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Mur, Mur, Mur

Earlier this year, during my first general practice physician appointment in nearly a decade, my doctor discovered I have a heart murmur.

Lots of things have changed since that day. I’ve gone from not even having a regular doctor to having a regular doctor, a cardiologist, and a surgeon. I’ve learned I’m going to need open heart surgery, and probably soon. It has been a bizarre, uncomfortable whirlwind — and even with all of that, perhaps the weirdest, most interesting aspect of it thus far began when my cardiologist sat me down one day and said:

“I have kind of a weird question for you.”

See, I’ve apparently got a “great” heart murmur. I know that because it’s been verified, apropos of nothing, by nearly every doctor and resident who has heard it since. I think it’s some mix of loudness and clarity that makes it a particularly good murmur. It’s actually kind of charming, how much they tend to nerd out about it. They’ll tell me, “Ah, that’s a really wonderful murmur!” and I’ll react with a “Thank you,” as if they’d complimented my fastball—because how else could one react?

The question my cardiologist had was: “Would you be willing to come over to the school and have a bunch of medical students listen to your murmur?”

And, in mid-November, that’s how I found myself in room 511 at the Jordan Medical Education Center, reclined on a table, wearing a patient’s gown, with groups of medical students hovering over me—stethoscopes at the ready.

It’s one of those aspects of medical education you don’t think about too often. Everybody knows about anatomy labs and donating your body to medical education, but it’s easy to forget there are folks who donate their time to helping medical students work with the living in a controlled, low-pressure setting. Sometimes, these are Standardized Patients—people trained to act out a given malady or presentation for medical students to diagnose. Other times these are real patients, like me, whose conditions can be of some use.

These two afternoons, the students were going room-to-room learning different aspects of cardiology and heart murmurs. They broke down into eight groups of ten or twelve and rotated through, each staying long enough to be instructed on what to look for, then look for it, then discuss their findings.

Immediately, I found it fascinating. I’d worked in the health system for more than five years and had plenty of involvement with the medical school in terms of photography, communications, and social media—but I’d never been so directly involved with a class as to watch the lesson and witness the students in practice.

One of the things I was struck by: How much the process of teaching heart murmur recognition can resemble a trip to the mechanic. It’s easy to feel a little foolish, standing there with someone who knows your car better than you ever will and trying to break your problems down into the same onomatopoeic vocabulary you’d use to communicate with a two-year-old—but watching a similar conversation unfurl in a medical setting helps you understand why sometimes that’s just the most effective way to go about these things. Here’s something I heard time and time again, from multiple instructors to dozens upon dozens of students, over the course of two days:

“What you’re listening for with aortic stenosis is a WHOOSHdub, WHOOSHdub, WHOOSHdub. Mitral regurgitation is more of a sustained whoooooooosh.”

There were hand motions, too. The WHOOSH of aortic stenosis was designated by an opened hand moving laterally, the dub by the closing of the hand. With a stethoscope over my chest, the instructors could replicate my heartbeat with these gestures, like some mix of a sign language interpreter and an EKG.

I also found myself learning more about my own condition. Watching the instructors go through the same mini-lectures sixteen times or so over the course of two days meant by the end of the second day I could tell you things about my heart murmur that I hadn’t known (or maybe just hadn’t processed) before:

  • Heart murmurs are caused by blood flowing improperly through some portion of the heart, be it a passage or a valve. I have aortic stenosis, meaning my aortic valve is tighter than it should be due to it being bicuspid (having two flaps) rather than tricuspid (having three flaps).
  • Aortic stenosis is a systolic murmur, meaning it occurs during systole, which is when the heart chamber contracts. The alternative is a diastolic murmur, which occurs during diastole—the period in which the heart refills with blood between contractions. If systolic and diastolic sound familiar, it’s because the pressure of circulating blood during each of those two states is what doctors are looking for when they measure blood pressure.
  • If you can hear a murmur but can’t tell if it’s systolic or diastolic, you can determine that by checking the patient’s pulse and figuring out if you hear the murmur during or between the heart’s contractions.
  • At least in the case of aortic stenosis, the loudness of the murmur is not necessarily a good indicator for the severity of the condition.

There’s much more, but it could be an entirely different post. The sheer amount of information, terminology, and procedure explained to those students in such a limited amount of time gave me a new appreciation for just how much is expected of them throughout the entirety of their education—and, later, their careers.

As I met more and more students, I came to understand that the process of just sitting there being an actual person and interacting with these young doctors-to-be served a purpose perhaps even greater than that of heart murmur education: It’s also a way for them to work on the less clinical, more human side of their development as medical professionals.

For some students, it appears to be natural. They’ll walk up to you, introduce themselves, and confidently go about their task. For others, it’s more difficult. They hesitate. They’re unsure what to say, or how to act. One even asked me at one point, their stethoscope somewhere just under my left pectoral, “Does this seem right? Have the others put their stethoscopes here?”

In those instances, I found myself slipping into the role of … coach, maybe, is the right term. I’d offer a reassuring word, or crack a joke to break tension. I did my best to be the kind of patient they’d be thankful for at the end of an otherwise long and difficult day.

And they helped each other out, as well. They’d offer encouragement, let one another know when they were doing something wrong or inefficiently, and help keep the atmosphere calm and welcoming. After all, nervousness in this setting isn’t an indictment on anybody’s ability so much as an example of why medical education is structured in this fashion. Everyone may be in this room to learn one particular diagnostic skill, but some are going to walk out with more than that.

Relatively soon, I’m going to need surgery to repair my stenotic valve (and, more importantly, the aortic aneurysm it created). I suspect once it is gone, so too will be that “great” murmur. And while that murmur and the problems surrounding it have caused me no shortage of concern over the past few months, I do at least owe it one thing: It afforded me the opportunity to contribute more directly, more actively, to medical education here in the health system than ever before.

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