A murmur in the ICU.
(aired in somewhat different form on All Things Considered March 24, 2004.)

 

The first time I visited an ICU was last year, as part of a physiology course. Learning how mechanical ventilation works helps medical students understand the physiology of breathing. So we went over to a nearby hospital and a doctor took us to the unit. In each room, there was a patient lying unconscious or nearly so, tubes in mouths, the whole unit quiet except for the whooshes and beeps of machine sounds and alarms.

We went into one of the rooms, and the doctor leaned down to the patient, and said hello to her, using her name, and then said, "I'm here with a group of students, and we're going to talk a little bit while we're here." He laid his hand on her shoulder a bit as he explained to us that although the patient was sedated, sometimes patients could hear or understand some or all of what was going on around them, and so a small introduction was in order.

And then he talked about respiration, about the physiology of the ventilators and about the monitors on and inside of her. He pointed to the monitor screen, which clearly showed what he was telling us. I could barely register it. A friend of mine, standing next to me, was in even worse shape. She felt faint, and had to walk out of the room to get some air for a couple of minutes. Pulmonary capillary wedge pressure? We weren't thinking about that; we were looking at the family pictures around the room and wondering what it would be like for this woman's kids to visit her here, to see her like this.

More than a year later, I was in another ICU. As an optional part of one of my classes, small groups of us traipse around the hospital, following a young resident who takes us to see patients with good findings, meaning, things you wouldn't want to miss if you saw them. So we all trundle into a room and say hello to the patient, and then feel his swollen liver; or look at his clubbed fingernails; or listen to her heart.

And so we went to an ICU to hear a heart murmur. The heart murmur was inside a man, who was deeply unconscious, who was plugged into machines. There were pictures of himself and his family in the room. Did the resident say hello to the man when we came in? I hope so, but I'm not sure; I came in a bit after everyone else. I know I didn't say hello as we put our stethoscopes on his chest.

I couldn't hear his heartbeat at first, because of the sound of the air being pushed into his lungs by a machine. Eventually, another student told me to look at the monitor. To hear the heartbeat under the noise of the air, we had to see it on the machine. We looked at a little valentine heart on the monitor that flashed with each beat, and then listened for a sound that happened every time the valentine flashed. Then suddenly, because we could see the beat on the screen, we heard the heart murmur in our ears, as clear as anything, whoosh, whoosh, whoosh. I showed another classmate how to hear it, and she put her stethoscope down on his chest and then looked pleased-now she heard it too.

As we were walking out, one of my classmates looked at the man and said, "Thank you sir." I criticized myself for not saying something too, but hearing her, I also realized that the ICU didn't bother me anymore or fill me with grand spiritual and moral questions. It was a place where sick people were hooked up to machines, and that was that. I was ready to plonk my stethoscope down on the chest of an unconscious man with no preamble, no introducing myself, no ritual of human connection, as if it was perfectly normal for him to be there, and for me to be there too. It was a murmur I was seeking; looking away from the man and towards the monitor, it was a murmur that I heard.

copyright 2004 joe wright