It was during a rotation in the Department of Internal Medicine that I realized that our bodies are a confused orchestra, a cacophony of sounds. Early in the mornings, we would make rounds with our professor, Dr. Armon, shadowing her like ducklings following their mother. With each patient we followed the same routine: she would sit on the bed beside a patient, and then gently lean over him, aiming her stethoscope at his heart. "Shhhhhh," she said, putting her finger to her lips, "Quiet! Let' s listen."
Taking turns, we carefully sat next to the patient. Hesitantly, we aimed our new, shining stethoscopes at his chest. Anxiously, we listened. Asked to describe what we had just heard, one student said he heard a systolic murmur. Another said, "It was diastolic, certainly not systolic." Yet another student noticed galloping heart sounds, "Like a horse, running in the meadow." And when my turn came, I listened for what seemed to be a long time. I heard the heart beating, with rhythm and vigor, and perhaps a gentle swooshing sound as well. I tried to peruse, in my mind, through the chapter I read the previous night in DeGowin's Diagnostic Examination, and go over the recordings of heart sounds and murmurs I had listened to, but listening to our patient's chest, I could not decipher the matters of his heart. "The sounds of the heart," I said, "it's beautiful." Dr. Armon looked at me kindly, totally ignoring the jeering smiles of my peers. "It is beautiful," she said, "isn't it?"
Listening to the sounds of the heart, lungs and other organs is an ancient art (called auscultation) that has miraculously withstood the test of time. At first, doctors listened by applying their ear directly (or over a silk handkerchief) to the patient's chest, or lungs. But then, in 1816, a French physician by the name of Ren-Thophile-Hyacinthe Laennec encountered a difficult situation: examining a young woman with symptoms of heart disease, Ren felt that direct auscultation was "inadmissible due to the age and sex of the patient." And since necessity is the mother of invention, he immediately had an idea which he later described: "I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear."
Dr. Shahar Madjar
Today's stethoscope is a binaural (allowing listening with both ears), flexible, light-weight fine-tuned acoustic instrument. It is mass-produced and reasonably priced. To listen in style I recommend you pamper yourself with a stethoscope such as the Littmann Classic II SE ($76 on Stethoscope.com). Once you have got your hands on this beauty, lie down in bed and turn all electronic devices off. And then: listen to your heart beating; listen to your lungs while you are breathing deeply, in-and-out; place your stethoscope over your abdomen, press gently and wait long enough to hear the sounds of your bowels moving (peristalsis); then move your stethoscope over to your carotid arteries and note your blood rushing, gushing in your arteries. You are alive! And making lots of noise doing so.
While the origin of the word stethoscope is from Greek (st?thos, chest; and -skopeion, to look at), a slight change in spelling, 'status-scope' may shed light on another role of this fine instrument. Stethoscopes are carried conspicuously, with pride, allowing everyone to associate the person who carries a stethoscope with the status of being a doctor, or other health care professional.
Although I am not a cardiologist, I examine each new patient using a stethoscope. I become a student again, searching for rales, rhonchi and wheezing, for heart sounds, rhythm and murmurs, for bowel sounds and bruits. I then put my stethoscope aside, reminding myself that for me, a stethoscope is not a status symbol nor is it a mere instrument of listening. Rather, it is a note-to-self that says: don't just hear, listen!
Editor's note: Dr. Shahar Madjar is a urologist at Bell Hospital in Ishpeming. Read and comment on prior columns by Dr. Madjar at DrMadjar.com.