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Hearing Heartbeats

Making espresso, like practicing medicine, is not only a science but also an art. I can’t help but draw comparisons in the early quiet of this morning sitting at my kitchen table, lazy sun beams brightening my face, steam from my coffee cup warming it. Maybe it is because I just finished a 6-day stretch, my body still up at five AM, my mind still walking the hospital halls and the patient rooms of the last week. What coffee was then brewed quickly, measured, and efficiently between a hustled workout and gear thrown into a work bag is now brewed slowly, patiently and enjoyed on my first day off.

In the same way, medicine is often quick, split-second decisions that can feel rushed but essential. Regardless of how fast or slow the pace, measured perfection is always the expectation. Anything less and the final product comes out lacking, either too weak or too strong. Sometimes though, medicine can also happen slowly and patiently in the same early quiet of a different morning. Bearing witness to what is and what was and what will be brings an aspect of humanity to our patients. It has been these moments, more than any other, sitting at the bedside of a patient taking their final breaths as the first glimmer of sunlight pools up over the horizon, that I find myself thinking—“This is the practice of medicine.”

Anyone who knows their espresso is quick to discuss the science behind it. The size of the grind, the exact amount down to the gram, and where the beans are from can make all the difference between a good cup of coffee and a bad one. Medicine is equally as intricate. Knowing the expected change in pH for elevation in pCO2 can mean the difference between intubating a patient versus measuring myself enough to not overreact, recognizing a chronically stable state for this patient with COPD.

It takes a skilled clinician to be able to determine the grade of a heart murmur. The ventilator humming in the corner, the chatty family member who is blissfully unaware of my listening, and the vibration of the bed inflating can all skew the scientific data that may inform a decision. But in the same way good espresso is most often procured by those who have been brewing it the longest, the art of hearing heartbeats is only accomplished by those who take the time to listen.

I have had great espresso from the best, most functionally cohesive operating systems across European cafes. I have also had great espresso sitting in a friend’s kitchen from their machine with the frother broken off. Sometimes the frother breaks off. Sometimes the code blue is called, and sometime during your first year of practice you assume the role of code leader, not only because there is no one else to do it, but also because the entire team is looking to you as the expert, whether you have grown into this truth yet or not. Sometimes there are blood shortages, propofol shortages, and staff shortages. Sometimes executive management doesn’t understand. These are again the moments where science melds almost unnoticeably into art. Where compassion is so often the answer. When our hip feels the vibration of our pager, but we choose to remain motionless and attentive to the one patient who desperately needs thirty more seconds of our time. Where there are still those clinicians who execute, learn, operate, rehearse, observe, and perform day in and day out, in the effort of what we call “practicing medicine.” Markedly choosing to remain open, strong, compassionate, and constant, rather than embrace the apathy that comes more naturally from operating in a broken system.

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Correspondence to Alexandra D. Skinner MSN, ACNPC-AG.

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Skinner, A.D. Hearing Heartbeats. J GEN INTERN MED 37, 2090 (2022).

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