Thursday, May 8, 2008

Seduced by a Stethoscope

It was the first week of medical school and Littman, the world-famous medical equipment maker was on campus giving brand new stethoscopes to every entering student. The free “little gray Littman” was unadorned – the disc to place on the chest, the tube to carry the sound, the hollow ear buds. Littman also brought the sparkling models with them, all making the little gray Littman look okay, but not very sexy, like a homely dress in a room full of evening gowns. The sultry knockout of all stethoscopes was the Littman 501. She could be seen draped around the necks of all great cardiologists -- in their clinics, hospitals, and family photos.

Ahh, the Littman 501. Her sound capturing device was like a warm hand that would lie gently on any chest. Her double tube body with dedicated conveyance to separate ear canals ignored all voices but the one she was intent upon. Her soft ergonometric buds were like lips that would whisper sweet lub-dubs into your ears. She was dressed in elegant black with silver accessories. Walk with her through the wards, and hearts throb, beats skip, murmurs rise for you and your 501. Your unbuttoned white coat flutters, leaving those with lesser stethoscopes gazing admiringly, with a twinge of envy, then hurrying to keep pace. Stay with her long enough and she would curl up into a perfect halo, illuminating your way.

I held the little gray Littman in my hand, and saw the 501 gaze seductively at me from across the room, promising love, happiness and the ability to hear a paradoxically-split S2.

“What do you think?” I asked the cardiology attending who was there to browse. His Kentucky drawl thickened the air before his lips, the words slowly making their way through it. His statement stayed with me throughout my career. “It ain’t what’s in your ears that counts; it’s what’s between them.”

I love the high-tech tools of my trade – my slit lamp, the ocular coherence tomographer, my phaco machine, the laser -- but the most valuable tool I possess is me: my brain, followed closely by my eyes and my hands, all held together by my soul which helps me work compassionately.

The doctor-as-tool may seem obvious, but it isn’t. We often give better care to our equipment than to our selves, thus growing dull, sometimes even broken, from lack of maintenance. People come to see us, because of who we are. They’re happy when we have the best equipment, but they know that without the talent to use the technology, and the soul to stay off grumpiness, the doctor isn’t much use.

Last week the new patient looked stunned when I said that the treatment for her lingering red eye would be, well, brain surgery -- that without it, she would die. She had walked in, expecting more drops. But my eyes had seen the tortuosity of her conjunctival blood vessels. My brain had noticed them and drawn a conclusion. My hands opened the drawer, dusted off the stethoscope, and placed it, oddly enough, on her skull. I heard the faint swoosh swoosh swoosh – a leak from a vessel in her brain, squirting blood with every heartbeat. The leak was raising the pressure inside the cavernous sinus, slowing drainage of blood from her left eye. This was causing her chronic “conjunctivitis” which no drops seemed to cure. I put my little gray Littman back into the drawer, and smiled, knowing that technology can be seductive, but it’s not what matters most.


QuietusLeo said...

Ah, the lowly stethoscope. The queen of all medical equipment. No physician (whatever the specialty) is complete without one. It convey's the rhythm of the heart and the flow of air in the lungs to the receptive mind of the clinician. And in a pinch can be used to ellicit tendon reflexes.

Dragonfly said...

In my experience the best chest physicians use any cheap old toy they can find.....unless of course they are a VIP on important committees who regularly hold press conferences, in which case they tend to have those $3000 electronic thingies (but could still use the Barbie version). I am lucky I have a good quality one that I won in a raffle back in 1st year...

Jeff said...

This was a very strong piece. I sat reading it while on a coffee date with my baby daughter and it had quite the impact. You in the medical field have an awesome knowledge and an awesome responsibility.

Jeffrey said...

what? they gave out free stethoscopes? lucky you!

i totally agree with the "what's between is what's matters!". i got friends spending their fortune on cardio IIIs when i just got a cheap littman classic II.

well they tell me they can hear murmurs better.

QuietusLeo said...

I always tell students that the stethoscope works under two conditions:
1. The earpieces are connected to the ears.
2. The ears are connected by one neuron.

Marianas Eye said...

Thanks, all, for your comments.

Jeff said something about the awesome responsibility of doctors. It's a dramatic responsibility, but in truth, I think that the highest responsibility of civilization belongs to teachers. They create the future. Hopefully, someday, the world will reflect this truth by paying them what they deserve, which should be more than a doctor's pay.