The Yale Journal for Humanities in Medicine    

Cardiology on Call

Stefanie Y. Lee
stefanie.lee@ualberta.ca

66 y.o. man with atrial fibrillation in room B13. Night has fallen over the city, but the hospital’s emergency department retains the intensity of its fluorescent ambience. Glancing at the note in my hand again, I round a corner and weave my way among the supply carts and wheelchairs, looking for the patient I have been asked to see.

He lies in his room alone, swathed in white blankets which cover several of the electrocardiogram leads attached to his torso. Despite the initial appearance of sleep, his eyelids flicker open and he responds alertly as I approach the bedside and introduce myself.

I’m feeling fine, he says, but his haggard eyes belie his fear. Just a day ago, he had been in the prime of retirement, enjoying a game of tennis, then visiting the doctor for his annual physical exam. No one could have foreseen the dangerously rapid pulse and abnormal ECG tracing that landed him in the emergency room this morning following an urgent phone call from his doctor.

Thanks to the efforts of the medical team, his heart rate is now slower than it was before, but the abnormal rhythms remain. We discuss the fact that it is a common condition, and that he will likely need to take medication on a long-term basis to guard against the risks of clot formation and stroke.

I pause while listening to his chest and gaze up at the heart rate monitor, with its everchanging green tracing. He looks too, anxiety evident in his expression. My mind goes to teaching rounds earlier that day: a dozen white coats gathered around the bed of a willing patient, each examining in turn, ever so solemn and formal.

On a whim, I ask my patient if he has ever listened to his own heartbeat. Slightly surprised, he responds No, but everyone always listens to it...  sure, I’d like to, as he reaches for the stethoscope I hand him. I recall in my mind what I have just heard as he closes his eyes and rests his chin on his chest, concentrating.

The beats are certainly fast, occasionally irregular, but he can hear for himself that they are strong and clear - something to hold on to amidst the whirlwind events of the last 24 hours. The blood pressure cuff inflates with a soft whoosh, interrupting the moment. He nods, satisfied. Outwards we turn again, back to the austere glow of the emergency department...

About the Author

Stefanie Y. Lee is in the medical class of 2008 at the University of Alberta.

Published: April 25, 2007