Montreal, Quebec, Canada
|Image from page 409 of “A practical treatise
on medical diagnosis for students and physicians” (1904)
There were only a few bodies that I had touched fully before entering medical school: my mother’s as a baby drawn to a life; my twin’s as a faulty mirror; my lovers’ who have known that fingers loiter like summer horizons whispering into the night.
But now as a student, I touch the strange yet similar skin of people who have had a lifetime before me, who may not have one after. I listen to their heart’s mumbling muteness, analyzing the notes of its music.
My first cardiovascular patient played one of these songs in a tune that was old, covered over in full-flowered clothing – on her sleeves, on her scarf, on the bobby pin of her hair – and she was going to die.
She knew the drill, she said to the doctor. In the office no bigger than a generous closet, she took off the yellow dress sewn with pink lilacs and purple tulips. The physician told me the case history on the other side of the closed curtains. This is the most important bit, he stressed. History.
Emergency admission four weeks ago, generalized patient presentation, common case, renal function normal. But the blood pressure is low, so we’ll want to work on that. Then there is the pitting edema. What else is a product of congestive heart failure? Do we think the patient has right decompensation? Wrong. The patient has left. And this causes? And the patient will suffer what? And what is the worst prognosis of this condition? Good. Good. Excellent.
Silence soon swallowed the office. The woman laid nearly naked in front of us, two males with their hands in their pockets. Her clothes lay on the empty chair, the floor.
The physician asked how she was feeling. She said okay. Some days are better than others. He said how was today. She said okay. He said good, good, excellent.
We carried on, equipped with professionalism and raw routine. Her hair was sparse and delicate, her skin as gray as fog. I touched her clavicle, walked my fingers to her shoulder. I looked at her distended jugular, made a rough approximation of her venous pressure. I placed my stumbling palms on her chest, where I thought her heart would be. Higher, the doctor said. The woman’s head fell slightly, slowly.
The blind regime of sentences dominated next. I blabbed aloud: Blood pressure fine. Legs swollen. No cyanosis. No xanthelasma. No conjunctival pallor. Good, good, excellent.
But could this language really be mine? Me – the child of poetry, the arts grad who wrote about the slippery danger of the mechanization of medicine. What was I saying? Whose words were dangling in my mouth?
Alongside the apex, why did I not instead ask of the happiest moment of her life, sneakily poking into memory like a teenager after dark? Among the pulse pressure, should I not wonder about mild evenings that cooed boredom and the shifting acceptance of loneliness? Were there not others who did this better, softer, who felt what I felt and what I could not? What was I doing here? What was this thing I was in?
Do not forget to listen to the heart, the doctor said.
My hands held onto the stethoscope around my neck. I moved the metal to her chest, to the space where my fingers had left a small, disappearing imprint. Muffled, I heard the doctor apologize for taking so long, mention that it was my first time with this kind of thing, and suggest to me that I should move yet higher again to the aortic valve for it would be the loudest, the clearest.
Grade four harsh systolic ejection murmur near the ICS radiating outwards to the carotids with no change in inhalation.
Thank you. Now you’ll have to be quicker for the next patient.
Yes, I will be. Sorry.
The patient sat still, waiting for instructions on what to do with her body, her life. The doctor told her. Medications, surgery unlikely, come back again when your legs are less swollen. Here, she asked. Here, he reaffirmed.
Weeks later when I came back to the clinic, she was not there. I asked how she was doing. The physician said she had passed. I tried to ask how, but another patient was coming in.
They’re early, the doctor said to no one at all.