The Anatomy of a Bureaucratic Impaction (A True Story)

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Abstract
Even in this high-tech age of Atari and extraterrestrials, the unyielding torpidity of bureaucracy can still bring harried physicians to their knees in defeat. I have recently encountered a notable example of such a bureaucratic victory. Like the mythical subway captive "Charlie on the MTA"1 incarnated in the renowned lyrics of the Kingston Trio, my patient, Mr P, remains incarcerated on a medical ward, the hostage of a colossal bureaucratic impaction. Last week, nurses, social workers, residents, and attending physicians gathered round to commemorate his 74th birthday and 480th hospital day. Lamentably, for the past 420 days his medical condition has not warranted hospitalization. "Why can't he be discharged?" the succession of incredulous interns inquire. It's a long story that goes something like this: In the summer of 1981, Mr P was casually dropped off in front of our emergency room by his son, who promptly vanished. Having edema and

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