How to Say Nothing, Technically

The procedure was performed.

Five words. Passive construction. Grammatically complete. Medically sufficient. Humanly catastrophic.

The procedure was performed is, on its face, a sentence about an event. It has the basic architecture of information: something happened, here is the record of its happening. It meets the minimum requirements of documentation the way a gas station sandwich meets the minimum requirements of lunch. Technically food. Technically a sentence. Missing something essential that you won't be able to name until you're already unsatisfied.

What's missing is the subject.

Not accidentally.

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The passive voice in medical documentation is not a grammatical error. Let's establish that immediately, because the impulse to treat bureaucratic prose as a failure of craft is itself a failure of analysis. This is not bad writing. This is extremely good writing, if your definition of good is precise achievement of intended effect, which in this case is the systematic removal of anyone who might be held responsible for anything that occurred in this building between the hours of seven and three.

The procedure was performed does not tell you who performed it.

The incision was made does not tell you whose hand held the instrument.

Complications were encountered does not tell you what the complications were or who encountered them or whether the encountering was, in any preventable sense, avoidable.

The passive voice, deployed with this consistency across the entire infrastructure of medical documentation, produces a world in which things happen without anyone causing them. Events materialize. Outcomes occur. Discomfort is experienced. By whom, at whose hands, as a result of whose decisions: the sentence has already moved on. The sentence is not interested in that conversation. The sentence has a form to complete.

This is not a bug.

This is load-bearing architecture.

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Discomfort may be experienced.

Spend a moment with this one.

Discomfort is doing the work of a word that was rejected earlier in the drafting process, a word that is more accurate and less manageable, a word that would require the document to acknowledge that what is being described is pain, that pain is predictable, that the predictability of it was known to the people who designed the procedure and the people who performed it and the people who wrote the discharge instructions, and that despite all this knowing, the document has selected discomfort and placed it in the passive future tense of may be experienced and called this information.

May be experienced. As if the pain is optional. As if there is a version of your recovery in which you opt out of the may. As if the passive construction does anything other than position your pain as something that is happening in the general vicinity of you rather than something that is happening to you, specifically, as a result of things that were done to you, specifically, by people who are now documented only as the absent subject of several passive clauses.

Your pain has been grammatically orphaned.

The discharge papers sent it home without a parent.

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Here is the full post-op instruction sheet, annotated:

The patient should rest for twenty-four to forty-eight hours following the procedure.

The patient. Third person. You arrived at this building as a first person. You are leaving as a third. The patient is the person the institution can address without looking at. The patient is the grammatical distance between what happened in that room and the person it happened to. You should rest would require eye contact. The patient should rest allows the instruction to be written without anyone in particular writing it to anyone in particular, which is the goal, which is always the goal.

Pain medication may be taken as directed.

May be taken. Not take the pain medication. Not you will likely need the pain medication, here is how often, here is that it is both expected and acceptable to use it. May be taken, which positions your relief as a hypothetical, as something that requires your independent authorization rather than something the institution is actively recommending because they know, from having done this procedure several hundred times, exactly how much it is going to hurt and exactly when.

Follow-up appointment should be scheduled within two weeks.

Should be scheduled. By whom? The sentence doesn't say. The scheduling exists in the passive future, waiting for a subject that will never arrive. You will schedule it. You will schedule it while managing the discomfort that may be experienced and taking the medication that may be taken, and you will do this because you are the one person in this entire documentation chain who is allowed to exist in the first person, the one person for whom action is not passive and optional but active and necessary.

You will do it.

The discharge papers express no opinion on this.

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The origins of medical passive voice are, predictably, legal.

Liability is the mother of all institutional prose styles. Every was performed and was administered and was noted traces its lineage directly to the discovery that first-person active constructions are considerably more useful in a courtroom than their passive counterparts. I administered the medication names an actor and an action and a relationship between them that a plaintiff's attorney can work with. The medication was administered names nothing and no one and produces a paper trail that goes, forensically, nowhere.

The language was engineered to not arrive anywhere.

The language has been very successful.

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What the bureaucratic prose does to the body before you've even read it — and here the body horror of medical language becomes literal rather than metaphorical — is prepare you for a particular kind of experience that the language itself is modeling.

The experience of not being the subject.

You arrived at the hospital as the subject of your own life. You have opinions and a history and a specific and unrepeatable interior life and a name that your mother gave you because it meant something. You walked in through the sliding doors of your own volition, which is to say: actively, in the first person, as the agent of your own movement through space.

The institution received you and immediately converted you.

The patient. The case. The procedure. The presenting complaint. The admission. The discharge.

Each of these nouns does the same work as the passive verb: it removes you from the subject position of your own experience and places you in the object position of the institution's. You are not doing anything. Things are being done to you, around you, for you, in the general vicinity of you and your body, which has been checked in like luggage and will be retrieved at the other end of the process, altered, with instructions.

The instructions are in the passive voice.

The instructions assume you know what to do.

The instructions would prefer you not ask too many questions about the subject of all those passive clauses.

The subject is not present.

The subject has gone home.

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There is a sentence I have been thinking about for years, encountered on a post-op summary sheet so bland and so devastating that I have returned to it with the regularity of someone returning to the scene of a particular kind of crime:

The specimen was sent to pathology for further analysis.

The specimen.

The specimen was, twenty minutes ago, inside a body. A specific body. A body with a name on a wristband and a person inside it who has been waiting for two weeks for the results of this procedure and who is currently in recovery, coming out of anesthesia, assembling their defenses, not yet fully back in the first person.

The specimen.

The word specimen does not contain any of this.

The word specimen is doing its job, which is to convert a piece of tissue with implications into a clinical object undergoing a clinical process, to remove from the sentence every element of human weight that might make the document harder to read or write or file.

The word specimen is very good at its job.

The word specimen should not be allowed to be this good at its job.

Nobody asked me.

The forms continue to be filed.

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What would an honest medical document look like.

Not a therapeutic one. Not a feelings-forward, empathy-forward, let's-sit-with-this document that prioritizes emotional acknowledgment over clinical accuracy. An honest one. One that uses the active voice without sacrificing precision, that names the actors in the sentences that affect the patient's body, that says you will experience pain rather than discomfort may be experienced, that says Dr. Chen performed this procedure rather than the procedure was performed.

It would be harder to read.

It would be harder to write.

It would be, for approximately ten minutes after reading it, devastating in the specific way of true things that have been dressed in false things for so long that the undressing is itself a shock.

And then it would be useful.

It would be the most useful document in the folder.

It would be the document that tells you what happened to your body in the building where you were the patient, where the procedure was performed, where the specimen was sent, where you were processed and discharged and handed a sheet of paper that told you in the passive voice what the active voice of your own recovery was going to require.

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The passive voice is emotional anesthesia.

It numbs the site before the procedure.

The procedure, in this case, is the truth.

The truth is: something happened to your body. People caused it to happen. Some of it was necessary. Some of it hurt. All of it was done to you by identifiable human beings with names and credentials and the legal infrastructure of the passive voice protecting them from having to say so.

The procedure was performed.

You were there.

First person.

Present.

The subject the sentence declined to name.