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.