"Nathan, have you read The House of God?"
"Yes sir, I have"
"And what does it say about taking temperatures?"
"One of the Laws in the House of God, is "if you don’t take a temperature, you can’t find a fever."
"Yes, now give me your hand so I can slap it."
The idea behind the law is, if a patient isn’t feeling sick, they probably aren’t. Therefore, medical intervention, which ethically obligates action upon abnormal findings, isn’t going to help them.
This is usually correct.
So today, when Mr. Seneca, 60 something, with no health problems, showed up for his annual physical feeling fine, I probably should have just left him alone.
I couldn’t though. I listened to his heart and heard a rhythm more like one of Billy Martin's creations than the normal lub dub. And feeling his pulse, I heard "beat-beat-beat-beat-beat *pause* beat-beat-beat-beat-beat *pause*" for several cycles.
Not good, right? No rocket science there. But Mr. Seneca feels fine. He’s actually just complaining of low back pain, and hasn’t even tried aspirin for it, because it’s so mild.
But I am a medical student, and I care about my patient, and of course, about my learning. So, I order an EKG. And that looks, for all the world, like Mr. Seneca is having a heart attack. PVCs, ST segment elevation, just general electrocardial craziness. This triggers pulling of old EKGs, a cardiology consult, a discussion with the inpatient medicine team, and two hours worth of work admitting the very last patient of the day.
My resident was not too pleased, but the leading conversation here was between me and my attending. He was thankfully, mostly kidding.
It’s maybe a bit morbid, but I was excited. A break from sore throats and well baby checks is always welcome to me. I didn’t even notice the time pass.
Mr. Seneca may be fine. But I might also have saved his life with that EKG.
That’s why I’m here.