Billy Rubin

The adventures of a pre-clerkship medical student.

Saturday, September 23, 2006

Systolic Murmurs

We sat in a semicircle unsure of how to proceed. Our clinical skills class commonly had us examining volunteers, but this was an entirely new challenge for us. Men and women in various states of undress would allow us to listen to their hearts, bend their knees and percuss their chests. They gave us the opportunity to learn and over time our fumblings became more experienced palpations, our ears became tuned to the sounds of the lungs and heart, and our eyes began to recognize atrophy and distress. As medical students we became familiar with the unfamiliar, but this was something different again.

Seated in the centre of the semicircle was today's volunteer. She had bright blue eyes and golden yellow hair. She smiled brightly as she played with a toy dog. Her name was Sarah. And she was a bright and beautiful four-year-old girl.

Sarah was very outgoing and engaging. She put us at ease quickly as she shook each of our hands, in turn, as we introduced ourselves.

Slowly we began to make our way through the Denver. Sarah was eager to perform the tasks. She hopped on one foot, drew shapes and completed sentences. She correctly answered questions well past her age bracket, reveling in the adoration she received after completely the assigned task.

Finishing the Denver, we moved on to the physical exam. Before listening to her chest, we had Sarah listen to each of ours. Placing the stethoscope on my chest, Sarah mouthed what she was hearing. "Swoosh."


"Yup. Swoosh." Sarah smiled. My mind flooded with the horrendous possibilities this entailed. I began drowning in thoughts of systolic murmurs. I thought about young relatives who had died or coronary heart disease. I AM TOO YOUNG TO DIE!!


My eyes focused on the small girl standing before me. Her small hand held the diaphragm to my chest. Her tiny face was encircled by the larger headset. She smiled at me, looking for approval. She was unaware of the implications of "thump, swoosh, thump". I weakly smiled back at the four-year-old who had just diagnosed by heart valve stenosis.

Sarah checked everyone's heart. "I don't hear anything," she said to the first student. She told the second student she heard, "Bang Bang Bang." The third was informed that she heard "Ka boom!" The worry quickly melted away, as I realized she had just diagnosed my fellow classmates with having no heart, CHD, and, the ever common, exploding heart, respectively.

Image credit.



Blogger Jo said...

Unfortunately, the one time I heard "thump thump squeak thump thump kaPING!" it was an actual problem.

A piece of guidewire from an angiogram set had broken off and migrated into the patient's heart.

Nothing like hearing "squeak" and "KaPING" on your initial exam.

11:47 a.m.  
Blogger Kim said...


Exploding heart.

I hate when that happens.

7:03 p.m.  
Blogger William Rubin said...

Jo: Wow. Squeaks and kaPings are not something you want to be hearing when listening to someone's heart. Hopefully the patient was ok.

Kim: Children are very funny and cleaver. She had a great time playing doctor and listening to everyone's hearts.

7:46 p.m.  
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8:25 p.m.  

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