Notes from a Healer

The Beat Goes On

Brian T. Maurer

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He’s come in to see me because his heart has been racing for the past two weeks.  Just yesterday he had an episode of chest pain and shortness of breath.  His mother told him that there was heart disease in the family, so he thought he should get himself checked out.

At 19 years of age he’s already had surgery for a ruptured ACL.  He’s gone through physical therapy to rehabilitate the knee, but he complains that it still cracks when he flexes and extends it.  He’s wearing a knee brace today.  “I was wondering if you could check out my knee too and tell me what I need to do,” he adds.

Tachycardia, episodic chest pain with shortness of breath, and post-op knee pain—a tall order of problems to be sorted out in a 10-minute time slot.

I start by asking him when the rapid heart beat kicks in.

“After I exercise,” he tells me.

“What sort of exercise do you do?”

He shrugs his shoulders.  “Some days I lift weights for my upper body, some days for my lower body, and then I usually finish up with some cardio on the treadmill.”

“And when you do you get short of breath, during exercise or immediately afterwards?”

“The last time it came on about half an hour after I got home.  I got a sharp stabbing pain in my chest, and then it felt like I couldn’t breath—my chest got all tight.”

“How long did this feeling last?”

“About 20 minutes or so, then it settled down.  But my heart was still beating fast—I could feel it in my chest.”

I flip through his medical record.  At one time he was given an inhaler for exercise-induced asthma.  “Do you still use your inhaler when you exercise?” I ask him.

He laughs.  “I haven’t used that thing in a couple of years.  I don’t even know where it is.”

I listen to his heart and lungs.  There are no extra sounds, no clicks, no murmurs; but I clock his apical rate at 96 beats per minute. His lungs are clear.

I step back and pop the stethoscope out of my ears.  “Did you exercise today?” I ask him.

He nods his head.  “Just got done about an hour ago.”

“Your lungs sound fine, but your heart rate is up a bit.  Do you take fluids during your workouts?”

“Just this,” he says, pulling a large plastic canister from his backpack.  “It’s got a ton of vitamins to give you energy while you work out.”

My eyes drift down the label as I scan the list of ingredients: mostly vitamin complexes and sugars.  Then off to the side I notice the statement: “This product contains caffeine.”

“How much of this do you take?” I ask him.

“I started out with one scoop like it says on the label, then bumped it up to two scoops—maybe a little more.”

I continue to read the label.  “When did you bump up the dose?”

“About two weeks ago.”

I hand the canister back to him.  “I think you’ve been overdosing yourself on caffeine,” I tell him.  “Too much caffeine will stimulate your heart to beat faster.  It can also make you jittery and anxious.  Do you drink coffee, tea or soda—particularly cola?”

“Sometimes I drink a can of Coke or two but no coffee or tea.”

“Let’s have you stop taking this product and monitor your heart rate over the next several days.  Give me a call, and let me know how you’re doing.  I have a hunch that your heart rate is going to slow down.”

Slowly, he nods his head.  “So there’s nothing wrong with my heart?”

“No, you’ve got a healthy heart and a healthy set of lungs.  I think you’re going to do just fine.”

“Good.”  He lets out a long sigh.  Then without missing a beat, he says:  “So, what do you think I should do about my knee?”


About the Author

  • Photo of Brian T. MaurerBrian 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: August 4, 2012