A 68 year old man comes into the clinic for a late afternoon appointment. As is typical for him, he’s 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 doing so for years on end.
The resident responsible for his care goes through the history, and checks a blood pressure in the man’s right arm.
152/103. High. Just like last time.
Then, the resident moves to check it in the other arm because his favorite med school professor, the one his classmates accused of pedantic badgering, hammered 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.
90 min. Later, the patient is on the operating table, while the vascular surgeon repairs his aortic dissection. 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 physicians who plod through medicine’s sometimes dry, but often invaluable fundamentals as heroes. The talented and the gifted – those who save lives with unwavering ease, poise and composure– rise into the medical pantheon.
The world renowned trauma surgeon who pulls a child back from the verge of death with other-worldly dexterity, or the brilliant diagnostician keeps a family fromlosing its mother 45 years too early by noticing the tiniest of details that enables the identification of a rare, life-threatening disease.
Heroism, by these standards, jolts into existence as a product of rare and unique abilities.
What would happen if we saw heroism not as buzzer-beater brilliance, but as the snowballing impact of choosing to make a difference when no else will?
Opportunities for heroism would not only burst into existence when 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 and bear witness their joys and sufferings.
Who would the heroes be? In an era of medicine when we face less time and more distractions than ever before, they wouldn’t have to be the talented, the gifted, or the brilliant. Instead, the title would go to those who, through the art of noticing, capitalize on the ephemeral opportunities to make a difference in the space of trust and compassion that floats at the beside between patient and physician.
Yes, the trauma surgeon and the brilliant diagnostician, but also the ones with the patience to always ask, “what else?” 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 most.
In other words, heroes choose to make people feel how much they care.