I pride myself on my assessment skills, my finely tuned senses -- the ability to see, hear, touch, smell, taste, and whatever the sixth sense is – I do that one well too. But lately, I must confess I have been having some issues with the hearing. I auscultate the patient’s lungs and hear nothing. I say to my partner, "You listen. Tell me what you hear."
“Fine rales,” he says.
“Ah, precisely,” I say as fine rales squares with my other senses that this patient seems to present with mild CHF. “But a bit decreased?” I add, trying not to sound too questioning.
I have noticed in recent years more and more of my patients have decreased lung sounds and I think this is more because of my hearing than their conditions. Twenty years of sirens have taken their toll. I find myself out at dinner or other functions having to say, “What? Speak up.” It is even worse with patients. “You have to speak up,” I say. “It’s hard to hear over the engine.” Oh, how I hate patients who whisper because they are too sick in their minds to talk at a normal level. I try to be polite. “Speak up,” I say. “Use your full voice. I can’t help you, if I can’t hear what you are saying.” I am beginning to sound like a crotchety old man. I remind myself of my old partner Arthur who was always scolding people to speak up. There have been days when I have put the stethoscope in my ears and held it out to the patient and said, "If you can’t speak up, talk to this.”
But I must confess in the last week, even that trick was failing me. Every lung sound I listened to was decreased. I thought it might be the stethoscope itself. I tapped against the diaphragm with my finger to make certain I didn’t have it turned off. It was on. But then I would listen and hardly hear a thing. "Decreased," I would say to the nurse. "But my hearing isn’t so great."
So anyway, the other day, I go into the hospital and approach a particularly attractive nurse. I stand over her in my paramedic uniform with my stethoscope dangling around my neck. “Hey there, beautiful,” I say. “You are looking fine today. How about you come home with me tonight?” The other nurses laugh. The nurse I am talking to of course in the mother of my daughters. All the nurses know this except for a new one who appears astonished by my confidence, my forwardness. She has heard (been warned perhaps) about paramedics and here she is witnessing one of this bold breed in action.
The mother of my daughters looks up at me and smiles. “Your stethoscope is broken,” she says.
“Huh,” I say as it look at it. “I’ll be.” The plastic diaphragm covering and rim are missing.
“Here,” she says, pulling another stethoscope out of drawer. “I have an extra.”
Later that day.
“How were the lung sounds?” The doctor asks as I give my report. “Fine rales,” I say. "with a slight expiratory wheeze.”
He listens as well. “Yes, yes,” he says. “Precisely.”
