Today I had a movie moment. Not a “finding true love” moment, or even a final speech “this is our time/we’ve earned this/win the game for [insert injured player’s name here]” moment. I had the moment where someone tells the player just how hard he’s going to have to work. It’s not the culmination of anything; usually, training has only just begun, and it’s going to get worse, but inspiring music underscores the speech and you know in your gut something amazing is going to happen.
It happened like this. I’m in a hospital room with three other students and a doctor learning how to interview and examine patients. Now, no one expects much at this point. After all, I’ve only been in school for a month and a half, and I don’t know any symptoms (though I can tell you why pain from a heart attack goes down your left arm if you let me pull out my dermatome chart…), much less what is important when trying to get a diagnostic history and perform a physical.
Everyone knows who the med students are (the short white coats give us away) and takes it easy on us. Except Dr. B., the physician. The surgeon. My mentor.
He’s one of those people you notice as soon as he walks into a room, probably because he’s the one talking loudly and making a sarcastic comment. The guy who’s the best at what he does and feels no obligation to hide it. The type of guy who makes you flinch when he looks at you. I learned on day one that he doesn’t put up with bluffing, that I should never break eye contact, and that he will always call on me when I have no idea what the answer is. It’s a variation on Murphy’s Law.
So back to the hospital room. He’s just finished explaining what we did wrong while questioning the patient, and is moving on to the physical exam. So far, all we’ve learned is to take pulses, measure blood pressure, and check lymph nodes, but that doesn’t stop Dr. B. Our patient has an interesting heart sound, and he wants us to figure out what it is.
With the patient’s permission, I listen for thirty seconds, eyes closed and one hand taking his pulse the way Dr. B. showed us. I can’t remember what taking his pulse is supposed to tell me. Something about identifying the different parts of the heart beat? I finish, the last of four students to listen, and we each say what we heard: nothing, nothing, whooshing. I heard a swishing sound between two faint beats.
“Systole or diastole?” Dr. B asks.
That was what I was supposed to figure out using the pulse. I have no idea and say so. A brief lecture follows, at the end of which everyone else nods and I’m still confused. I start to ask the girl next to me to double-check what we were told, but she shrugs and can’t repeat it back. Everyone starts listening to the heart beat again, and I take a deep breath and look over at Dr. B., who is talking with the fourth year student supervising us. I’m setting myself up to be the dumb student, the one who always needs to hear things twice, but suddenly I don’t care.
“Dr. B?” I ask, “I’m really sorry, but can you explain where the murmur is one more time?”
And he does. In excruciating detail, even mimicking the sounds for me very loudly and slowly.
I return to the patient and listen for the heartbeat. At first, all I hear is the rustling of my stethoscope against the hospital gown. I readjust my hand so I can feel the pulse more strongly. It should be there, right when the pulse is strongest, a little swishing sound between the two beats. Systole.
Everyone is waiting for me to finish, so I consider taking my stethoscope off and pretend I heard it. But I want my question to count. If I must be the slow one, I at least want to get it right.
More rustling. I close my eyes and slow my breathing until the sound emerges, faint and barely there. Lub-swish-dub. The lub-dub is barely audible, but the switch crescendos and drops with the beat of the man’s pulse. Lub-swish-dub.
I open my eyes and see Dr. B. watching me sidelong while he talks to another student. “I heard it,” I tell him. “I couldn’t hear anything at first, but it was there.” And he smiles. Not a sarcastic smile, a real one. He tells me that he spent two years listening to hearts before he really started to hear it. Then he’s back to normal, making a smart remark about a time everyone around him missed a murmur and he had to decide whether they were just idiots or he was better than he thought he was. He went with the idiot hypothesis. Of course.
Outside, we rehash the session: what worked, what we messed up, how we can improve. Then it comes. The Moment. Except it’s not coming from a gentle, kindly mentor, it’s coming from an abrasive, loud surgeon who would fit in on any street in New York and is wearing a t-shirt under his white coat. Without any soaring music to back him up, Dr. B. tells us that he will teach us what we need to know. That we will eventually be able to hear what the heart tells us. That we will be able to do more than just read test results. And that our time spent in medical school here will not have been wasted.
It’s not a fancy speech. It’s not particularly eloquent. And it’s not even really directed at me. But when he looks at me, I feel a surge of excitement. I admitted I had no idea what was going on today, and because of it I heard that heartbeat. I will be a doctor someday.
My moment was grumpy, and unshaven, and repeated itself loudly to me just in case I still was too slow to catch on.
But I had a moment.