My ninety-three year old patient and friend Arsène Voisine died last week. I have written about him before in a post titled “Attitude!”, and in the four years since then, his spirit never faltered. Funny and inquisitive as ever, he lost only a small fraction of his razor-sharp wit and analytical power as time passed. He did stop driving to the big city dance hall on Saturday nights, but we still talked ballroom dance favorites every time I saw him.
His heart condition worsened and he had a small stroke a year ago. In spite of my efforts to reduce his risk, he had another stroke last week and died a few days later surrounded by his family.
Friday afternoon, our office fax machine printed up his discharge summary. It made me think about how awkward this term is. My hospitalist friend, Dr. Harris, didn’t discharge Arsène Voisine. He was just witness to the end of a ninety-three year old life, a life lived well, filled with joie de vivre until in one instant his brain could no longer make jokes, remember cha-cha steps or question the doctors’ treatment strategy.
Arsène left us with only our vivid memories of his joy and vitality. He left into the arms of the God he sometimes spoke about, but Dr. Harris didn’t discharge him. The summary of what happened during his two and a half day hospitalization is better described by the word we used for discharge summaries in Sweden – “epikris”. This word is derived from the Ancient Greek word for “determination” or “judgement”. The 1881 edition of Sweden’s largest encyclopedia defines the word as “a scientific account of an illness, pertaining to its cause, course and outcome”.
The corresponding English word for “epikris”, “epicrisis”, is almost never used for discharge summaries in the U.S. and I don’t believe it was ever commonly used. But perhaps we should use it when we don’t discharge patients ourselves, but they leave in spite of our efforts, on their own or God’s accord.
A Country Doctor Writes: 
I love getting your posts. I’m a psychiatrist in Northeastern Connecticut, where life is quite poor and bleak. Often my patients seem to relate to me as if I’m their Primary Care Doctor; they often don’t have access to many specialists. They show me rashes, talk about aching back discs and cancer; and they die.
Your post today reminds me of the fact that I am supposed to write an “incident report” to be submitted to the State Department of Mental Health because an old man died of emphysema. He was coming home from another state where he had visited family. He had COPD ever since I met him 8 years ago. His death was due to the fact that he couldn’t breathe.
Yet his daughter was given instructions, I don’t know by whom, to contact all of his doctors and this is the mental health reaction to learning of his death. I think it’s very strange.
He lived, he died. We all do that. He was a good person. He had been on an extremely small dose of the same psychiatric medication for about 15 years, without changes. The striking thing about his appearance at every visit, was his shortness of breath and his deafness.
So I relate to the hospitalist, and I relate to you.