Patient BW, DOB 2/16/1971

[By special request]

Patient: Wayne, Bruce

DOB: 2/16/1971

Occupation: Industrialist

Insurance: Self-pay

Emergency Contact: Dick Grayson, XXX-269-9637Patient BW, DOB 2/16/1971

Interval History:  Patient was seen for his last annual physical approximately one year ago.  Since that time he has had numerous visits for acute illnesses or injuries, generally accompanied either by his companion Mr. Grayson or Alfred, a senior member of his household staff.  These recent maladies appear to be in keeping with the pattern that has emerged over the past several years, in which significant medical problems are associated with odd or incongruous explanations.  Most recently, patient was seen for numerous areas of lower extremity cutaneous blistering, erythema and thickening, consistent with moderate to severe frostbite.  Patient had reportedly gotten lost while camping in the mountains, but could not account for how he had sustained these injuries in mid-August.

Past Medical History:  As stated, patient has a somewhat lengthy and complicated medical history, best summarized by system —

Orthopedic:  By far the greatest contributor to patient’s ongoing morbidity are his multiple and seemingly ceaseless musculoskeletal injuries.  The most significant of these was sustained several years ago, when he was rushed to GCGH with several fractures of his lumbar vertebrae, reportedly after falling while rappelling.   Skeletal series obtained at that time revealed numerous (>20) areas of orthopedic injury in various states of healing, which could not be fully explained by recent fall, including areas of all extremities and many ribs; confirmatory bone scan similarly showed many areas of increased uptake.  Patient’s robust stature is not consistent with osteogenesis imperfecta, and skin biopsy was negative for abnormal collagen and P3H1 or CRTAP genetic defects.  Malignancy was suspected, but eventually ruled out following oncology consultation.  Patient explained most of these (and most subsequent) injuries as being the result of membership in a private and apparently quite intense mixed martial arts club.  Patient has denied being the victim of domestic abuse by Mr. Grayson following indirect and direct questioning on numerous occasions.

Neurologic:  Patient has been evaluated numerous times over the past several years with complaints of headache, blurry vision, memory deficits, nausea and emotional lability.  As with above injuries, most of these symptoms occur following some blow to the head during MMA sparring or competition, and were diagnosed as consistent with concussion.  (Patient reports that the club frowns upon protective headgear, a stand with which he seemingly complies despite numerous exhortations to do otherwise.)  Following the third such episode, patient was referred to neurology due to significant concern about second-impact syndrome.  While no gray matter changes in the cingulate gyrus or white matter hyperintensities were noted on magnetic resonance imaging, given history and known risk factors neurology has recommended MRI to be repeated every two years, and they are arranging for diffusion tensor imaging in the near future.

Allergic:  Earlier this year, patient was again rushed to GCGH for what appeared to be severe anaphylaxis, with marked angioedema of the face and hands, and widespread urticaria.  After administration of high-dose IV Solu-Medrol, patient’s angioedema resolved sufficiently for him to report “tripping into a bunch of weeds” while hiking, and he eventually left the emergency department against medical advice.  On outpatient follow-up, patient was referred for urgent allergy testing given the severity of his reaction.  Skin-prick testing was negative for all food allergies, but was markedly and instantly positive in reaction to all plant allergens, such that a dose of IM Decadron was administered by allergist in the office.  Despite was appears to be an extraordinary hypersensitivity to phytochemicals, patient has had no further symptoms following the one episode.

Psychiatric:  During most visits, patient displays a somewhat somber and flat affect.  Numerous inquiries into his mood yield answers that it is “just fine,” followed by requests to change the topic of questioning.  While dysthymia or frank depression is suspected (particularly considering patient’s voluntary participation in flagrantly harmful recreational activities), patient seems to have avoided any major depressive episodes.  More worrisome was an episode about a year and a half ago, during which patient appeared to have a psychotic break.  On arrival at GCGH, patient was found to be suffering from vivid, terrifying hallucinations, rendering him essentially incoherent and requiring high doses of both benzodiazepines and haloperidol to abate.  After regaining consciousness several hours later, patient stated that the “stress of [his] job” had gotten to him.  He vehemently refused evaluation by Arkham consulting psychiatrist, and eventually left the ED AMA.

Social History:  Patient denies smoking, drinking or taking any illegal controlled substances.  He resides with Mr. Grayson, reportedly without romantic involvement.  Diet consists largely of meals prepared by private household cooking staff.  He reports serially monogamous sexual relationships with female partners.  When asked, he states that he “usually has proper equipment,” which is interpreted to mean that condoms are used for contraception and STI prevention.

