on compassion

22Jul09

This morning, as we were sitting around on rounds, the cardiologist attending grabbed us all and took us into this room to listen to a woman’s aortic stenosis murmur. It was amazing. I have never been so excited about hearing a heart murmur before in my life, but it’s the first real one on a real patient I’ve heard. Despite writing the auscultation rap, I’ve never been awesome at auscultation, but the excitement of the attending at teaching us was contagious. Her aortic valve was so stenotic you couldn’t hear the aortic component of S2 over her aortic valve area, but you could baaaarely hear the pulmonic component over her pulmonic valve, and he wanted to prove this to us. The woman was old, grumpy, and not entirely happy to see the four of us, but the attending joked with her that we were his groupies and followed him everywhere, at which she laughed and slapped at him playfully. I hesitated, because she was still grumping at the residents, but the attending looked at me and asked me if I wanted to hear and I of course said “Yes!” and he teased, “Don’t worry, I cleaned my ears out.” since we were all just using his stethoscope. And I heard it, after concentrating past her breathing, which was hard, because the murmur sounds a lot like breathing. But I heard it, fwoot fwoot fwoot fwoot, and then I ended up being the first to hear over the pulmonic valve, barely, fwoot dub fwoot dub fwoot dub fwoot dub and at that point I think my face broke out into this crazy grin as I looked at the attending and said, “I heard it!” I must have looked like an idiot at this point, but I didn’t care. I have the feeling that if I could learn cardiology from that attending, I would be amazing at it.

I grabbed lunch after we were done, called my mom and talked to her for a bit, which was lovely, and then took a nap until 2pm, whereupon I went down to the derm clinic that was going on in the family medicine offices today. It was really good; I got to see and feel and watch and assist a little in a lipoma removal, saw the hyphae of fungus, got a long lecture on the different kinds of tinea (I never really knew that ringworm wasn’t ringworm before, oops?) and if anything, I learned several things — never be lazy and prescribe a combination steroid/antifungal, always take the time to do a scraping for a KOH prep, and never ever ever use steroid creams to treat fungal infections, especially in the groin area. I also got to see, feel, watch, and assist (ever so slightly, just getting/holding stuff) with a lipoma removal! It had been on her forehead for the past 10 years.

It wasn’t very notable except for what I hope I will never forget about being a physician — how important the small things are. She was nervous and is afraid of pain, and I definitely empathized with her. They laid her down and got her ready for the lidocaine and I noticed her fingers laced together so very tightly, so I offered her my hand and told her, “Squeeze as hard as you can.” She did, squeezing her eyes shut as well as she was anesthetized, and when it was all over, she whispered to me, “Thank you.” I could hear the raw gratitude in her voice, and in that moment, I was incredibly grateful I had summoned the courage to ask if I could go with the resident and watch. I’m not going to pretend that what I did was medically significant, but I know that I touched her. And that, at the end of the day, is what I believe medicine is all about.

If you actually are a doctor and admitted it, you’d say, “I don’t cure a huge percentage, I don’t have a 50 percent cure rate… but I can have a 100 percent compassion rate.”

- Hunter Patch Adams

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