[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)

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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?