Family History:  Both parents deceased (homicide).  Generally assumed to be non-contributory

Physical exam:

Temp 98.7, HR 60, RR 12, BP 113/68

General – well-nourished, well-appearing adult male in NAD; alert, oriented, cooperative

Skin – confluent, symmetrical, faintly erythematous rash extending from anterior hairline onto malar region (“from the hazmat mask they make me wear when I visit the lab”); four linear, well-healed lacerations on left pectoral (“fencing accident”).  Numerous ecchymotic areas in various stages of healing

HEENT – small area of firm edema on the left occiput, c/w contusion.  PERRLA, EOMI.  TMs grossly intact bilat.  Nares patent.  Oropharynx normal.  Good dentition, with evidence of repaired trauma

Chest – CTAB

CV – RRR without murmur.  Radial, femoral pulses +2/4

Abd – soft, NTND, no HSM, + BS x 4.

Ext – well-defined (borderline hypertrophic) musculature.  Limited active ROM in shoulders, elbows, wrists, knees, ankles, consistent with healing contusion/sprain or overuse injuries in numerous joints.  Normal tone, strength UE/LE bilat.

Neuro – CN 2-12 grossly intact.  ? faint resting tremor.  FTN intact, no dysdiadokinesia.  DTR +2/4 at patella, Achilles.  Gait normal.  Refuses MMS exam (“I have an aversion to riddles.”)

Psych – well-groomed, pleasant and conversational.  A & O x3.  Affect somewhat flat (baseline, as stated above)

 Assessment/Plan — 40-year-old male with complicated past medical history as noted.  Generally normal exam, excepting the following:

Rash — Patient advised that mask seems to be causing an irritant rash, and advised him to have lab personnel fit him with another, less occlusive size.

Resting tremor — Given risk factors stated above, there is some concern about early Parkinsonism.  Will contact patient’s neurologist to have next follow-up appointment moved up.

Joint stiffness — As with previous visits, patient was advised to consider recreational activities that carry less risk of ongoing physical injury, or at very least allow himself to heal fully from previous trauma before returning to participation.  Given the apparently quite aggressive tendencies of patient’s MMA club, advised him that almost any other activity he might choose is likely to confer less risk of ongoing morbidity (or even mortality).  Patient responded to this advice with his usual polite indifference.

Looking more globally, there is some concern that there is an underlying illness that accounts for some of patient’s extensive symptomatology.  Discussed with patient that there may be some obscure syndrome that includes brittle bones, but also propensity for severe hypersensitivity, psychiatric symptoms and skin damage.  Advised him that many journals publish reports of puzzling cases, which may allow other physicians to comment helpfully about treatments or diagnoses that might be pertinent.  Patient politely but emphatically refuses consent for such publication at this time.

Advised patient to limit stress, continue with (hopefully more benign form of) physical activity, continue with healthy diet.  Flu shot administered.  Planned follow-up in one year, sooner as needed.

(Note to clerical staff — please exclude the following note if there are future record requests.  An alternate explanation, more plausible than the histories associated with many of patient’s injuries, is a series of industrial mishaps.  As head of Wayne Enterprises, patient presumably takes a very active role in the company’s various subsidiary R&D departments.  These subsidiaries include biotech, chemical and numerous other firms that traffic in hazardous materials.  One might infer that some of patient’s more extreme medical problems stem from exposure to these hazards while taking a hands-on approach to running his company.  There are a few understandable reasons that patient might wish to keep the true nature of his injuries private, despite assurances of medical confidentiality given that leaks of this information might undermine confidence in his company’s governance or alternatively might jeopardize secret government contracts.  While it is somewhat regrettable that patient does not feel comfortable revealing the true nature of these injuries and exposures, it is nevertheless understandable.)

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0 thoughts on “Patient BW, DOB 2/16/1971

  1. I’ve re-read this four times (interrupted each time), and a different line is my favorite every time.

    Currently the fav is:“I have an aversion to riddles.”


  2. Great job, but one thing that kept bugging me was the doctor’s confusion over Bruce’s relationship with Dick. Dick is technically his son. Why would it be odd that one of his 3 adopted sons or one biological son would accompany him to the hospital? Suggesting that he might be romantically involved is kinda pervy on the doctor’s part.


  3. This has been linked by numerous other locations.

    From the comments here, my favorite:

    That is a forgery based on pure speculation. The simple fact of the matter is that Mr. Wayne has enjoyed an uninterrupted and long period of excellent health – to which state of affairs several boards of directors can attest. I read (sorry, lost the link) a press release on monday in which he was forthcoming about the fact that he often seeks routine medical care for a man his age from some very private and elite physicians, including several offshore — but as he reasonably explained this is precisely because conventional domestic medical care providers are unable to protect the privacy of a man of his stature. The medical records leaked here are certainly a forgery for the simple reason that no such records can exist, for Mr. Wayne has never sought or received treatment from these people. Indeed, in this forgery, you can see that not only does the conventional system fail to protect his privacy but it will even make stuff up if he won’t cooperate.

    Next week after arrangements are finalized Mr. Wayne will release key excerpts of his authentic medical records as they are maintained by his personal physicians in Switzerland and Denmark. These will include many X-ray images that lay to rest rumors of “(> 20) orthopedic injuries.”

