Back in medical school, I remember trying to listen to the heart of a newborn. Damn thing was beating so fast, I kept thinking, “How the hell can anyone hear a heart murmur?” A pediatrician told us it just takes practice. One has to listen to hundreds of normal hearts in order to be able to recognize one when it’s NOT normal.
Well, that’s actually true for a lot of things in medicine. Last year, I felt a very abnormal prostate. It was so obvious to me at the time, that I wasn’t that surprised. I just realized that it was NOT normal. Two months ago, I did a routine breast exam on a woman and felt something very, very concerning, completely unbeknownst to the patient, sadly.
Then, yesterday, I saw a two-week old infant for a weight check. I put the stethoscope on his chest and heard something. “Whoosh-whoosh-whoosh….” Hmm … I concentrated really hard, asked mom to stop talking (she was telling me all about his bowel movements) and listened again. Was this his breath sounds I was hearing? Definitely not – watching his chest rise and fall, this was clearly a cardiac sound. Oh. My. G.. This wasn’t there a week ago!
I drilled mom with questions:
“Does he ever sweat with feeds?”
“Does he turn blue in the lips when feeding?”
“Does he breathe faster than you think is normal?”
She answered no to all the questions. I watched him. He looked happy, content, breathing normally. The child seemed perfectly fine. Still, I was concerned enough that I referred him to our local pediatrician who confirmed the presence of the murmur, “It wasn’t really that loud,” she later told me. Well, it was LOUD to me!! lol! In any event, the infant is in good hands and will be diagnosed soon (with, hopefully, nothing more serious than a small VSD that will close on its own).
Despite the pediatrician telling me it wasn’t all that loud, I still had to pat myself on the back. I heard it.
There are times in my career (and personal life) that I wonder if I am doing the right thing, if I have done all I could have, if I should have done things differently. I am far from perfect. I am a flawed individual but I am deeply conscious of it. I am very good at admitting my mistakes and “bad calls”, yet I rarely give myself due credit for a job well done.