Fillers

An old friend

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7248.1529 (Published 03 June 2000) Cite this as: BMJ 2000;320:1529
  1. Graham Sutton, consultant in public health
  1. Wakefield.

    It was high time I chucked away my old stethoscope. Much was wrong with that battered, grubby Littman: the rubber ring missing from the bell, the warped metal end tube, the left ear piece fallen off. All of which had little to do with the fact that I could never hear anything through it.

    Junior medical days had been a nightmare, the eminent physician inviting us all to listen to his classic case of reverse splitting of the fifth heart sound, and me barely able to hear lup-dup. Eventually I developed a perverse pride in this disability: I argued that such sounds were so highly subjective that they could not support any diagnostic inference, and thus, in an epistemological sense, they were not there. I became entrenched in this view after a visit to Sri Lanka, where the chest pathology could be seen and heard from the end of the bed, just as the medical textbooks' Edwardian authors would have encountered it; and with comparable social conditions at its root. With an attitude like that, I was obviously destined for provincial obscurity and public health.

    Mid-life approached, and the millennium, and a spirit of chuck out the old, bring in the new. If I was going to carry a stethoscope at all let it be a decent one. But I sensed that there were a couple of last tasks in store for the old one.

    The meningitis immunisation clinic was crowded just before Christmas, so I left my paperwork, pocketed the Littman and walked up through town to lend a hand. And there it sat on the desk, like a badge of office, through a busy but rewarding day. Luckily that was all it was required to do: imagine a public health doctor using a stethoscope? That's like seeing a psychiatrist plying a tendon hammer, or an orthopaedic surgeon with a pleasant bedside manner—nice in a curiously old fashioned way.

    The “holidays” were spent sitting by my beloved, occasionally fetching her juice or medicines, as machinery hissed and tubing snaked around our little bedroom. Late afternoon on Boxing Day the crisis came, her breathing faded, and her pupils widened with that vision that is beyond life. I disconnected the assorted gadgetry and noted the time. And then I solemnly placed my stethoscope on her chest, and heard absolutely nothing at all.

    We welcome articles of up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

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