An amazing murmur

On the other side of the ward, there’s that ‘amazing murmur’ – the mitral stenosis, who lies coughing up pink frothy phlegm into a stained handkerchief. He’s in his mid forties, and his face and body are swollen with oedema.

A framed picture of his two little children stands on the bedside table, smiling at him from a beach somewhere, but he’s too ill to smile back at them. There’s a tiny vase of flowers, a bottle of guava juice, a Bible, and a neat tract of paperback books beside him. A small bespectacled woman in a floral dress sits quietly at the bedside reading a religious tract.

No matter how hard one looks, there’s no scarred narrowed heart valve in sight.

From An amazing murmur of the heart; feeling the patient’s beat by Cecil Helman

Commentary

The extract highlights a dangerous potential gulf between a clinical/mechanical view of a diagnosis, and the patient’s experience of illness and disease. We must understand both.

An amazing murmur of the heart; feeling the patient’s beat is the title of Cecil Helman’s short book of memoirs and stories from his time as a doctor in South Africa and the UK. He was a medical student at Groote Schuur Hospital in South Africa in the 1960s. Subsequently he became a London GP, and then Professor of Medical Anthropology at the Royal Free Hospital in London. Suburban Shaman: Tales from Medicine’s frontline is an account of his medical school experience during apartheid, and early medical experiences.

More info

  • Helman Cecil. An amazing murmur of the heart; feeling the patient’s beat. Hammersmith Health Books, London, 2014.
  • NYU Med Humanities entry on this book, by Lois LaCivita Nixon.
  • The image come from Internet Archive Book Images (Flickr), where the diagram is explained in detail. Source: Modern diagnosis and treatment of diseases of children; a treatise on the medical and surgical diseases of infancy and childhood (1911) by HB Sheffield, F.A.Davis Co., Philadelphia.
  • Cecil Helman (Wikipedia); 2009 obituary (Guardian)

Contributed by

John Gillies

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