The 7 Stages of Writing a Discharge Summary at 2 a.m.

You glance at the clock. It’s 2:01 a.m. The ward is finally quiet, save for the predictable hum of IV pumps and the occasional unholy beep from a monitor that has no business beeping. You've just returned from reviewing yet another chest X-ray that, surprise, looks exactly like the last one.

Then, the file glares at you. A patient is to be discharged in the morning. You knew this. You've known this since rounds at 10 a.m. when the consultant said the blessed words, "Ready to go home tomorrow."

But now, at 2 a.m., you're absolutely convinced that writing a discharge summary can wait until the morning shift takes over. Maybe you could… you know… delegate. You begin mentally preparing your defense: “Well, I thought they were going to stay another day…” or “I didn’t have the full notes from the surgical team…” You tell yourself it’s fine. You’ll remember everything tomorrow.

Spoiler alert: You won’t.

Stage Two: Anger (a.k.a. “Why Does This Even Exist?”)

Denial starts to erode once the unit clerk gently reminds you, "Doctor, don't forget to finish that summary before 6 a.m. — the transport is scheduled."

And there it is. Rage. That hot, caffeine-fueled, sleep-deprived, disproportionate fury. Why are discharge summaries even a thing? Why do we need to write a novel for every patient who leaves the hospital? Why does every system require a different portal, format, and password you always forget?

You question the very foundation of modern medicine. You dream of a world where AI just scans your thoughts and prints the perfect summary. (Though you suspect even AI would ask for a psych referral if it tried to process your 2 a.m. mind.)

You mutter something unrepeatable about documentation protocols and spend three minutes just staring at the EMR login screen with contempt.

Stage Three: Bargaining (a.k.a. “If I Write It Fast, Maybe I Can Sleep?”)

It’s now 2:19 a.m. You’re negotiating like you’re at a hostage crisis. You promise yourself that if you can just finish this one summary in under 20 minutes, you’ll treat yourself to a lukewarm instant coffee and maybe even close your eyes for five minutes.

You start calculating. If you skip the social history, do a vague medication list, and just say “condition improved, fit for discharge,” you could technically hit all the necessary fields.

But then the voice of your attending echoes in your head: “The discharge summary is the most important part of the record. It’s what the next doctor sees. It’s what protects you medico-legally. It’s your legacy.”

Your inner intern replies: “My legacy is not dying during night shift, thanks.”

Still, you try to find the balance. Enough detail to look professional. Not enough to cost you another half-hour of consciousness.

Stage Four: Depression (a.k.a. “I Don’t Even Know What Happened This Admission…”)

You open the patient's chart and realize… you don’t remember a single thing about them. Their face? A blur. Their initial presentation? Vaguely something abdominal. You scan through 40 progress notes, each more cryptic than the last.

One doctor wrote “?cause unclear — plan: monitor.” Another wrote, “R/o cardiac. Consider GI. Or psych.” The surgical registrar’s note is a haiku of abbreviations. The medical consult simply says “agree with plan.”

You begin to spiral.

You read the patient’s past history: hypertension, diabetes, gout, anxiety, probable alien abduction (you wouldn’t be surprised at this point). The admission diagnosis? “RUQ pain — ?biliary colic.” Discharge diagnosis? Still “?biliary colic.”

Your fingers hover over the keyboard as you weep internally.

You consider writing “unsure what happened, but patient survived — discharge.” You delete it. You write “patient improved with conservative management.” You delete that too. You finally settle on something safe and nonspecific: “Patient admitted with abdominal pain, likely hepatobiliary in nature. Symptoms resolved. No further issues.”

You feel neither joy nor pride. Only the soft, numbing emptiness of existential dread.

Stage Five: Acceptance (a.k.a. “This Is My Life Now.”)

By now it’s 2:48 a.m. The world outside is silent. You’ve stopped resisting. Your fingers type reflexively, almost spiritually. “Day 1: Presented with RUQ pain…” You’re narrating the arc of the hospital stay like a Greek tragedy.

You’ve accepted that the discharge summary is not a task. It’s a ritual. A rite of passage. A sacred contract between you and the gods of clinical documentation.

You dig deep into the chart, recovering old ECGs, forgotten scans, nursing entries hidden like buried treasure. You start to care. You begin to shape the summary not just as a list of events but as a story. A story of struggle, of healing, of hope.

You’re not writing for the next doctor anymore. You’re writing for yourself. For closure.

Stage Six: Delirium (a.k.a. “Why Did I Just Write ‘The Patient Was Discharged from Planet Earth’?”)

At 3:12 a.m., reality starts to blur.

You find typos where you definitely didn’t type them. You start calling the patient by the wrong name. You write “the patient was discharged from the emergency department via orbit” and stare at it for a full minute, wondering what that even means.

You correct it. Or do you?

You question whether you’re awake. You’re unsure if the past hour has been a dream. The monitor beeps again — or is it the sound of your soul crying out?

You reread what you wrote and find five contradictory timelines. You write, delete, write again. You write “discharged home with plan to monitor in Mars outpatient clinic” and don't even blink.

This is the peak of your creative powers. Unfortunately, it’s also the point where you’re least fit to use them.

Stage Seven: Resurrection (a.k.a. “Sweet Victory and the Click of ‘Submit’”)

It’s 3:29 a.m. Your summary is finished. It’s not perfect. But it’s detailed. Accurate. Professional. You’ve included the key labs, the response to treatment, the pending outpatient imaging (which may or may not ever happen), and even the name of the family doctor (after triple-checking the spelling).

You stare at the screen.

You click “Save.”

You click “Submit.”

And in that moment, you are reborn.

The weight lifts from your shoulders. The fluorescent lights seem softer. You get up from your chair and stretch like a champion who just won a marathon. You high-five yourself mentally. You consider taking a lap around the nurses’ station. You settle for a celebratory sip of that terrible instant coffee.

Your pager goes off. “New patient in ER, query sepsis.”

You return to your seat, take a deep breath, and whisper, “And so it begins again.”