Saturday, January 9, 2016

Day 3 of Subinternship: Listening to the patient's heart

Today morning we were following the professor during rounding, and this one patient in her early 20s had infectious endocarditis with mitral regurgitation. She was quite beautiful considering she had no make up on. The professor suddenly held out the stethoscope expecting one of us students to listen to the heart of the patient. There was a sudden silence, and since I was at the front, with a moment of hesitation I took a glance at the 2nd year resident. He smiled at me and gave me a nod. I couldn't believe what was happening so I took a second look at him. He again nodded vigorously with a face that was telling me "go on!"

I bravely took the stethoscope, oriented it so that the direction of the earpiece was facing towards me, then placed the earpiece inside my ears. Suddenly the professor grinned and snatched the stethoscope away from me and rotated the direction of the stethoscope as if experimenting with it, put it on, then gave it back to me. Confused, I placed the earpiece again in my ears  the same way I did it the first time, pondering about her odd action.

(In the end I learned from my group members that the earpiece is supposed to face the patient's direction when putting them on. I was so embarrassed)

I swiftly moved the stethoscope to the region slightly left to the patient's sternum. The patient was a female so I was really nervous at first, worried that I might somehow offend her by touching her breasts or something. Gosh it was so embarrassing. Thankfully I did avoid her breasts and did get to hear a murmur that was very different from a normal heartbeat sound. I probably stood there for about 10 long seconds to appreciate the sound. After the 10 seconds, I decided to interrupt the silence and return the stethoscope to the professor. 

Now I've never been trained to hear a patient's heartbeat, so this was a huge deal for me. I was kind of proud of myself for being able to carry out the procedure to listen to the heartbeat. Last semester a professor had encouraged us to all buy stethoscopes and listen to our own hearts every day before we went to sleep. I did exactly that and it had proved to be useful in being aware of where to hear the sound and what a normal heartbeat sounds like.

Everything seemed great, and I felt good about myself, but the second let down occurred when right after rounding the professor told me that I was supposed to listen the heart's apex. After hearing that I panicked. Slightly left of the sternum; wasn't it the apex that I listened to?? Apparently the apex is positioned at the midline of the clavicle. The position I listened to was more medial, near the RV, so technically I wasn't doing the right thing. Nevertheless I was satisfied for being able to at least detect an abnormal sound. 


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