A 68 year old man comes into the clinic for an afternoon appointment, complaining of vague symptoms that seem like nothing more than those of an older man who doesn’t take great care of himself feeling the effects of neglecting his own health for so many years.
The resident responsible for his care goes through the history, and checks a blood pressure in the man’s right arm.
152/103. High. Typical for him, someone consistently inconsistent with medications.
Then, the resident moves to check it in the other arm because he knows it’s the right thing to do.
As he does it, he can hear his favorite med school professor, the one his classmates accused of pedantic badgering, hammering home that, ‘‘You always check a blood pressure in both arms. That’s just good medicine.”
This resident swore to himself he was going to be the doctor who does it right. So, for this patient, like all his patients, he moves the cuff to the other side and takes the extra 45 seconds to check the left arm.
It reads 107/73.
“Oh my god. He’s in the midst of an aortic dissection.”
90 min. Later, the patient is on the operating table. 4 hours later, he’s still alive.
This resident is a hero, albeit an atypical one.
As Atul Gawande explains in The Heroism of Incremental Care, traditional medical culture does not see heroic physicians as those who plod through medicine’s sometimes dry, but often invaluable fundamentals. The taltented and the gifted – those who save lives with unwavering ease, poise and composure– rise into the medical pantheon.
Ones like the world renowned trauma surgeon who pulls a child back from the verge of death with other-worldly dexterity and skill, or the brilliant diagnostician who catches and cures the rare, life-threatening disease just in time to keep a family from losing its mother 45 years too early.
According to this perspective, heroism is a product of rare, unique, life saving abilities. What would happen if we saw it as choosing to make a difference when no else is willing to?
Opportunities for heroism would expand beyond moments when they bolt into our hands as lives flicker between persisting on and becoming a memory. They would bubble up in the all the seemingly minor moments when patients give us the opportunity to understand them, know their sufferings, and bear witness to their joys.
And who would the heroes be? In an era of medicine when we’re more strapped for time and more distracted than ever before, they wouldn’t have to be the talented, gifted, or brilliant. Instead, the title would go to those who notice and capitalize on opportunities to make a difference whenever they step up to the bedside and into the space of trust and compassion between patient and physician.
Yes, the trauma surgeon and the brilliant diagnostician, but also the ones with the patience to ask, listen, pause, and listen some more. The ones who check a blood pressure in both arms and listen to everyone’s heart and lungs because the touch of caring hands can be a medicine in and of itself.
Even though it may not save a life that time, and even though it’s the 15th time you did it that day, it’s the first time for that patient and it just may be the moment that matters to them.
In other words, heroes act on the chance to make people feel how much they care.