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Thoracic Exams and the Grand Canyon

I tripped into the practice clinic room at 12:05 p.m., cradling my cold coffee and explaining to my preceptor that, despite being a first-year medical student, I did not own a stethoscope yet. I had revealed this already to my roommate, Michelle. When I told her, she was confused; she already had hers for a while now because her aunt had gifted her one the previous Christmas. Michelle had never considered doing anything else. I know this because I once asked her what she would be if she wasn’t training to become a physician, and she replied, “I’ve really never considered doing anything else.” In contrast, I, a true commitment-phobe, felt that a stethoscope would be the last nail in the coffin of me definitely being in medical school and not being anywhere else. This made my skin crawl any time I opened up the Amazon web page to order one.

Back to that morning, my preceptor kindly lent me his stethoscope. In practice clinics, the female students rarely have to be practice patients. (The color drained from the faces of our class’s Midwestern-polite male students when preceptors explained how to ask females to move their breasts out of the way in order to adequately palpate for the liver.) I always got to practice instead of being practiced on. As a result, I have turned a classmate’s arm purple with a blood pressure cuff once; another time, I had almost blinded a different classmate with a penlight. A stethoscope seemed relatively harmless, so I got to work.

Hands fumbling, I placed the bell to my classmate’s chest and heard … nothing. From my cursory clinical assessment, my patient seemed very alive, so I adjusted to the diaphragm side, counted my way down to the second rib space and hoped for the best. Out of nowhere, the reverberations from the classic lub-dub struck my tympanic membrane. I giggled like a love struck teenager; I could not stop beaming as I finished the rest of the physical exam.

Hearing a heartbeat through the stethoscope was like seeing the Grand Canyon with my own eyes. People who have not been to the Grand Canyon know that it is large, and they’ve heard that it is magnificent. They may think that seeing such an astounding sight on a postcard is enough to give them an understanding of the experience. It’s not. Of course, it’s not. It is the Grand Canyon.

I felt this same overwhelming sense when I first heard the sound of a beating heart: listening to a heartbeat was a striking contrast between familiarity and awe. It was a sudden awareness of the massive task that the body takes on to keep us above ground while we trip through doorways. The lub-dub was astoundingly beautiful: reliable and anonymous.  

This essay is not only about the first time I auscultated a heartbeat, a task an actual child could accomplish, but it’s also about me finally committing to being in medical school and nowhere else. After this experience, I finally bought a stethoscope, and Michelle forced me to wear it around my apartment so I would get used to it. It’s about remembering what it was like to discover something on my own. It’s about realizing that hearts and their owners are Grand Canyons: surreal, ordinary and hopefully not as large, but arguably as magnificent.

Image Credit: “Grand Canyon – 2014” (CC BY-SA 2.0) by screaming_monkey

Claire Porter Claire Porter (1 Posts)

Contributing Writer

University of South Dakota Sanford School of Medicine

Claire is a first year medical student at University of South Dakota Sanford School of Medicine in Vermillion, SD. In 2017, she graduated from University of Minnesota, Twin Cities with a Bachelor of Science in chemistry. She enjoys running, watching Law and Order reruns, and bar trivia in her free time. In the future, Claire would like to pursue a career in pediatrics and/or palliative care.