Five students gathered with their tutor around the patient. This one had a heart murmur, a rare one. The five students all had excited looks on their faces, waiting to detect this rarity. The tutor approached the patient.
“Could we all have a little listen to your heart? It won’t take long.”
The patient nodded. This had been the 4th group that day but he acquiesced. First the tutor placed his stethoscope on the chest of the patient.
Listened at the four valve sites. Asked the patient to inhale and exhale appropriately before ending off by listening to the carotids. Then gestured for the students to listen.
The first student stepped up, introduced herself, and proceeded to listen. Her eyes squinted as she knew she heard something. She listened more carefully, and for ten seconds there was dead silence as she closed her eyes and pictured the murmur, the valve.
Asked the patient to exhale, and hold it there. Another five seconds. To check and double check. She was satisfied. And then the next student approached.
“Hi, I’m Jess. Just gonna have a quick listen yea.”
Another nod. The patient closed his eyes. He almost knew the routine. The student listened. Her face twitched as she heard the murmur. Now to seal the diagnosis. She was quicker than the first. After the inhaling and exhaling it was all over.
The third student did the same, then the fourth.
And finally the fifth student approached.
“Last one here. Just another quick listen alright?”
It was almost a rhetorical question. One that needed no answering, yet the man nodded. A much slower and weaker nod.
The student, having watched the actions of his peers, could have well already known the diagnosis. A murmur heard best with the bell of the stethoscope in expiration at the mitral area could only be one thing.
He was the fastest. Placed his stethoscope on the chest right at where he thought he would hear it best and listened. He had no sign on his face that he’d heard something. But he performed the manoeuvers, and it was clear he had heard it. And he was done.
“All over Mr Jones. Thank you very much for this.”
He pulled down the patient’s shirt and covered his chest. The cardiology lesson was done. The murmur was heard, now to go away from the patient and discuss its causes, etiology, etc.
But the life lesson wasn’t learnt yet. Here was a patient, a sick person, warded for mitral stenosis due to his past history of rheumatic fever. His mitral valve cusps had become so tight they had resulted in him having heart failure. And so he needed surgery. Surgery to keep him alive, for him to see his children grow up. Surgery to let him see another day.
The students didn’t know this, they didn’t know the fear in the patient; fear of the surgery, fear of whether he would see another day. All the students knew was that this was a rare murmur, and they wanted to hear it. Sharpen their skills, they thought.
But here was a man, a living story in which the murmur was only a tiny component. Alas, the story would never be known, unless a soul were to sit by his bed and hear him out. Actually listen, not just take a succinct medical history. This was a man, who smiled at the students’ request, who nodded every time they asked. This was a man whose smile and nod hid a lifetime of worry and anxiety.
Worry and anxiety that needed listening to, not the heart murmur. The cardiology lesson would be remembered; the life lesson wouldn’t.