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Heart Sounds

At his mother’s request, or rather pestering, a forty-year-old male presented to an urgent-care center after several weeks of progressively worsening flu-like symptoms. His mother asked that the providers please check her son’s heart. They replied that there was no need and sent the man home.

His symptoms progressed, and the pair went to the ER, hoping for better results. Again, the mother asked the doctors to check her son’s heart.

“His heart sounds fine, there’s no need,” they said again and sent him home.

His symptoms kept progressing, and his body began to swell. On the third visit to the ER, the mother refused to leave until her son’s heart was thoroughly examined. Finally, someone listened.

Her son’s heart, it was discovered, had grown to the size of a large grapefruit—a response to a viral infection. He was admitted to the hospital. Had he been sent home one more time, he would have died. This is what I was told when the patient and his mother came under my care while in the hospital.

As a first-year medical student, I had no business managing a patient with newly diagnosed post-viral dilated cardiomyopathy. Yet if his mother, with no medical background whatsoever, had figured out that something was wrong with his heart, I felt that I should be able to offer something medically useful to this man.

I pored over his chart for what seemed like days on end. I read up on all the latest treatment modalities, algorithms, designer medicines and fancy implantable devices. I quickly realized, however, that I was in way over my head.

I’d barely finished my cardiology unit and had met only simulated patients up to this point. I knew just about nothing about how to deal with a patient as complicated as this.

What I could do, though, was listen. I could listen to the mother and her son and let them be heard. Heard by someone within the medical community—the community that had twice seemingly turned its back on them and nearly cost this young man his life.

So each day I sat with them. I did my best to answer their questions. If there were questions I didn’t know the answer to, I would research them and bring the results to the mother the following day. Though I personally couldn’t offer any useful clinical services, I could use my foundational knowledge to interpret the medical jargon and explain things in ways that made sense to them. This, I believe, was more valuable to them than anything else I could offer.

When I wasn’t searching medical texts for answers to their questions or serving as their personal medical translator, I simply sat and listened to the mother and son. I listened to their worries and frustrations. I listened to them describe the financial struggles they were facing. I listened to the worries about child care that this single father was wrestling with, on top of his new diagnosis. I listened as many liters of excess fluid were drained from his body by diuretics. I listened to the beeping of the machine beside his hospital bed as the cardiac drugs and implanted device kept his weak heart beating.

I listened when the doctors told him that he would need a heart transplant. I listened to him and his family cry.

At the same time, I listened as love poured into his hospital room. I heard the laughter of family members who’d traveled across the country to be there. I heard excitement in the voices of friends who hadn’t seen each other in years. I heard FaceTime calls between estranged loved ones. I heard playtimes with young sons who didn’t quite understand why Daddy couldn’t get up.

And, after several months, I was also lucky enough to hear the news that a heart had become available.

Together, the family and I listened as the helicopter carrying a new heart landed outside the man’s hospital window. We listened as the intercom paged the transplant team to prepare. We listened as the surgeons told us what was to come. We listened as a prayer was said. We listened as the man was wheeled down the hall into the OR. We listened to each other, sharing stories all night to pass the time, anxiously awaiting news. Finally, we listened as the doctors told us that the surgery was a success.

On that night, my brother Max received a new heart.

My brother now has two birthdays: One is the day he was born, and one is the night he got a new lease on life. This would never have happened if not for my mother’s instincts and persistence, and if not for one ER provider’s willingness to listen to her. We now joke that no matter how many letters I have behind my name, I’ll never know more than a mother’s intuition. She didn’t need a medical degree to pay attention and listen to her son.

This is the lesson I learned from my brother’s transplant: We must listen to our patients. He was not simply a forty-something Black male with a cocktail of generic viral upper-respiratory symptoms and a couple of weeks’ swelling. He was a son, a father and a brother who enjoys disc golf and IPAs, but hadn’t done so lately because his feet had swollen so much that he could no longer tie his shoes. The subtle details matter. The person behind the symptoms matters.

Sometimes you don’t need a stethoscope to hear what’s wrong with a person’s heart. Sometimes you just need to listen.

