Seduction by a stethoscope

It was the first week of medical school and Littman, the world-famous medical equipment maker, was on campus giving brand new stethoscopes to every entering student. The free “little grey Littman” was unadorned—the disc to place on the chest, the tube to carry the sound, the hollow ear buds. Littman also brought the sparkling models with them, all making the little grey Littman look okay, but not very sexy, like a homely dress in a room full of evening gowns. The sultry knockout of all stethoscopes was the Littman 501. She could be seen draped around the necks of all great cardiologists—in their clinics, hospitals, and family photos.

Ahh, the Littman 501. Her sound capturing device was like a warm hand that would lie gently on any chest. Her double tube body with dedicated conveyance to separate ear canals ignored all voices but the one she was intent upon. Her soft ergonomic buds were like lips that would whisper sweet lub-dubs into your ears. She was dressed in elegant black with silver accessories. Walk with her through the wards, and hearts throb, beats skip, murmurs rise for you and your 501. Your unbuttoned white coat flutters, leaving those with lesser stethoscopes gazing admiringly, with a twinge of envy, then hurrying to keep pace. Stay with her long enough and she would curl up into a perfect halo, illuminating your way.

I held the little grey Littman in my hand, and saw the 501 gaze seductively at me from across the room, promising love, happiness and the ability to hear a paradoxically-split S2.

“What do you think?” I asked the cardiology attending who was there to browse. His Kentucky drawl thickened the air before his lips, the words slowly making their way through it. His statement stayed with me throughout my career. “It ain’t what’s in your ears that counts; it’s what’s between them.”

I love the high-tech tools of my trade—my slit lamp, the ocular coherence tomographer, my phaco machine, the laser—but the most valuable tool I possess is me: my brain, followed closely by my eyes and my hands, all held together by my soul which helps me work compassionately.

The doctor-as-tool may seem obvious, but it isn’t. We often give better care to our equipment than to our selves, thus growing dull, sometimes even broken, from lack of maintenance. People come to see us, because of who we are. They’re happy when we have the best equipment, but they know that without the talent to use the technology, and the soul to stay off grumpiness, the doctor isn’t much use.

Last week the new patient looked stunned when I said that the treatment for her lingering red eye would be, well, brain surgery—that without it, she would die. She had walked in, expecting more drops. But my eyes had seen the tortuosity of her conjunctival blood vessels. My brain had noticed them and drawn a conclusion. My hands opened the drawer, dusted off the stethoscope, and placed it, oddly enough, on her skull. I heard the faint swoosh swoosh swoosh—a leak from a vessel in her brain, squirting blood with every heartbeat. The leak was raising the pressure inside the cavernous sinus, slowing drainage of blood from her left eye. This was causing her chronic “conjunctivitis” which no drops seemed to cure. I put my little grey Littman back into the drawer, and smiled, knowing that technology can be seductive, but it’s not what matters most.

[I](David Khorram, MD is a board certified ophthalmologist and director of Marianas Eye Institute and the author of the book, World Peace, a Blind Wife, and Gecko Tails. Comments and questions are welcome. Call 235-9090 or email him through www.MarianasEye.com, or leave comments at www.MarianasEye.blogspot.com. Copyright © 2008 David Khorram)[/I]