The Yale Journal for Humanities in Medicine

Notes from a Healer

Matters of the Heart

Brian T. Maurer
btmaurer1@comcast.net

Three decades ago, when I was a resident in training, I spent two weeks pursuing an elective clinical rotation in pediatric cardiology. Although I had a keen interest in congenital heart disease, I had an even keener interest in the cardiologist himself. Well-known in the greater Hartford area at the time, he has since retired. During his long tenure in practice, he mentored hundreds of young doctors, many of whom benefited immensely from his erudite knowledge and model of impeccable bedside manner.

He was, in essence, a physician’s physician.

One afternoon we sat in his office, the medical record of his next patient lying open on the desk between us as we discussed her condition.

“When I set up practice here, she was one of my first patients: a tetrology of Fallot defect that had not been picked up early enough for timely intervention,” he explained.  “In those days, our surgical options were limited. Still, she continues to get along.”

He lifted his eyes from the desk and paused to look out of the window across the city. After a brief silence, he said,  “You may be somewhat shocked when you step in to see her. The ravages of chronic hypoxia are evident in her coloring, her drawn face, the clubbing of her fingers...”  His voice drifted off as he gently leafed through the pages in her chart.  He picked up a letter, hand-written on lined paper that had been torn out of a spiral-bound notebook. “You might want to read this before you see her,” he said softly. “She wrote it several years ago. It has always amazed me every time I read it—the script is beautiful, as are her thoughts. Looking at her physical appearance, you would never guess that she could have authored such a letter.”

I studied the letter in silence, then gathered the chart together before stepping into an adjacent exam room where the young woman waited. The cardiologist was right on both counts: I was shocked at her personal appearance, although I managed to hide it well; and the letter was beautiful, both in form and content.

In his book The Art Spirit, the American painter Robert Henri observes, “Beauty is an intangible thing; it can not be fixed on the surface, and the wear and tear of age on the body cannot defeat it.… It is more the gesture of a feature than the feature itself which interests and pleases us. The feature is the outside, its gesture manifests the inner life.”

We in medicine have come to learn a great deal about the inner workings of the human body. With modern noninvasive imaging techniques we can see a computer generated replica of an actual patient’s heart as it squeezes blood through its series of valves and great vessels, however defective and aberrant they might be. Yet for all our scientific expertise, we still need to learn how to read the workings of the human heart through deeper and perhaps more subtle techniques.

That afternoon in my cardiologist mentor’s office, I learned that lesson.

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades.  As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine.  Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care.  His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: May 12, 2008