Reece Vesperman is a rising fourth-year medical student at the Florida State University College of Medicine, in Tallahassee. “I have always enjoyed writing, and this essay began as a school assignment. My story, based on real events, resonated with my peers and faculty, who encouraged me to share it with others.”

Comments

22 thoughts on “Heart Sounds”

  1. Wow. That was so powerful. And such a lesson to learn that will serve you- and your patients- for your entire career.
    Listening well isn’t the least we can do, it’s the most important thing we can do as physicians and caregivers.

  2. Your story brought tears to my eyes, for all the reasons you revealed as the essay developed. Thank you for sharing this with the Pulse community.

  3. Thank God someone finally listened
    To the mother and helped to get the care
    He needed . You are going to make an excellent physician blending care and skill!

  4. Loved this, thank you so much for sharing and allowing us all to take in that lesson as well.
    Best wishes moving forward for your brother and continued great health.

  5. Marc D. Wager, MD

    WOW! What a great essay! I got goose bumps and got all choked up. I loved the surprise that the patient was your brother. And what a great take-home lesson, just like we learn on the first day of our pediatric rotations: always listen to the mother! And as you move on in your training, keep listening to your patients.
    PS I’m glad your brother is doing well. What a lucky guy to have your mother as his advocate and mother, you as his medical translator, and the gift of life with a new heart.

  6. Maureen Mastandrea

    Reece, you have always been a stand out in every aspect of your life! You are on the road to being an outstanding doctor! I am so proud to know you!

    1. As a Hospice Chaplain, I too agree the best gift we can give our patient and their family is the art of listening.
      Great job Doctor….

  7. This story packed a triple punch, and so gracefully. The wrenching tale, the reveal of the family connection, skillfully woven in, and then the seemingly casual mention of your race. We know that this is not, in fact, a casual fact. Thank you for this brilliant and powerful piece, and yes, so glad that you and your brother and the rest of your family all have each other.

  8. What a heart-wrenching, heart-felt, and heart-warming piece of writing – a lesson for us all, kindly and gracefully done. Thank you! and keep writing, please.

  9. On several occasions, I’ve been responsible for getting a patient released from the hospital and taking them home. It was never easy, but one time I went ballistic. My friend had been waiting endlessly for the paperwork; the people at the nurses’ station were “busy.” I finally stormed out to the station and demanded Professor [name withheld]’s release papers. “They’re being faxed from the 2nd floor.” “Well, has anyone looked in the fax machine?” “Oh, gee, here they are.”

    If I were a super-hero, my glare would have set the place on fire.

    Do I need to explain that my friend–a distinguished professor of the early 20th century French labor movement, fluent in French, and a member of an equally distinguished family of educators, ambassadors, architects–is Black? I am not, by the way; not that it made any difference.

  10. Your post demonstrate what we need in the U.S. today:
    “patient-centred medicine” which means listening to patients
    (and their mothers) .

    Your story is both moving–and brilliantly plotted.

    Two- thirds of the way through, we find out that this is Your brother.
    (I had been wondering why your superiors at the hospital let you spend
    so much time on one patient. Of course he and your mother needed someone
    to listen, but U.S. Hospitals tend to be “hospital-centred” not patient centred”.
    Time is allotted in ways that hospital administrators think will work
    best for the hospital bureaucracy. )

    Then, toward the very end of the story, you let us know that your family is
    Black.

    I’m afraid this explains the first part of the tale–when he went to the ER
    twice, and doctors refused to take a close look at his heart.
    He is just very lucky that they third time they went to the ER, your
    mother refused to leave.
    Most patients (and mothers) wouldn’t have the resolve to do that.
    They would be embarrassed.

    They wouldn’t want to “make a fuss.”
    I have been in that situation with my 90-year old husband.
    In one case I had to appeal to a cop in the hospital to get us
    the help he needed. Of course, I felt like an idiot, but I did it and
    the cop came to our rescue.
    Your mother is an example to us all.
    If a loved one is very sick, and not getting the care he or she
    needs, Stand Up.

  11. Listening is so vital. You will never forget this. Also, I think the doctor, patient, mother relationship provides deep rewards of practice as a healthcare professional. Something we should fiercely protect and advocate for i.e. time to listen and build relationships.

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