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Spring 2014
BMM Current Issue
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Heart on Sleeve
Who are we if we cannot doctor?
As a chief medical resident, I teach medical students about the art of the physical exam. Today, the students and I wandered the halls of the hospital requesting permission to listen to the hearts of strangers. It is innocent work— the practice that allows one to ultimately “practice medicine”—and most patients are gracious with their bodies once they glimpse the eager students peering in from the door behind me.

Our visits are brief; I listen first, then chat with the patients and their families as the students take their turns at the bedside, stethoscopes plugged in ears and jaws clenched in focus. As mere visitors we will not follow these patients throughout their hospital stay, nor are we a part of the care team. What is precious to me in the patient-physician relationship— healing borne from understanding as a patient comes to know the illness at hand—is not a part of these brief encounters. Yet I will remember today’s patient for the rest of my life. You see, hers was the first heart I listened to in many months.

Not long ago, deep in the trenches of residency, I experienced my own health scare. At the insistence of my physician, I was plucked out of rounds and found myself on my couch…where I stayed for nearly three months. Days into my house arrest, I brought my white coat in from the car and hung it in a storage closet. As a rule, I am ambivalent about the white coat; it can help or hinder your rapport with patients, sometimes acting as a barrier rather than a foundation for trust. Nonetheless, I felt a wave of grief as I closeted that coat knowing my doctor identity had been shelved.

Even in an era of work-hour regulations, residency is all-consuming. When you spend 80-plus hours a week training as a physician, who are you—what are you—when you must stop doctoring? Certainly we all yearn for more time off, for vacation, for our quiet nights at home. But what happens when the pager falls silent and the calls cease not because it is your day off, but because you no longer have responsibilities to patients?

The answers would likely be different for each of us. I know I was humbled greatly to find myself on the sidelines. It is all too easy to gripe about hours and tasks—a difficult patient, a family that cannot let go, yet another consult— when immersed in the hospital’s daily grind. Indeed, medical educators are well aware of the phenomenon of eager interns coming to resent their patients for the very needs that attracted the idealist to medicine. But from afar, with my white coat in the closet and stethoscope on the bookshelf, our work seemed doubly precious. So much so that upon returning I knew that just listening to a stranger’s heart is a privilege.

Heather Cassidy earned her medical degree at the University of Colorado School of Medicine. She is currently a chief medical resident in Brown’s Internal Medicine residency program.
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