    These forgeries are particularly nefarious and targeted because, as far as Wayne’s organizations can determine, some of the physicians involved may have at one time believed that they actually provided service to Mr. Wayne when, in fact, they have never met. Wayne Enterprises is working with these doctors in an attempt to identify and prosecute whatever Bruce Wayne impersonator obtained treatment under a false identity.”


  4. This is already the seventh most popular post (page views) this year, according to our local stats database.

    I will bet dollars to donuts it beats out everything except possibly The Second Date Story by tomorrow morning.


  5. Fantastic stuff. See, this place just keeps getting better and better. All the traffic we’re getting from this post – think of all the ad revenue! Oh the riches…

    Actually, I’ve been at a conference the past few days and didn’t see this until io9 emailed me about it, but it’s quite brilliant and deserving of all the attention its getting. Bravo, Russell.


  6. That was fantastic. We are testing a new EHR system at my office and have to make several dummy accounts, I made one for James Bond, though not nearly as detailed or funny as this, you Sir are brilliant.


  7. I keep re-reading this article, it makes me chuckle. Bravo! Also :

    Patient has denied being the victim of domestic abuse by Mr. Grayson following indirect and direct questioning on numerous occasions.

    This was comedy gold! I keep imagining how mortified Bruce must have felt when his doctor brought that up. Haha.


  8. yes bruce wayne is the most “human” superheroes of all,he can fall asleep,he needs to eat,he doesn’t has any superpower ability…but the thing is ..he has a lot of toys !the combination of his gadget and his brain is just great !thats why he could outsmart DARKSEID …


  9. I can’t praise this enough fellas. This is absolutely fantastic. Extremely well detailed in every aspect (and funny too!). The part that Grayson might be abusing Bruce was the best part by far.


  10. BP is only reported with an odd number (113) if taken by machine, however the fact that both the heart and respiration rate are divisible by 4 suggest a manual approach. Change BP to 114/68 and it’s perfect.


  11. Just wanted to chime in, Dr. Saunders, that this was a huge hit on the medical school student forums at UCSD – not only is this awesome, but you are also teaching us how to write medical reports properly with abbreviations! Thanks!


  12. I teach in a practical nursing program and a student emailed me this link!  I loved it so much that I plan on using it with my beginning students tonight to talk about how to read an H&P!

    I’m not even a huge comic book fan, but I got it! 

    Thanks for the laugh!


  13. This now officially out-views “The Second Date Story”.  That’s not even counting the views on the subblog.

    The good doctor owes everybody a round!


        • Just thinking out loud, Batman worked because the whole “olympic-level athlete” thing was pulled back to earth by the “merely human” thing along with the positively brilliant discussions of the leftovers from the various injuries that he’d be likely to have survived (and the little easter eggs that readers found when they knew the REAL story behind injuries).

          What other superheroes would be interesting to read about for this many paragraphs? I certainly can’t think of any. Daredevil, Mr. Fantastic, Superman, Wonder Woman, Ben Grimm, The Flash, Wolverine… just trying to imagine the stories they’d give their doctor would be interesting after they came from the hands of our Dr. Saunders, but none thrill me the way that the thought of a Batman one would.

          Now, Carmen mentioned James Bond and that has possibilities… additionally, characters such as Rocky might be interesting… but the whole template of “human, all too human” belongs to Batman.


  14. brilliant, so so so perfect, thanks you so much for this. First fav line was

    “significant medical problems are associated with odd or incongruous explanations”

    then these

    “result of membership in a private and apparently quite intense mixed martial arts club.  Patient has denied being the victim of domestic abuse by Mr. Grayson following indirect and direct questioning on numerous occasions.”

    but to end w/ this

    “leaks of this information might undermine confidence in his company’s governance or alternatively might jeopardize secret government contracts.  While it is somewhat regrettable that patient does not feel comfortable revealing the true nature of these injuries and exposures, it is nevertheless understandable”

    is when you became my hero.




  15. I’m a bit late to the party, I know, but I just had to comment.

    I routinely do a lot of “faux professional reports” for various projects.  I have a lot of difficulty coming up with good references for me to base my work off of more often than not; for example, it’s pretty hard for me to find after-action reports for modern clandestine operations of the type that I occasionally write about.  Often times, I have no idea where to even begin looking.

    Now, at last, I have a point of reference for one of those frustrating moments.  Something that, while I may not be able to emulate perfectly due to a lack of education, I can now be able to say to myself “Oh, a medical history for this character would fit in perfectly here.  I know right where to go to figure out the format for that!”

    Or, in less flowery prose, thank you!  Thank you so much!  You’re going to save me so much time of staring blankly at the screen and wondering how I thought this was a good idea!  Not only does this seem very professional, but the fact that I enjoyed reading it makes it that much easier for me to get an idea as to how it works!  I owe you one!  (Can I fit another exclamation point into this paragraph?  Yes I can!)


  16. The only other hero I could think of that fits the “all too human” category would be Indiana Jones, and with the supernatural/classified/no one would believe this if I told them aspect of his adventures, it might make an interesting medical report.

    Excellent and funny read, keep up the good work!

    That’ll be $.02, please :)




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