Auscultation

Daly Walker, MD
Boca Grande, Florida, United States

Hearts

Arterial Nests, 2009 (detail)

Michelle Frick, New York
Cast silicone, intravenous line, ceramic,

30 x 18” silkscreen lightbox, sound

In the hospital’s x-ray department, Dad and I entered a small room with a wall of lighted boxes. A man with dyed reddish hair sat, sipping at a mug of coffee and reading a magazine called The American Spectator.
“Harry,” Dad said. “Meet my son, Bud. Bud, this is Dr. Stevens.”
I gave him my big, firm, phony handshake and called him “sir.”
“What grade you in?” he asked.
“A junior.”
“Bud’s first in his class,” Dad said.
“Good for you, Bud.” He stuck an x-ray film up on one of the view-boxes. The images belonged to a murderer on death row. I had glimpsed the man while shadowing my father on his morning rounds. “Sir Charles Woodhouse, that fine, upstanding denizen of the world. That splendid piece of humanity,” Dr. Stevens muttered.
“This is his heart, Bud,” Dad said, pointing with his pen at boot-like shape in the middle of the chest. “It’s enlarged. That’s what happens to the heart when it fails.” He moved his pen. “These are his lungs. What you see is pneumonia. Four-plus, bilateral pneumonia and pulmonary edema.”
“A white out,” Dr. Stevens said. He smiled a broad, ominous smile. “This guy’s in deep doodoo.”
“It’s Staph,” Dad went on. “His organisms are resistant to all the big-gun antibiotics.”
Dr. Steven’s swiveled in his chair and looked up at him. “So what you going to do with him?”
“I don’t know,” Dad said. “He needs to be on the ventilator and have his heart failure treated.”
“ A ventilator,” Dr. Stevens said. “How about a little skillful neglect. Let nature takes its course. You could save us tax payers some dough.”
“Maybe death would be too easy for him,” Dad said.
It hadn’t occurred to me that keeping him alive would be punishment. I was becoming more confused about what should be done.
“Jesus Christ, Ed, he’s a killer waiting to die. Give the world a break. Let the bastard go.”
“We’ll see,” Dad said. “Thanks for the advice.”

In the tiled corridor outside of the x-ray department, there were beads of sweat on Dad’s forehead. He squirted his nostrils with the nasal spray he used when he was nervous about something. I could see it wasn’t easy to hold death in your hands, even a killer’s.
“ Did you notice Woodhouse’s face?” Dad said.
“It was kind of flat,” I said. “He didn’t look too smart. Why?”
“You’re right. His face is flat. That little upturned nose. The thinness of his upper lip. The funny folds around his eyes. We call them dysmorphic features. They’re typical of fetal alcohol syndrome.”
“Fetal what?”
“His mother was a drunk. Her drinking damaged him when he was inside her womb. I’m sure he was abused, too.”
“Is that why he’s so bad?” I said.
“It helps explain it,” Dad said, “but it doesn’t excuse what he’s done.”
“Do you feel sorry for him?”
“No. I can’t stand him, but as his doctor, I have to ignore my personal feelings.”
“So what are you going to do with him?”
Dad hesitated.
“I haven’t decided,” he said. “I need to talk to the patient.”

