Like the "new-world" monkeys, unable to get rid of their prehensile tails, I still hang on to my stethoscope. Not just as a tool to augment my ID card for faster access through hospital security, or as a color-coordinated style statement complementing my blue iPhone to enhance my ego. Not even as a diagnostic tool.
Today, the stethoscope won't stand beyond two rounds in the "fist-fight" of diagnostic cardiology against heavyweight echocardiograms. Echo machines have quietly sneaked out of echo labs, transforming into ninja turtles moving into the ICU, initially as bedside point-of-care help, but in the long run aiming clearly at the next-gen cardiologist as a "handheld" ultrasound device. The latest Butterfly handheld device promises to be a game-changer, promising to light up every nook and corner of the heart, even before the admission charts are filled out.
But listening to the heart is different, it is a contrastive experience altogether. The privilege of listening to a secret music, stored in a mysterious vault, unappreciated and unheard even by the owner. A privilege of privacy shared between patient and doctor.
The hospital is a nasty place. Hidden behind the shiny stainless-steel instruments and starched green drapes are not only the world's most notorious antibiotic resistant criminals, the bacteria and bugs, but also, an emotional kaleidoscope that the health worker feels 24/7. The air is thick and stale with the pain of anxiety, the sighs of sadness, the anticipation of loss and terror of impending death. From outpatient department to cafeteria, from operating table to ICU, it stalks us everywhere -- even to our bedroom, long after the white coat is on the hanger.
But medical algorithms cannot run on an emotional slippery slope. Like the right amount of oil in the cog, the "professional sympathy" makes the system run "noise-free"; a little overdose would make the gears lose their grip. A sob of fear or the anxiety of a procedure doesn't deter a nurse from giving an injection or the surgeon making an incision.
As I place the stethoscope on the patient's chest and slide up the chest piece, a placid intermission of calm sets onto me. The toxic hospital atmosphere, ruled by feral emotions, fades in the background, as the "lub-dub" takes over. It pauses the ambient staccato of sadness, mutes the depression, and shuffles to a soothing lullaby.
Like any first encounter, the initial response of a fast hoof-beat of anxiety settles down in a minute, as the patient's heart becomes comfortable to me. Interspaced by the soft rustle of respiratory background music, the heart sounds try to tell me the patient's problem in whispering soliloquy.
I try my best to interpret and translate one of the body's oldest musical scores, trying to visualize the thud of closing valves, the splash of regurgitation, the venous hum and continuous murmurs.
Sometimes I give up. Sometimes the algorithm reminds me to do so. I apologize and ask permission for an unromantic ultrasound beam to light up the darkest corners of his heart, or let a sharp beam of radiation or a strong burst of magnetic resonance slice through every millimeter of heart, to make a diagnosis. Echo, CT, and MRI scans leave no secrets.
I silently apologize for my inability to decipher the Mozart in the Rosetta Stone.
Tiny Nair, MD, DM, is the head of the Department of Cardiology at PRS Hospital in Trivandrum, Kerala in India.