The man had a tumor in one lung. A big one, apparently. Large enough to pull his gullet and Adam’s apple visibly to the left. I wait my turn with other medical students walking the wards, put my stethoscope to his back and hear…nothing.

Other side, other lung. Nothing. Back and forth, again. Not a damn thing. Again.

Frustrated, I move aside so others can get their turn. The pulmonologist teaching us asks if we’d heard the difference in how sound travels through the clear lung and the cancerous one. Others say yes. I hope they did. I’m embarrassed, so I mumble an “I think so.” It’s a lie.

I don’t know if anyone expects first-year med students to be able to catch the fine points of breath sounds. But I expect myself to hear something. Like breathing. I rarely do.

I don’t know if my classmates have similar problems. I suspect some do, but it’s not something we talk about much. This med school has a pretty friendly, noncompetitive ethos. Still, students rarely advertise our shortcomings. A steady, quiet pressure to  always know the right answer and do the right thing pervades medical school, maybe all of medicine. I’ve never told anyone I can’t really hear breath sounds, until now.

Our teachers know that we don’t know it all. Some try to reassure us that no one knows all the right answers, especially in year one. They say we learn by practicing and tell us to fake it until we make it.

One teacher tells about a famed cardiologist whose student complains he can’t hear any heart sounds with his stethoscope. The doctor trades scopes with him. The student returns two weeks later. The new scope is great, he says; I can hear every murmur. The cardiologist congratulates him, then points out that they had the same model of stethoscope all along. The point is clear: The issue isn’t the stethoscope, but what goes between the earpieces. You just need confidence, and practice.

I should be comforted by the story. And I can hear heart sounds. So, fortunately, I have no problem with my stethoscope. Unfortunately, that means my problem lies between the earpieces. And I don’t have a lot of confidence right now. So I’ll have to practice. To fake it until I make it. Until then, if you see me pull a stethoscope out of my pocket, please be patient. And breathe loudly.

3 responses to “Breathless

  1. Andy, there is some pretty worthwhile stuff between your earpieces. It gets better. Once you’re good at hearing breath sounds, you’ll tell your attending about all the wheezes and rales your patient has, and your attending will listen, and say, “Nope, sounds clear to me.” [The trick: ask the patient to cough for you and see if the sounds clear up.] With that said, once I got my new stethoscope, everything sounded much clearer.

  2. It may have been the stethoscope, Rae. Or maybe the four years of medical education. I did hear a baby’s heart today, twice. That was fun.

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