Our first block as second year medical students has come to a close. Even though we’re done, I don’t think I’ll ever forget our first cardiology lecture taught by Dr. P. He is undoubtedly an amazing physician, mentor, and teacher. If I end up being half the doctor he is, I’ll be pretty happy. I hope the following story he told us inspires others in the field of medicine.
This is the most dramatic story of my entire life in medicine. Period. I’m in my 20’s- can you relate? I’m now in practice for the first time using this thing called a stethoscope. People are interested in it and enjoy it, watching me as I teach with it. One day, one of the heart surgeons comes up to me and says, “Dr. P, a very dear friend of mine’s mother is up the road in another hospital. They did all these tests and said that her heart is so sick and so weak- an end-stage cardiomyopathy- that there’s nothing more they could do. They told her to get her affairs in order since she only had a few more days to live. Can I transfer her to you? I’ve seen how you do things and I would just feel more comfortable”
Boy was I flattered! I was just a young kid! I just got out of training, I had been here for only six months.
I said, “It’s highly unlikely I’ll find new medical information since she had all the tests. But if you want to transfer her for emotional support then I’ll be more than happy to have her here”
She comes over, and I still remember it to this day: they wheel her in on a stretcher and she looks horrible… no muscle mass, wasted, with a belly full of fluid like with Kwashiokor…there’s swelling and her neck veins went all the way up to her earlobes like a rope with tension. I went up to her and said, “I’m Dr. P and I’m so sorry you’re not feeling well”. As I say this, I hold her hand and I’m feeling her radial pulse. Why? Well part of it is the bonding. Another reason is that if you have a very weak heart, there will be a very characteristic feel to that pulse called pulsus alternans…the problem was that I didn’t feel it. I thought maybe my fingers weren’t sensitive enough, but I’m good with hearing- I can listen- so I decided to listen with my stethoscope. She should have had a classic gallop and leaky heart valves from papillary muscle dysfunction..but I didn’t hear any of it. Something was wrong. I decided just to listen to her heart, inching my way up, and I then I heard it- one extra heart sound. It was a clue- the pearl. That extra sound with those neck veins, maybe she doesn’t have a weak heart. After all, I don’t see and hear what I’m supposed to. Maybe she has something else. Maybe the extra sound is a result of her pericardium constricting her heart like a straight jacket. Maybe the extra sound I heard is a pericardial knock and the neck veins are swollen because of that. Otherwise, I’d hear the gallop, the MR, and feel the pulsus alternans. I wasn’t sure, but I thought, “With pericarditis, wouldn’t you see calcium in the pericardium?” So I grab her xrays on the stretcher, looking for calcium and….it’s not there. I look it up: 30% get it and 70% don’t. I had nothing else to go on. I say to the surgeon, “I can’t promise this, but if she has pericarditis and we take her to surgery and remove her pericardium- we can help her”.
“But how is she going to survive this operation?”
“I’m not pushing you, but if we don’t, she’s not going to live more than a day or two”, I replied.
We both went to talk to the family and they decided to go with the surgery.
It was a fourteen hour surgery. Fourteen. The surgeon carefully scraped away the pericardium that was firmly matted to her heart.
When everything was removed, everything got better. She walks out of the hospital normal. Completely normal.
Two years later she comes back for a totally different reason…and they give her a diagnosis of a uncommon disease. I looked it up and back then, there was only a paragraph on it with nothing about the heart. We didn’t know any better. I went to the pathologist and asked if they saved the tissue sample. He says yes. I ask him to put the same stain on it and he says he’ll call me back in the afternoon. It’s positive. So this woman had this disease all along, a rare condition, causing the constrictive pericarditis.
I would tell this story in closing for 25 years to any class that would listen to me. I did this to try and show you the joy and exhilaration of making a diagnosis and saving a life when the so-called cutting edge technology of the time couldn’t even cut it.
After telling this story for 25 years, all of a sudden I get a letter on my desk.
Dear Dr. P,
It’s been 25 years since you’ve heard from me. In fact it will be 25 years this November. I’ve had three lovely daughters grown into three lovely women. I have four beautiful grandchildren. You were just a young boy starting your career, but with determination, perseverance, compassion, and care, you and your colleagues diagnosed my problem and saved my life. Yes, I am the lady with constrictive pericarditis. Thank you for my life.
I cried. I called her on the phone and asked her where she’s been all these years.
She said, “I’ve been just fine, and I haven’t had to see another doctor all this time”
I close with her story and I hope and pray that this inspires you to pick up a stethoscope one day, practice your clinical skills, and re-discover the lost art. It will bring such tremendous satisfaction to you and, not only that, it will bring you closer to the patient; the reason you came into medicine in the first place. Create that personal bond that engenders the trust and confidence that is so important to that privileged and sacred doctor-patient relationship, for as it is said, no one cares how much you know, until they know how much you care.
As we continue to move into the 21st century, a time where the American healthcare system is undergoing incredible change, there is one thing that has stayed the same throughout the passage of time. And that’s the importance of the doctor-patient relationship. To me, being a doctor takes knowledge and skill for sure, but it requires so much more than that. It takes honesty, integrity, a selfless concern for humanity, a deep concern and sensitivity for the suffering of others, with a touch of a good and strong dose of optimism, humor, and wit. I have always felt, and I feel more strongly about it today than ever before- that it is as important to heal the mind as it is to heal the body. For when the body is ailing, the mind is ailing as well, and it needs comfort and attention too.
I leave you with the credo of the caring practitioner: Cure if you can. Alleviate if you can not. But always comfort and support. And never, ever, take away hope.