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…well…not taking great care of himself.
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 hammered home the need to ‘‘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, and 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 as the vascular surgeon repairs his aortic dissection. 4 hours later, he’s still alive.
The resident ends up a hero, albeit an atypical one.
As Atul Gawande explains in The Heroism of Incremental Care, the physicians who plod through medicine’s sometimes dry but often invaluable fundamentals end up overlooked and undervalued.
The talented and the gifted – those who save lives with unwavering ease and composure– have their legacies etched into medical history and their portraits hung in hospital halls. The world renowned trauma surgeon who pulls a child back from the verge of death with other-worldly dexterity. The brilliant diagnostician who keeps a family from losing its mother 45 years too early by identifying a life-threatening disease from the tiniest nuance in her lab work.
Heroism, by these standards, jolts into existence as a product of rare and unique abilities.
What would happen if we saw heroism not only as buzzer-beater brilliance, but also as the snowballing impact of choosing to make a difference when no one else will?
Opportunities for heroism would still arise when lives flicker between persisting on and becoming a memory. They would also grow out of all the seemingly minor moments when patients give us the opportunity to understand their joys and sufferings.
Who would the heroes be?
In an era of medicine when we face less time with patients than ever before, the title wouldn’t be limited to the talented, the gifted, or the brilliant. Instead, it would also go to those who practice the most basic and pure crafts in medicine- noticing, listening, and bearing witness. The ones who work in the space of trust and compassion that serves as the foundation for the art and science of medicine. The ones who step up to the bedside and into their patient’s realities.
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, “Hero” would go to those who choose to make people feel how much they care.