Chain of Custody: Irreversibility, Dissipation, and Traceability in the Clinical Relay

Five honest clinical crossings, no deception at any step, can still leave a patient unrecognizable to themselves. This paper asks how, and what an honest relay would require. Building on a prior analysis of the single clinical conversion, in which reflection can remain accountable to the phenomenon it transforms, this paper extends the inquiry to the multi-step relay characteristic of ordinary clinical practice: intake note, history and physical, problem list, referral, specialist impression. Drawing on Roman Ingarden's account of concretization and indeterminacy, the paper shows how legitimate local fillings-in sediment into positive findings once each concretization becomes the object of the next. Drawing on Ilya Prigogine's account of dissipative structures, it formalizes the resulting irreversibility through a hysteresis operator, showing that fidelity preserved at every local step can still fail globally across the chain. Read against Dewey's criterion that reconstruction is legitimate when it resolves the inquirer's own problematic situation, the relay is shown to displace legitimacy from patient to institution by the third link, so that reconstruction continues to satisfy Dewey's rule while no longer serving the patient whose situation began the inquiry. The paper's contribution is traceability: not restoration of the original at each step, which the clinic cannot practically deliver, but a minimal condition of provenance marking that keeps drift visible rather than silently accumulated, restoring accountability to the relay without requiring impossible fidelity to a vanishing source.