Listening through both ends of the stethoscope - A patient encounter, Part 2

Continued from previous entry...

The first patient that listened to my chest did not seem to hear a thing, not surprising given how loudly he was laughing. While I went on to switch sides of the stethoscope and listen to the child’s heart, I hardly needed to. A child who is taking ARVs consistently and laughing is rarely in danger of being ill, making laughter an excellent screening tool.

The next child did hear my heart, and was able to clap in unison with it. After taking the stethoscope off, her little brother took it from me and held it up to his ear like a telephone. “Hello?” he said.

The third patient, while listening to my chest, told her father, who was asking me a question, to “please...not talk” as she was “not finished with the heart listening yet”.

The fourth child, after examining my heart, insisted on listening to his mother’s, his grandmother’s, and then his own. He suggested that we go out to the waiting room to continue examining everybody, but I talked him out of it. “They have to wait their turn, just like you did.”

The next child, when I placed the listening end into her ears, just cried. It turned out that she had a painful ear infection. This was also news to mom, leaving me feeling a little less guilty.

If any of the patients are to become health care providers, the next one is a leading candidate. She asked me to hold my breath while she listened to my heart. After a very long thirty seconds, she said, “breathe now.” She then asked me to turn around so that she might listen to my lungs, which she did while asking me to “breathe deep like blowing out a candle”. (I often use this trick to help kids understand what a deep breath is.) After this, she gave me a concerned look then asked me to please lie down on the exam table. I declined, instead writing in her chart, “HIV encephalopathy and developmental delay, previously of concern, seem to be resolving.”

I continued to see several more patients in this fashion, learning something about each one.

Then came my last patient of the day. Her name was Mary. (To be continued.)