The sounds of the ICU reminded me of a woods on a summer night—the electric cicada-hum of the fluorescent lights, the cricket-chirp of a heart monitor. I stood by the bed, listening to the hungry rattle of Woodhouse’s breathing. The little man seemed so alone now. I wondered if he would still be alone after he died. The possibility created a strange emptiness inside of me.
Into his ears, Dad plugged the stethoscope that he wore like a necklace and quickly listened to Woodhouse’s lungs. When he finished, he held the instrument up for me to see.
“A Frenchman named Laennec invented this,” he said. “It’s a simple device, but it revolutionized the way patients were examined. Listening with it is called auscultation. If you know what to listen for and pay attention you can learn a lot about what’s going on inside a patient.” He handed the stethoscope to me. “Here, Bud. Take a listen with it. Auscultate his chest.”
“Who me?” I asked, amazed.
“Yeah, you. Put the bell here and listen carefully.”
He pointed above the left nipple on Woodhouse’s hairless chest where the word “SOUR” was tattooed. With my hands shaking, I placed the listening bell where Dad had indicated. The prisoner’s skin was cool and sticky like clay. I could hear the two-note thud of his heart and the labored gurgle of his breath. Woodhouse stared up at me. There was a glaze of fear in his pale eyes like there must have been in the eyes of the woman he killed. I closed my eyes and listened. When I was finished, I handed Dad the stethoscope.
“What did you hear?” he asked.
“A bubbling, kind of wet sound.”
“That’s good, Bud. You’re hearing the music of disease. We call it rales. You get it with pneumonia and heart failure. Did you hear his heart going “lub dub, lub dub”?”
“Yeah, I think so,” I said.
“That’s the sound of the valves in the heart closing. His heart has an extra sound because it’s failing. We call it a gallop rhythm.”
I nodded although I hadn’t heard a third sound.
Suddenly Woodhouse was seized by a fit of coughing and choking. His odd, flat face contorted and turned purple. His eyes rolled up, and I thought he was going to die. But he stopped coughing and lay gulping for air. I noticed that his blue lips were dry and cracked. I felt something nudge me like a hand between my shoulder blades. I picked up a glass of water from the bedside stand. I turned and looked at Dad who was writing in the chart.
“Can he have a drink?” I asked.
“That’s fine. Just a sip.”
“Would you like some water?” I asked Woodhouse.
He nodded his head. I held the glass as he sucked on a straw. He choked and a trickle ran out the corner of his mouth. For an instant, he looked at me, and an understanding seemed to pass between us.
Dad stepped up to the bedside, and I retreated to a place by the window. Through the glass panes, I watched smoky clouds drift by and mute the sun. On puddles in the parking lot, bronze platters of light trembled. The picketers were gone, but a “LET THE KILLER DIE” sign remained propped up against a tree.
For a few seconds, Dad stood, studying his patient and stroking his mustache as if waiting for the right answer to rise up and announce itself. Woodhouse was sucking air through pursed lips, tensing his neck muscles to help him breath. It seemed to take all of his strength. I knew he couldn’t keep it up much longer.
Finally, Dad said, “Charles, your heart and lungs aren’t able to do their job. I need to put a tube in your throat so a machine can breathe for you.” He paused a second. “Is that what you want?”
The room was quiet except for the ragged rasp of Woodhouse’s breath. Finally, he slowly turned his face toward Dad. His lips quivered as he fought for the strength to speak.
“The machine,” he gasped. “Get it.”
Dad closed his eyes, and for an instant, I thought I saw his shoulders sag.
“Okay, then,” he said. “We’ll get it.”
With his knuckles, Dad rapped on the window of the cubical and motioned to Irene, the ICU nurse. She nodded and began to roll a ventilator with corrugated tubing and a glass canister of billows into the room. While Dad popped on a pair of rubber gloves, Irene injected a syringe of medicine into Woodhouse’s IV line. The prisoner’s eyelids fluttered closed and his limbs went limp. Quickly, Dad pried open his mouth with a lighted, silver blade. As he suctioned Woodhouse’s throat with a rubber tube, I peered over his shoulder, and he showed me the uvula, a little stalactite of flesh and the vocal cords, a hollow, pink V. Through the opening I could see the rings of a dark tunnel to the lungs that Dad said was the trachea. I wondered how oxygen got from there into the blood. I wondered if there was something in the world that this man loved that made him want to go on living. Or was it only the fear of death?
Dad slid a plastic breathing tube through the vocal cords into the trachea. Woodhouse coughed and shot a foul breath into my face. After Dad switched the respirator on, he pointed to its billows which was squeezing air into the killer’s lungs.
“Hydraulics,” he said. “Do you know Pascal’s Law?”
“Yeah. We studied it in physics.”
“So what is Pascal’s Law?”
I thought for a moment, then I said, “A change in pressure on a confined fluid causes a change in pressure equally through out the fluid.”
“You got it right,” Dad said. “The force is the same in every direction.” He reached up and adjusted a dial on the respirator that regulated the flow of oxygen to Woodhouse’s lungs. “You know, Pascal was a philosopher as well as a scientist. He wrote that life is a prison in which we are executed. He said we are all living under a death sentence.”
I stood, watching the rise and fall of the sick man’s chest synchronized with the puff of the billows. I tried to understand how Pascal’s philosophy applied to keeping Charlie Woodhouse alive. Did it mean, that in spite of his crime, he deserved the same as anyone else? Were we all guilty? Who was to judge?
The color of Woodhouse’s skin slowly turned from dusky blue to pink. He lay quietly with his eyes closed. I wondered if he was reliving the darkness of his past or dreaming of whatever awaited him.
Dad bent over and placed his stethoscope on Woodhouse’s chest. The movements of his hand with the bell were slow and deliberate, priestly. I stood, listening to the sigh and wheeze of the ventilator. I was aware of my own breathing. A pressure inside me seemed strong and equal in every direction. I could feel myself enlarge, feel the naked beat of my own heart.

 


DALY WALKER, MD practiced general surgery in Columbus, Indiana for many years prior to his current retirement. Originally graduating from the Indiana School of Medicine, he completed his surgery residency at the University of Wisconsin. He now is a fellow in the American College of Surgeons. In addition to his medical pursuits, he has studied creative writing at Indiana University. His stories and essays have appeared in The Atlantic Monthly, The Sewanee Review, The Louisville Review, The Sycamore Review, and The Southampton Review; and his fiction has been anthologized in several literary publications. His work has been short listed for Best American Short Stories and an O’Henry Award and was a finalist for The Best American Magazine Writing. His collection of short stories, Surgeon Stories, was recently published by Fleur de Lis Press.

About the artist

MICHELLE FRICK was born in New York City. She received a BFA from Pratt Institute and studied at the School of Visual Arts. She is a 2008 recipient of the Artist in the Marketplace fellowship, and she received a BRIO grant in 2008. In 2012, she was selected to participate in the Governor’s Island Art Fair in New York City. Her work has been written about in The New Yorker, The New York Times, and Time Out New York. Michelle lives in the Bronx, NY and works in Yonkers, NY.  Visit her website at http://www.michellefrick.org

Artist’s statement: Silkscreened imagery of the heart often plays a conspicuous role in my installation work. These images, taken from 19th-century anatomical lithographs and modern cardiology textbooks, are one visual element that contributes to the narrative of the piece. Other elements of the installation that expand the story are drawn from the hospital experience and nature. Medical carts, hospital gurneys, IV stands, and the like are populated with birds and nests which are made from nurses’ supplies, such as surgical tape, intravenous line, and electrodes. My work implies a series of contradictions. These include the natural resilience of the human body and the advanced medical technology we have come to rely on, nature and the synthetic world that sustains us, as well as waste and environmental awareness.