Mr. M arrived in the middle of the night. Like many patients transferred from surrounding community hospitals, he came with no advance notice, little time for preparation, and a pile of “outside hospital” records. I quickly rifled through the thick stack of papers that came with his chart, looking for a coherent summary of his medical history and reason for transfer. All I could find were lab results from several days earlier, barely legible, handwritten daily progress notes, and a one-page X-ray report.

Mr. M himself was in no condition to provide a medical history. He failed to respond to my voice, and his eyes barely opened as I pressed my knuckles into his sternum. I had no idea what his latest blood tests showed, or how recently his mental state had deteriorated. But he needed to be intubated (attached to a ventilator to help him breathe) and transferred to the intensive care unit immediately. Making sense of the disorganized pile of papers would have to wait.