Kacper Niburski is a medical student in the Class of 2021 at McGill University
There are only a few bodies that I have touched fully and fumblingly: my mother’s, as a baby drawn to a life that spills kindness; my twin’s, as a faulty scanner realizing that meaning is not found in mirrors; my lovers’, who have known that fingers loiter like summer horizons when undressing the lightness of being. I’ve hugged big bodies, mountains of men and women. I’ve stretched to bodies that have slipped away, that have asked for my palms to leave. And I have felt the bodies that whispered into a night that saw everything that this is what it was all about — to hold and be held, to love and be loved.
Sometimes, in the steep silence after these uneven affairs, there are heartbeats. Tiny, repetitive things that almost seem too quiet to be, but are. There, under your nail. There, in my own now. They bumble braveness. They tickle familiar muscles and call like sunlit laughter. Against the unseen quiet, their sacredness spools out in a language older than language itself.
As a medical student, I am to translate this sound that gives reason for every other sound. I touch the strange yet similar skin of people who have had a lifetime before me — who may not have one after. I listen to their heart’s mumbling muteness, analyzing the notes of its music to destroy the song.
My first cardiovascular patient played one of these songs in a tune that was old, covered over with fully flowered clothing — on her sleeves, on her scarf, on the bobby pin in her hair — and she was going to die.
She knew the drill, she told the doctor. In an office no bigger than a generous closet, she took off her yellow dress sewn with pink lilacs and purple tulips. The physician told me the case history on the other side of the closed curtains. This is the most important bit, he stressed. History.
“Emergency admission four weeks ago, generalized patient presentation, common case, renal function normal. But the blood pressure is low, so we’ll want to work on that. Then there is the pitting edema. What else is a product of congestive heart failure? Do we think the patient has right decompensation? Wrong. The patient has left. And this causes? And the patient will suffer what? And what is the worst prognosis of this condition? Good. Good. Excellent.”
Silence soon swallowed the office. The woman lay nearly naked in front of us, two males with their hands in their pockets. Her clothes oozed from the empty chair onto the floor.
The physician asked how she was feeling. She said okay. Some days are better than others. He said how was today. She said okay. He said good, good, excellent.
We carried on, equipped with professionalism and raw routine. Her hair was sparse and delicate, her skin as gray as fog. I touched her clavicle, walked my fingers to her shoulder. I looked at her distended jugular, made a rough approximation of her venous pressure. I placed my stumbling palms on her chest, where I thought her heart would be. Higher, the doctor said. The woman’s head fell slightly, slowly.
The blind regime of sentences dominated next. I blabbed aloud: blood pressure fine. Legs swollen. No cyanosis. No xanthelasma. No conjunctival pallor. Good, good, excellent.
But could this language really be mine? Me — the child of poetry, the arts grad who had written extensively on the slippery danger of the mechanisation of medicine. What was I saying? Whose words were dangling in my mouth?
Alongside the apex, why did I not instead ask about the happiest moment of her life, sneakily poking into memory like a teenager after dark? While taking her pulse pressure, should I not have wondered about mild evenings that cooed boredom and the shifting acceptance of loneliness? Were there not others who did this more gently, more softly, who felt what I felt and what I could not? What was I doing here?
Do not forget to listen to the heart, the doctor said.
My hands held onto the stethoscope around my neck. I moved the metal to her chest, to the space where my fingers had left a small, disappearing imprint. Muffled, I heard the doctor apologize for taking so long, mention that it was my first time with this kind of thing, and suggest to me that I should move yet higher again to the aortic valve for it would be the loudest, the clearest.
Chitchat poured. Heavy, whole discussions of her thick life came into my ears. Each note lapped on itself, a race finished and begun in a single step.
Her heart, those waters, that ocean. Yes, this was it. This was what was missed among this wreckage. It was all that needed to be said. It was poetry and paragraphs. It was books and spines. It was a body of busy work. It was nature. It was universal. It was a single blade of grass standing to challenge the meadows, the trees, the entire sky. It was it was it was.
What is it, Kacper?
A grade four harsh systolic ejection murmur near the ICS radiating outwards to the carotids with no change in inhalation.
Thank you, Dr. K.
Now you’ll have to be quicker for the next patient.
Yes, I will be. Sorry.
The patient sat still, waiting for instructions on what to do with her body, her life. The doctor told her. Medications, surgery unlikely, come back again when your legs get less large. Here? she asked. Here, he reaffirmed.
When I came back to the clinic weeks later, she was not there. I asked how she was doing. The physician said she had passed. I tried to ask how, but another patient was coming in. They’re early, the doctor said to no one at all.
Note: This is a true story. Consent has been given consent for this story to be told.