Tip reminds you: Did you try offering a drink of water or a tissue? Surveys show that sometimes it’s the little things that make patients feel better.”

I look over at her. I can’t bring myself to offer her water. Her knuckles are blanched white from the death grip she has on the side rail. She’s mouthing the word “no” over and over to herself and shaking her head back and forth. Her eyes are wide with terror and do not see me. The skin of her face is pulled taut with fear.

I know that look. She is seeing the moment. I know she is going to see it again and again for the rest of her life. It will come in nightmares, it will come in dreams, and it will come at the worst possible moment of what should be happy occasions. More likely than not, it will even come at the moment just before her own death, no matter how long she lives. She will never escape it. Sixty-eight minutes ago, her brain burned an image into the inside of her skull that she will never be able to unsee.

I click “Skip.”

The doctor icon disappears and is replaced by text.

Please choose one:

Did you offer the patient water?
Yes No

I click “No.”

The little figure pops up again—this time with a stern look on his face and his arms crossed.

“Surveys show patients like it when their doctors offer them water or tissues. Patient satisfaction scores go up. Try it. You might be surprised.”

He uncrosses his arms and holds out a little glass of water.

For a brief second, I imagine punching my fist through the computer screen. It would feel so good to climb the stairs to the top floor of the hospital with the computer stuck on my arm. I imagine spinning in a circle and launching it as hard as I can off the roof of the hospital toward the pavement below. I would give anything to see it smashed, destroyed, and ruined—to do to it what it has done to the profession I once loved.

But I know they would just replace it with another computer and—just as quickly—with another doctor.

I sigh and look around the room.

There is a cup on the counter.

I frown, as it is very dirty.

I pick it up and turn it over.

A child’s tiny bloody shoe falls out onto the counter.

The woman cries out, “Oh God! Oh God! Oh God!” and grabs the child’s shoe before I can pick it up.

She holds it next to her face. She’s sobbing now and starting to scream. “Oh God, oh God, oh God!” She clenches the shoe to her chest. The blood on the shoe matches the blood on her chest.

The computer dings.

“Did you give the patient a cup of water?”

I lie and click “Yes.”

“Good job!”

The computer trumpets out a happy horn sound. It’s hard to hear over the patient’s screaming. The little doctor gives me a thumbs-up and high-fives a hand that appears on the screen next to him.

“Sometimes it’s the little things that make people feel better.”

I click “Next.

The “Patient Disposition Screen” loads.

Please choose one:

Where is the patient going after the ER?

I hover the mouse on the screen for a second, trying to decide.

I click “Home.”

Please choose one:

How is the patient doing after your care for her?
Improved Not Improved Other

I look at her again.

I click “Not Improved.”


This time the whole screen flashes. The little doctor is back, hands on his hips. His face is stern, and the speech bubble appears next to his head. The letters are in red this time.

“Patients who are not improved should not be sent home. You clicked Psychiatric as her primary issue. Perhaps some medications would help the health care consumer. Would you like me to recommend some choices available on the hospital formulary?”

I ponder the question. Is there a drug for this? Something that will make her feel better? Something that doesn’t wear off, like, ever?

I click “No.”

Are you sure? The computer asks again.

I click “Yes.”

A big red flag now pops up on the screen, and the computer buzzes like a halftime buzzer in a sports game that I have just lost.

A note of this patient encounter has been sent to your hospital administrator for chart review of this patient. It is the goal of our health care facility to make patients feel better before they are discharged. You have acknowledged that you failed to do so. You will likely receive a lower patient satisfaction score for this.

Please acknowledge.

I click “No.”

It flashes again.

Please acknowledge.

I click “No.”

Please acknowledge.

I click “No.”

A box pops up.

I am sorry, valued health care provider—do you not understand the question? Would you like to fill out a service ticket?

Yes No

Please choose one.

The words blink at me on the screen.

I look over at the patient. She is on her side again, sobbing as she cradles the tiny shoe to her chest. Her eyes are squeezed shut, and she’s rocking back and forth so hard the whole gurney is shaking.

I look back at the computer.

Please choose one.

I look back at my patient.

Please choose one.

Suddenly I get it. I choose.

I reach down and unplug the computer. The screen goes black.

Without the noise of the computer fan whirring, the room is suddenly silent—save for her quiet sobs.

A strange feeling comes over me—one that, after so many years, I almost forgot existed.

I remember who I am and why I am here.

I stand up and take a deep breath. I step toward the patient and begin the long, tedious process of gently picking out the shards of bloody glass stuck throughout her hair. As I start to work, she opens her eyes and blinks.

She sees me.

The terror that fills her eyes fades just a tiny bit.

For once, the computer stays quiet.

I pick through the strands of her hair. The three words blink in my mind over and over.

Please choose one.

Please choose one.

Please choose one.

©Philip Allen Green

Follow me on Twitter.

Two Patients

Photo: Nicolas Raymond
Photo: Nicolas Raymond

Right now there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.

Both demand my time.

Both demand my concentration.

A little over two weeks ago I wrote the short story Please Choose One. I posted it online. The response it generated exceeded anything I could have ever imagined. It struck a nerve. People contacted me from all over the world, from all walks of life, about the story. Everyone, it seems, can relate to the challenge of having to choose between a person and a screen.

People sent me all kinds of suggestions and ideas. A few sent words of encouragement. Yet, what struck me the most about the people who contacted me was what they did not say. Not a single IT person argued the computer was more important than the patient. Not a single healthcare provider stated they wanted more time with the screen and less time with the patient. And finally, most importantly, not a single patient wrote me and said they wished their doctor or nurse spent more time typing and less time listening.

Medicine is the art of the subtle- the resentful glance from the mother of the newborn presenting with the suspicious bruise, the solitary bead of sweat running down the temple of the fifty three year old truck driver complaining of reflux, the slight flush on the face of the teenage girl when asked if she is having thoughts of hurting herself. These things matter. And these same things are missed when our eyes are on the screen instead of the patient.

I get it. We need to collect the data on patients. In the modern world, medicine is also a business- a business of collecting, sorting, and collating data for billing purposes. I am not naïve enough to believe or argue otherwise. But maybe right now we need to step back and ask ourselves the one question no one seems to want to ask:

Has the data we store about the patients somehow become more important than the actual flesh and blood patients themselves?

One of the most difficult things to do in the practice of medicine is to recognize when a previously established diagnosis is incorrect. It requires having an open mind that maybe, just maybe, the prior five doctors have been wrong. I wonder if we are at a similar point. Maybe we do not need another screen in the room, another page of data, another flag popping up on the screen warning us to address some incomplete part of the patient’s record. Maybe instead, we just need to spend those thirty seconds interacting with our patients.

Computers, EMRs, and patient databases are ultimately a good thing. We need them. I have no doubt that we will reach the point when they can collect all the data they need without inserting themselves between the doctor and the patient. But we are not there yet.

To the IT people out there who were offended by the story, my message to you is clear. You are the very ones who can help save us. Keep working, keep innovating, keep looking for ways to build a better, more invisible system that still does what it needs to do. After hearing from so many concerned people in the IT industry, I have nothing but faith we will find our way together. Ultimately I am reminded that we all want the same thing: to do what is best for the patient.

I am looking forward to the day when I step into a room and there are two providers. One made with flesh, bones, and blood. One made with a monitor, a mouse, and a keyboard.

Both advocates for the patient.

©Philip Allen Green

Trauma Room Two: Stories from the ER is out now on Amazon
Native Cover_5458367_Front Cover
Follow me on Twitter.