Never Lose Heart

"Henry, listen to the patient's heart and tell you what you hear." I did as my cardiology preceptor instructed. I placed my stethoscope over the patient's left sternal border. I couldn't hear crap. It sounded faint and muffled. I moved the stethoscope over to the right sternal border. Same story. I moved it back to the left, but more left than before. Still faint and muffled. Why couldn't I hear anything? There must have been something audibly significant for my preceptor to want me to take a listen. I thought I could maybe delude myself into believing there was a systolic murmur. Maybe. I moved my stethoscope back to the right side. Man, I must be the worst medical student ever. I gave up but pretended like I knew what I was doing. I finished up with a lung exam and felt the patient's pulses.

"So, what did you hear?"

I thought for a moment. Do I say that I heard a murmur? What other noises could there have been? A click? Those are often accompanied by murmurs. A pericardial rub? That might be mistaken for a murmur to an untrained ear. A murmur sounded like a pretty safe guess. How would I describe the murmur if questioned further? I'd be propagating made-up details of a wild guess. So I described exactly what I heard. Hey, it's supposed to be a learning experience, right?

I said, "Heart sounds were very faint. I couldn't really hear anything."

The doctor replied, "That's correct. The patient has distant heart sounds."

Whoa... what? I thought I heard a choir of angels singing. There was much rejoicing. It turned out the lady had emphysema, which, coupled with her copious body fat, made her heart sounds difficult to hear. Today, not only did I learn an important medical fact, but I learned an even more important lesson in honesty.

I encountered a situation today where my preceptor explained a physiological concept incorrectly. My fellow students didn't question him further about it, so I started to reason through it out loud in an attempt to generate discussion and point out inconsistencies without directly calling anyone out. I wasn't trying to be a smart ass. It was a concept I understood well at one point but had since forgotten, so I was earnestly trying to reconstruct the theory with the help of my colleagues. I don't fault my preceptor for confusing the facts, considering there's so much to remember in medicine. Besides, there's no questions that knows way more than I do. It's hard to tell people they're wrong, especially a superior, and especially in the presence of others. Medicine is a delicate craft, and we're taught to step lightly around feelings and personal convictions. Did I tread lightly enough today? I think so. I don't need to be burning bridges at a time when constructing them is so critical.

I attempted to draw blood today from a lady's hand. Epic fail. The nurse couldn't find any good veins in her arms, so we had to use her hands, and that's supposed to hurt like mad. Can't I just leave the needlework to the nurses? The world is probably safer if I stay away from sharp objects anyway.

This morning was spent learning some physical medicine maneuvers all over again. We got a free lunch out of it and lots of free time. The afternoon was spent in Junior Teaching Clinic where we saw some general medicine patients and went through basic clinical scenarios. I have three JTC sessions a week, each with different preceptors. My Wednesday one is definitely the best so far. But then again, maybe that's not a fair assessment because my other two preceptors didn't show up for our first sessions. Not that cool. I did get one free afternoon off though.

Let Me Eat Cake

I had a lot of amazing and cheap food in Taiwan. I also had a great deal of amazing and ridiculously expensive food in Taiwan. My recent culinary experiences are begging me to reflect a bit on the enjoyment of food. As fodder for the following discussion, I'd like to use pineapple cakes, arguably one of the finest Taiwanese snacks ever invented. My earliest memories of consuming pineapple cakes were of the ones packaged in sleeves, like Fig Newtons. I later learned that those were mere pedestrian versions, and that there existed high-class versions that come in decorative boxes, with each pineapple cake exclusively packaged in its own fashionable wrapper. These are arguably more delicious and have a finer texture, but with every bite, I feel like I am consuming guilt-ridden diamond-studded desserts. There is also the added tediousness of opening these packages without smashing the contents therein. It makes me miss the pineapple cakes that came in sleeves, the ones that I could cram in my mouth one after the other without the slightest air of presumptuousness. Sure, the quality might be just a tad lower, but it's not like I'm running a side-by-side taste test. And the cumulative effect of inhaling multiple pineapple cakes in a row more than makes up for any lack in quality. All I want to do is smile with my mouth chocked full of sweet cakey pineapple bits, and the bulk-packaged pineapple cakes allow me to do just that. Don't get me wrong, though. Give me 100 of your most exquisite pineapple cakes, and I'll stuff my face with those, too.

I have a pretty bad memory. I've learned that people with bad memories benefit from surrounding themselves with lots of people. Friends and family and random acquaintances serve as reservoirs for memories of my life events that I can only poorly recall. Also, talking to people you haven't interacted with in a while opens up a time capsule that preserved your last interaction with them. For example, a cousin recently asked me about a drawing I was working on over a year ago. A friend helped me remember thoughts of another friend who passed away. Relatives in Taiwan informed me of how much I used to cry as a child. Apparently, I would cry while eating or sitting on the potty. Good memories.

It's like other people are helping me piece events of my life together every time we reminisce. I think everyone I've ever met should just get together to write a biography about me so I can read it and find out what I've been up to for the last 23 years... because I have no idea.