Every Patient Tells a Story by Lisa Sanders

Author:Lisa Sanders [Sanders, Lisa]
Language: eng
Format: epub
ISBN: 978-0-7679-3141-0
Publisher: Crown Publishing Group
Published: 2009-12-02T16:00:00+00:00

CHAPTER SEVEN

The Heart of the Matter

I leaned forward in my seat and pressed the cheap plastic earpieces of the stethoscope deeper into my ears. I could hear the normal double knock of the heart at work, but there was another sound there too—one I didn’t recognize. It was a quiet scratchy noise—regular, rhythmic, driving—like a percussionist thrumming out a rhythm on a washboard.

At the business end of the stethoscope I wore about my neck, the end that I would normally place on the patient’s chest, the silver-dollar-sized disc was missing. In its place was a small black box made of cheap plastic, about the size of a pack of cigarettes. It was a lightweight radio receiver and the sounds I heard through the earpieces were being broadcast to me.

What is that noise? I should know this.

I sat among a dozen or so other doctors listening intently, trying to identify the cause of these abnormal sounds. All of us, medical school graduates, several years of specialty training and practice under our belts, were here at a class taught at the American College of Physicians conference, to relearn one of the fundamentals of the physical—the examination of the heart. I glanced at the woman next to me; her casually curly gray hair framed a brow wrinkled with concentration. She caught my look and smiled sheepishly. Clearly she too was stumped. A younger guy with oversized glasses stared intently at the floor.

“Who can tell me anything about what we’re hearing?” asked Dr. Vivian Obeso, the course leader. She scanned the faces of the dozen or so doctors who sat before her, on the other side of a life-sized mannequin of a young man. His chest was exposed, a sheet covered the rest of him, and his plastic legs were amputated mid-thigh. The missing end of our stethoscopes rested on the upper left side of the mannequin’s chest, a couple of inches below the clavicle, demonstrating where the sound we heard would be coming from, had this plastic dummy been a living patient. The tiny class sat silent. Despite the age and years of experience of most of the doctors, there was an awkward pause as we hesitated to answer—it was a moment straight out of sixth grade. I knew from my own years of teaching medical residents that it’s often hard to tell what that silence means. Is the question too hard? Or too easy? Both provoke the same uneasy hush. I still hadn’t recognized the heart sound and suspected that was true of the others as well.

“All right. Don’t tell me what you think it is—we’ll get to that. Just describe the sound.” Obeso tried again. “First, when does it occur? Is it systolic or diastolic?”

A normal heartbeat has two sounds separated by a very short period of what is usually silence—these two beats and the pause between them is known as systole (from the Greek word systole, which means contraction, so named by William Harvey when he first described the circular motion of the blood through the body in the seventeenth century).

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