Sometimes the patients do read the textbook

I heard my first real life honest-to-God murmur today.  It was 3/6, blowing, crescendo-decrescendo, best heard at the right sternal border, radiating to the apex and carotids. No surprise, then, to learn that the patient’s aortic valve was about the size of a pinhole.

Murmurs (and rubs, and gallops) have always eluded me in the past. Second year, when I was studying for boards, I would turn my computer sound ALL THE WAY UP, as though I were deaf, trying oh-so-hard to hear a bruit or a murmur. Once, during my primary care rotation, I caught a mitral valve prolapse (though technically that’s a click), but that patient had such a marfanoid habitus it would have been silly of him not to have cardiac findings.

And so I always had this fear, lurking right behind the “intern in the ICU” fear, that I’d graduate from medical school unable to identify a murmur. So check one off the list!

Overeager student-ness aside, though, just being back in the hospital for the last two days reminds me how much I missed clinical practice. The nurses’ station is always buzzing with energy. The conferences are esoteric but the teaching is excellent (like the fellows’ whispering explanations to us students at the back). That said, I do prefer the more structured, ownership format of being on the primary team. My fellow is very chill, and uses much of the downtime to teach, but when it’s all downtime?

Let’s hope I didn’t just throw a jinx and we get 10 new consults tomorrow!

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