Friday, March 20, 2015

[Poetry] Mending a Broken Heart

"The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind." - Philippus Aureolus Theophrastus Bombastus von Hohenheim (Paracelsus)
Angiography came back normal, and his
Brain natriuretic peptide was within normal limits. I ordered a
Creatine kinase, which was perfect, so no infarction. The
Doppler imaging showed no evidence for flow disturbances. The
Electrocardiography strip demonstrated normal conduction, and his
Fractional ejection was excellent. Last admit, they did a slew of
Genetic tests, but they were all negative. Maybe the
Histology from biopsy will reveal something? Should we consider
Invasive cardiac electrophysiology for this patient? His
Jugular venous pressure was just fine, and he is without
Kussmaul signs to suggest frank heart failure. Some labs of note:
Lactate dehydrogenase was inconspicuous, as were his
Myoglobin levels. The patient underwent a
Nuclear stress test, but results were fine. We want to avoid
Open heart surgery for him … perhaps a
Positron emission tomography scan, or a
Quantification of chamber volume could save the day? But the
Radionucleotide imaging from last week’s admit was good. With the
Stethoscope I heard no murmurs, rubs, or gallops. Did I mention
Troponin was fine? And the
Ultrasound provided no remarkable findings. Is he going to need a
Valvuloplasty? Is it even a busted valve? And, I found no
Water hammer pulses. Radiology said the chest
X-ray did not hint at cardiomegaly. I cultured everything, even
Yersinia enterocolitica, but his blood is clean. And for his age,
Z-scores of cardiac valves were solidly in range.

So many tests to analyze a broken heart
But why does the patient continue to demonstrate cardiac decline?

Ask the patient what brings him in, and
Believe in truth his word. Promise to
Care for him as if he were your kin; in so doing, you
Demonstrate your passion. Find a way to
Express yourself with your whole soul, and learn to
Feel what he feels. I ask of you to
Give it all you got to find the diagnosis, but
Hide not when you are in doubt or uncertain. Be sure to
Investigate thoroughly his social history, and to
Judge not the choices he has made. Remember,
Kindheartedness goes a long way, especially when you
Linger a bit to talk about non-medical things. Always
Mind the patient’s privacy, but never
Neglect to ask if he might need anything. You must
Open yourself to his concerns, and even
Pray with him, even if just your presence is enough.
Question your biases, and remember to
Reconsider your differential.
Study hard and
Trust yourself.
Understand that life and medicine are not algorithms, so
Value deeply the stories he tells. Furthermore,
Watch his facial expressions,
X out of the computer screen, and look him in the eye! You should
Yearn for more time to spend with him, and
Zero in on his greatest fears and worries.

So many tests to analyze a broken heart
But without empathy and love, how can you ever understand it?