Free Every Patient Tells a Story by Lisa Sanders Page B

medicine. “I want to remind our students that there’s a real person here.” Medical students fall in love with what the doctor’s story can do, what medicine can do, she tells me. The morning’s performance is there to remind them of what a patient’s story can do and how the infatuation can look and sound to the patient they are trying to help.
    At the end of the morning Angoff said a few words to the students, summarizingwhat she hoped they have learned. “You’re starting out on the journey across this bridge, this education, and right now you are on the same side as your patients. And as you get halfway over the bridge you’ll find yourself changing and the language the patient had and you had is being replaced by this other language, the language of medicine. Their personal story is being replaced by the medical story. And then you find yourself on the other side of that bridge—you’re part of the medical culture. When you get there, I want you to hold on to every bit of your old self, your now self. I want you to remember these patients.”



CHAPTER THREE
A Vanishing Art
    H ere’s a story I read not long ago in the New England Journal of Medicine:
    A man in his fifties comes to an emergency room with excruciating chest pain. A medical student is told to check the blood pressure in both arms. He checks the closer arm and calls out the blood pressure. He moves to the other side of the patient but is unable to find a blood pressure. Worried that this is due to his inexperience rather than a true physical finding, he says nothing. No one notices. Overnight the patient is rushed to the operating room for repair of a tear in the aorta, the vessel that carries blood out of the heart to the rest of the body. He dies on the operating table.
    A difference in blood pressure between arms or the loss of blood pressure in one arm is strong evidence of this kind of tear, known as a dissecting aortic aneurysm. The student’s failure to speak up about his inability to read the blood pressure on one side of the patient’s body prevented the discovery of this evidence.
    Here’s another story—this one from a colleague of mine:
    A middle-aged woman comes to the hospital with a fever and difficulty breathing. She’d been treated for pneumonia a week earlier. In the hospitalshe’s started on powerful intravenous antibiotics. The following day she complains of pain in her back and weakness in her legs. She has a history of chronic back pain and her doctors give her painkillers. They do not examine her. When her fever spikes and her white blood cell count soars, the team gets a CT scan of the chest, looking for something in her lungs that would account for a worsening infection. What they find instead is an abscess on her spinal cord. She is rushed to surgery.
    Had the team examined her, they would have found a loss of sensation and reflexes, which would have alerted them to the presence of the spinal cord lesion.
    This story was recently presented at Grand Rounds, a high-profile weekly lecture for physicians, at Yale:
    A man has a heart attack and is rushed to the hospital, where the blocked coronary artery is reopened. In the ICU, his blood pressure begins to drop; he complains of feeling cold and nauseated. The doctors order intravenous fluids to bring up his dangerously low blood pressure. They do not examine him. When, after several hours, his blood pressure continues to drop, the cardiologist is called and she rushes back. When she examines him she sees that his heart is beating rapidly but is barely audible. The veins in his neck are distended and throbbing. She immediately recognizes these as signs that the man has bled into the sac around his heart—a condition known as tamponade. It is a well-known complication of the procedure she’d done just hours before. She rushes him back to the OR and begins draining the blood, which by now completely fills the sac, preventing the heart from beating. Despite her