I retired my first stethoscope today. I bought my Littmann Cardiology III during my first term of medical school in 1999. It came with a penlight, otoscope, ophthalmoscope, manual blood pressure cuff, tuning forks and reflex hammer, all contained within a traditional black leather physician’s bag with my initials in gold. Receiving your medical student diagnostic kit is one of the rites of passage for all of us who enter this profession.
I still own all of these items. Most are in that same black leather bag on a shelf in my office. But it was my stethoscope that I have used most often since then, well, until today.
That stethoscope was with me in the Caribbean where I placed it on the bodies of mock and real patients. I listened to patients with dengue fever, Jamaican vomiting sickness, as well as diabetes and heart disease. I almost lost it on a bus outside of Kingstown, St. Vincent and the Grenadines. An old man with hardly any teeth ran after me when it fell from my white coat on the seat beside him. I was so appreciative; I gave him a hug and bus fare.
I used my stethoscope at Highland Hospital in Oakland when I saw my first patient as a third-year internal medicine clerk, a young woman with HIV and Churg-Strauss Syndrome. It bore witness to a young man screaming “F*CK YOU!” at me because my resident refused to give him narcotics in the emergency department for his chronic back pain. When I transferred to Northeastern Ohio, my stethoscope moved from hospital to hospital while I worked in my third year clerkships, from auscultating a quiet belly of a six-year-old girl with an acute abdomen to an Asian-American man getting electroconvulsive therapy for depression to visiting the home of an Amish family worried about their teenaged boy with pneumonia. I heard the muffled explanations to my attending about how “the onions didn’t work” as I heard egophony in his chest.
My stethoscope then accompanied me on my away electives in internal medicine in Scripps Mercy in San Diego where I saw a patient with Familial Mediterranean Fever and then on to San Francisco General Hospital where I took UCSF’s famed AIDS Elective to UC Davis and gastroenterology before returning to Ohio to finish up my medical school by seeing patients in the Burn Unit at Akron Children’s Hospital for my surgical subinternship.
My stethoscope then went with me to Dartmouth-Hitchcock Medical Center in New Hampshire, where I used it in various units, on the general medical floor, in the bone marrow unit, in the ER, on codes, at the White River Junction VA and at a retirement home auscultating a murmur on a WASP veteran of World War II. It helped me listen to the lung crackles of one of my heroes, another dying WWII veteran who served as a marine in the South Pacific. My stethoscope was with me when I heard him tell his family not to cry for his grave prognosis because “every day since ’45 has been gravy.” I listened to the heartbeats of former surgeon generals, governors and senators.
My stethoscope came with me on my allergy electives at UCLA and a private allergy practice in Crescent City, CA. I took my stethoscope with me on volunteer trips with Los Medicos Voladores (the Flying Doctors) at a migrant clinic south of Indio, CA. My stethoscope walked the halls of Yale-New Haven Hospital with me for three years during my allergy and clinical immunology fellowship. We assessed asthma patients together, consented patients with unstable coronary lesions for aspirin desensitization in the cardiac ICU, worked-up kids with primary immunodeficiencies and desensitized a pregnant woman with penicillin allergy to penicillin to treat her secondary syphilis and hopefully keep her baby from that spirochetes ill effects. We even heard the worsening stridor of a patient with hereditary angioedema requiring that he be quickly intubated.
After my training, my stethoscope traveled with me to Colorado for seven years where I learned the efficiencies and joys of private practice. And eventually, it has moved back to California for the last year and a half. There hasn’t been anywhere that I have practiced medicine where my stethoscope wasn’t in the pocket my white coat, until today.
My stethoscope taught me about murmurs, rubs, crackles, rhonchi, wheezing (lots of wheezing!), bowel sounds, E to A changes, fluid levels, COPD, bruits, normal and abnormal bowel sounds and opening snaps. I even heard the machinery murmur of a patent ductus arteriosus in the chest of my eldest daughter, and the lack of the same murmur after that PDA was coiled closed. I’ve been through two sets of earpieces, two diaphragms, and two bell covers. The acoustics have waned in recent years from being washed and re-washed and washed again. It was making me think that my hearing was beginning to fade. No, it wasn’t my aging ears that were failing, but the PVC tubing breaking down that muffled the sounds I was straining to hear. My new Cardiology IV scope is like trying readers on for the first time. I can see! I can see! Now, I can actually hear those subtle murmurs again!
My stethoscope helped to keep patients alive so their children could fly in to sit with them when they died. And it helped me to pronounce the deaths of twenty or so of my fellow humans. It witnessed so many tears, even a few of my own. It also could tell of those who we saved, those who went home with their parents, those who survived an epic motor vehicle collision with a moose, those who were scared mentally but not physically, those who were shot by accident and on purpose. My stethoscope was witness to the things that matter most like discussions of DNR status to talking with families in palliative care consults to getting consent for a cardiac catheterization. It also was there with me for the frivolities of physicians trying to unwind, for the dark humor that doctors utilize to cope. It heard my attendings and colleagues express doubts and argue about appropriate next steps for treating complicated patients.
Earlier this year, my wife received a sword her great(x3)-grandfather, a lieutenant who served in a West Virginia Militia regiment from 1863-65 during the Civil War. I have been looking into display cases for that blade, and I’ve often wondered about what horrific things that sword witnessed in its youth.
I wonder if I should find a similar way to display my stethoscope. Certainly, a companion of the last 19 years of my professional life deserves more than to be stuck away in a physician’s bag sitting on a shelf. If my descendants someday come across my stethoscope, I hope they will be able to know and appreciate the history of this special device. Thank you, my old friend.
Matthew Bowdish is an allergist-immunologist.
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