The Patient Was…

The patient was a 37 year old male, the same age I was when he came under my care. He had a background in pharmacy, and with a family history of coronary heart disease he was naturally aware of, and reasonably concerned about, the possibility of developing it himself.

He didn’t smoke cigarettes, but indulged in cigars when watching hockey games, a favorite past-time. The more exciting and violent the game, the more and harder he smoked. His alcohol use followed the same pattern, and when I once attended a hockey game with him at Madison Square Garden, the beer flowed freely.

In his personal relationships of which I was aware he was loud and commanding with both males and females, and somewhat bullying if he didn’t get his way. He was bright and articulate, and could wear you down when arguing his point of view. He didn’t like to be contradicted and took offence easily.

When he called me one day to describe a vague and mild discomfort in his chest, accompanied by slight nausea, it was enough for me to direct him to the hospital emergency department where I met him. He was not in any great distress, and his physical examination was normal, but his electrocardiogram showed a classic pattern of an evolving heart attack. The damage seemed to be confined to a portion of the bottom of the heart, which was considered to generally have a more favorable prognosis than injury to other portions of the heart muscle.

In young patients with such a pattern, the blood vessel blockage causing such heart muscle damage is usually limited to a single coronary artery. Nowadays, a patient with an evolving heart attack would routinely be whisked to the coronary catheterization department for an angiogram  — a procedure where a catheter is inserted into the coronary arteries and pictures are taken showing the arteries after an injection of a dye —  this event happened before coronary angiography was routine. So, with apparently limited damage to  his heart and no clinical signs of distress or danger, he was admitted to the hospital for monitoring of his condition.

I routinely saw my hospital patients twice each day, in the early morning before going to my office and again at the end of the day after my office hours were finished. The patient’s recovery was uneventful, which is exactly what one hopes. There were no signs of further heart damage, and no evidence of impairment of the heart’s pumping ability.

In those days, patients were kept in bed after a heart attack for several days and in the hospital for a couple of weeks. (Nowadays, early mobilization and discharge from the hospital are routine in uncomplicated cases). One evening, as his discharge date was approaching and I turned to leave his hospital room after examining him, he suddenly called out loudly.

“What’s wrong?”

“What do you mean?” I asked.

“Something’s wrong with me,” he said.

“Nothing’s wrong,” I said. “You’re doing great.”

“Something’s different,” he countered.

“Nothing’s different,” I insisted. “Why do you think something is wrong?”

“Every time you leave after examining me,” he said, “you say ‘Excellent.’ Tonight you just said ‘Terrific’. What’s changed?”

I was stunned. First, I never realized that I had always said “Excellent.” Second, to me “Excellent” and “Terrific” would mean the same anyway. And third, it never occurred to me how carefully he listened to every word and drew meaning from what was said. But he was convinced that I was describing a subtle change in his condition and it concerned him greatly.

It took a long time and an earnest discussion to assure him that there was no change in his condition, that he was progressing perfectly, and that he would be discharged just as planned.

Patients do listen to what you say, some very carefully, perhaps too carefully; and they may draw serious conclusions where none are intended.

Yes, sticks and stones can break your bones, but words can also harm you.