My stethoscopes. I had several. They were special, awe inspiring tools and badges of my new life and identity. I inscribed them with my name and learned to care for them - by trial and error. My first stethoscope – a gift from my proud parents - was usually crammed into a pocket of the short white coat I wore around the wards. One day, the tubing split. I learned the most durable way to wear it was draped around my neck.
I slowly and progressively learned to use it - to keep it clean, to not transfer infection and how to wield it without mutual embarrassment to the patient’s benefit. I built up a library of sounds in my own head and developed a sense of what was normal, what was not normal but not pathological and what was definitely pathological.
What episodes stick in your mind?
I remember when it did not work. When I could not get a BP reading because the BP was too low for Korotkoff Sounds, because I was in the back of an ambulance going lights and sirens to hospital, when I was attending to a patient in dire peril and the pounding of blood in my ears blocked out any other sound.
I listened and no noise came from one side of the chest.
I took a slow deep breath and eventually learned to focus on the needs of the patient - my fear served no function except as a distraction.
I heard the wheeze of asthma, the rales and crepitations of infection and the pleural and pericardial rubs, the hollow echoes of cavitated TB. There were things absent that should have been present and vice versa. I heard the unilateral wheeze of a stone in the right bronchus, of a compressive cancer. Far too often, I heard nothing and having heard nothing I turned to the nearest table and completed the Death Certificate.
I remember the roadside trauma, the cricothyroidotomies I had to do. I recall the anaesthetics. Did I really do all that?
I remember all the techniques I was taught by those who had seen it all, done it all and were only too glad to have an eager pair of ears to finally tell. They had so many stories bound up in medical confidentiality that they could not share with family or intimates. Finally, as my teacher they could unload. Their passion imprinted their stories into my consciousness – I can see them still. May they rest in peace. In spite of my encouragement, they never wrote their life stories, which is probably why I have become a researcher, a teacher and now RACGP Victoria Historian - to see that they are remembered. They learned their craft by the trial and error of everyday practice. They had paid a high price for their knowledge - if I or any other doctor could be spared by their experience, they will rest happy. “Chris, experience is what is left when you survive your errors.”
Dr Chris Hogan
First published on the RACGP History page, under Tales from the Tools
