Had a lovely encounter with my 92 year old patient this past week. I had been taking care of him for over a decade and we had grown fond of each others company whenever we met. He was in exceptionally good health for his age despite his aortic valve that was getting severely narrowed. We had now reached the point in his care that we were approaching valve replacement. We had also agreed not to compromise his quality of life if he were to undergo a surgical procedure.
He had been adamant about not replacing it, despite its severity.
“ Doc I was born with this valve, and I am going to die with it still in me”
I alway respect my patients’ opinions and choices. I did not try to strong arm him with fears of what might happen to him if he chose not to the valve. I figured he is a grown man and he has been responsible enough to make his own decisions till this ripe age, so who am I to take away the autonomy of this venerable elder.
“ It is your decision Mr J. I have respected your choices all these years. If you have any other symptoms of chest pain, or worsening shortness of breath or passing out let me know, I can adjust your meds without sending you for surgery. “ I informed him.
“ Son, I am 92, when you get my age, shortness of breath maybe something you learn to live with” he replied.
Then I had a thought. I took off my stethoscope after listening to his heart sounds, I put the ear piece into his ears, and gently placed the chest piece onto his heart. And I waited. His eyes widened and turned to me.
I nodded in silence. We both understood. Yes that is your heart my eyes affirmed.
He started to tear. “ That is my heart”, he said.
“ Yup and that whoosh is your blood rushing through your narrowed calcified aortic valve “
“ I have never heard my heart before, thank you”.
“ You are welcome” I replied. I let his 68 year daughter, who had accompanied him, listen to her own father’s heart sounds. She had the same reaction as he did.
Not everything is about fixing, or handing out medications. It is not always about educating nor is it about making everyone follow institutional medical guidelines. Sometimes it is just about making an old man get in touch with his himself by hearing his own heart that he was born with, abnormalities and all.
This is the perfect image of healing.
End of lesson.
…………….
I love you
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