There’s certainly a personal bias for me to reveal that the vital sign I most admire is the respiratory rate. The lungs, after all, are a pulmonologist’s favorite organ. Yet the reason for my affection is that the respiratory rate is the one vital sign that can be observed from the doorway of the patient’s room. Before I place my hand on the wrist, before I pull the stethoscope out, before the leads and blood pressure cuff are in place, I can watch the heave of the chest and learn a great deal about my patient in an instant. There is the rapid shallow pattern of the older lady in extremis, stricken by a bacterial pneumonia and in immediate need of ventilatory support. There is the lopsided teeter totter of the patient with a pneumothorax in grave need of chest tube drainage. Then there is the slow and shallow pattern of the dying patient that Ron Lands describes in his poem “Listen to the Ocean” from the Spring 2018 issue.
Your respirations slow.
Now and then you pause,
and I count the seconds
until you start again. The tide
is going out. The light
Here, the breath of the departing loved one brings the poet closer to memories of watching the ocean’s waves ebb and flow in “happier times.” How fitting for the sea to be such a colossal stand-in for the rhythms of life itself. Breath is the mingling of existence and beauty and intimacy and memory. The lungs are a metronome, letting him know when the song has neared its end.
In my essay “Numb” in the current issue of Intima, I too become a silent observer of my patient’s rhythms. There is so much for clinicians to learn just by witnessing the patient lying in bed, negotiating their reality. My patient, riddled with cancer, did not want to acknowledge her pain let alone treat it because she felt that naming it would make her situation that much more real, more tangible to her. And she wasn’t ready to embrace that reality. So I watched her and coaxed her into some degree of acceptance by addressing the things that she feared. We physicians sometimes need to be reminded that one of the healer’s greatest tools is quiet observation.
Nikhil Barot is an Associate Professor of Medicine at David Geffen School of Medicine at UCLA and practices Pulmonary & Critical Medicine and Palliative Care Medicine at Olive View-UCLA Medical Center in Los Angeles. He has written essays and poetry for Nautilus, The Smart Set, Open Letters Monthly, and Medical Humanities. His non-fiction essay “Numb” appears in the Spring 2019 Intima: A Journal of Narrative Medicine.
©2019 Intima: A Journal of Narrative Medicine