Blog | Friday, April 13, 2018

The gospel


I was told one thing. That your aortic heart valve was narrow and tight and that, just maybe, one day very soon you would need that valve replaced.

Aortic stenosis. That's what I was told. With clear certainty and not so much as an eye twitch or a blink. From his lips to my ears like it was the gospel. Aortic stenosis.

I entered the room alone. Armed with the gospel that I had been told about you. Aortic stenosis. I spoke to you for a few moments and talked about what was going on. “What is your understanding of what is happening with your heart valve?”

“The blood rush over it in a way that's not normal. They heart valves don't open and close like they s'posed to.”

I nodded because, for the most part, that was true. It was. And I went into a description of what it all meant. Your tight and narrow heart valve. I said the words over and over again. “Aortic stenosis” this. “Aortic stenosis” that. You looked a little bit confused but when I asked if you understood you said, “I think so.”

I think so.

Next I pulled my stethoscope from my pocket. Slipping the rubber tips into my ears, I looked at you and smiled. You smiled back. Then I gave the diaphragm a vigorous rub with my palm remembering that a Grady elder had told me once: “Even though it don't do much to warm it up, something ‘bout seeing you try make me feel good.”

So I did that. And I do that. Most times, I do.

I close my eyes and place the instrument on your chest. I follow the map of listening areas taught to me as a medical student and quietly listen for the telltale sounds of aortic stenosis:

First a soft sssssssshhhh. Then it grows louder to a SSSSSHHHHH. Falling down quickly to the that soft hush again.

I know it when I hear it now. And so, instead of fighting to discern what it is, I am armed with experience. You patiently allow me to confirm what we both already know. My breathing slows. My hand glides with the stethoscope over your skin.

You are so cooperative and kind, I wish I wasn't alone and that a student could be beside me. To hear and learn right next to me. Aortic stenosis.

My eyes open.

Wait huh?

I am hearing sounds, yes. But they are NOT the ones I expect. I squint my eyes and listen harder (as if this changes what the ears hear.) “Can you hold your breath?” I ask. And you do.

Same thing.

A soft whoosh followed by what sounded like a deep sigh between heart sounds. Again and again I listen. And again and again, I hear the same thing.

Shit.

“They told you your heart valve was small? Like tight and stiff?”

“They told me something. I don't know if it sounded like that.”

“What about a leaky valve? Did somebody say that?”

“I don't know, Miss Manning. Y’all be saying so much sometimes.”

And you're right. We do.

You don't have aortic stenosis. And while you do have an issue with your aortic valve, it isn't that. And though I am not a cardiologist, I can say that right now it doesn't look like you need surgery either.

You were gracious when I told you I was wrong. You shrugged and laughed a little. Like none of it was a big deal.

While my face burned hot like coals.

This happened a while ago. But what it taught me was that, like all gospels, I need to listen for myself, examine for myself and interpret for myself. Because even though a lot of times there is no discrepancy. . .sometimes there is. When telling someone life impacting information, it's good to have at least checked for yourself before talking.

Whew. Preach, pastor.

I also learned that there is a lot we say that gets missed. Yeah, so I work at doing a better job in that area, too. Explaining until you know so. Not just think so.

Yeah.

Last I checked, you hadn't had your aortic valve replaced. You were still doing well and seeing the cardiologists regularly. Today I am hoping and praying that you know exactly why. This is what I am hoping. And that the gospel you hear is the gospel indeed.

Yeah.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.