Notes from a Healer

By the Numbers

Brian T. Maurer

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I walk into the kitchen to find my wife seated in the breakfast nook. On the table sits a portable unit that periodically projects a digital display of numbers. A flexible grey tube runs from the unit to the cuff wrapped snuggly around my wife’s upper arm. She finishes recording the numbers in pencil on a notepad and looks up at me, beaming.

“Look at this,” she says, demonstrating the numbers with the point of the pencil. “When I woke up this morning at 6:52 AM, my blood pressure was 140/88. Before I walked the dog at 7:15 AM, it was 142/90. After we got home at 7:40 AM, it dropped to 138/86. Then I drank my cup of red beet juice, and now at 8:06 AM it reads 126/77!”

“Amazing,” I comment, as I pour myself a cup of freshly brewed coffee.

“I’ve been conducting an experiment this past week,” she says, flipping through the notepad filled with numbers. “So far it’s consistent: my pressure drops every time after I drink the beet juice.”

“Well,” I say, adding a dollop of cream to my cup, “fresh beet juice is certainly healthy for you.”

“Who would’ve guessed?” she says, beaming again.

Numbers. In three decades of medical practice I’ve always been amazed at how much they mean to people. I think of parents who bring their febrile children to the office with slips of paper bearing temperature readings over the preceding days. “Yesterday morning at 7:32 AM she had a fever of 99.3. At 9:10 AM it was up to 100.8. By noon it had spiked to 102.4.” No matter that the child’s temperature in the office is now 98.6.

At infant well-child visits new parents bring reams of feeding logs documenting formula consumption. “Today she fed 2 ounces of formula at 8:00 AM, another 2 ounces at 10:30 AM, then 3 ounces at noon. Oh, and then she vomited a good ounce. Do you think she’s dehydrated?”

Numbers are a big part of medical practice. Clinicians need to know vital signs: the patient’s height, weight, blood pressure, heart rate, temperature, pulse oximetry. In the diabetic patient, blood sugar values are necessary to manage insulin requirements. In the patient with thyroid disease, levels of TSH and free thyroxine dictate adjustments in thyroid hormone replacement therapy. Electrolyte values are critical in managing the dehydrated patient; peak flow values in the asthmatic.

Numbers are the words of mathematics; mathematics is the language of science; science forms the basis of modern medical practice. How could it be otherwise?

Yet sometimes, like my wife with her blood pressure readings or my patients that take care to record every ounce of formula their infants ingest, we can get caught up in the numbers to the extent that they cloud our outlook of the larger picture. We count the trees, but miss the forest. We calculate the milligrams of medication, but fail to look at the patient.

I recently evaluated an adolescent boy who presented with a one year history of inattentiveness at school, inability to focus on task, moodiness and insomnia. His psychiatrist had tried a number of stimulant medications in an attempt to ameliorate these symptoms of ADHD.

When I examined this boy, when I saw the fine tremor in his hands and felt his warm moist skin and the diffuse mass in his neck, I wondered why no one had picked up on the fact that he had developed Graves Disease.

Of course, in the end it was the numbers from the lab tests that bore the diagnosis out.

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 patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.

Published: October 31, 2009