Mary looks not too bad for having a two-week-old baby only now getting good at nursing. He looks content. His weight is not quite where I would like to see it, but not worrisome.
Lifted in my hands, his tone is great, his gaze intensely locks on mine. Put back down, his arms and legs flail enthusiastically. Cheeks are chubby, soft skin is pink. He passes the gestalt test – no worrisome sense that something is not quite right.
The exam steps are always the same to insure completeness, so ingrained I don’t have to think much about it. We’re chatting about how things are going as a new mom while my hands automatically begin at the top and move downward, soothing her concerns as my hands sooth mine. Fontanel, pupils, red reflex, ears, mouth…
Finger to my lips for silence, my stethoscope touches the chest. Strong and regular beat, but then a murmur. I slide the scope to other benchmark positions, slide it back, hoping my ears have deceived me. No, No!
Now my exam has a heightened intensity. I continue commenting to Mary on how normal all his parts are as I touch them, but my focus is zeroed in on cardiac signs.
After listening to the vigorous digestion of mother’s milk, my fingers move to the round belly. I feel no enlarged liver or spleen. “His abdomen feels totally normal.” Nothing amiss here -Thank God.
I spend more time on the pulses than usual. They are symmetric and full. Surely this will be OK – Please.
Fingers and toes pink. “Perfectly formed.” Perhaps I misheard.
My apprehensive hands return again to the stethoscope. I blow on it to warm it. Gently it returns to that spot that gives my own heart a lurch. The murmur is still there. Not the ones I hear all the time, that catch my ear but not my breath, but a quiet, atypical Pay Attention murmur. No, NO, Damn it!
I swaddle, then pick up this healthy looking baby, the vessel that already at just eight pounds carries so much love and expectation. I breathe in that unique, newborn smell from his perfectly formed, round head.
“Mary” I begin, “this is a most wonderful boy, but I hear a sound in his heart that may be worrisome and …”
Portola Valley, California