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Lost a metaphor
Old 01-24-2015, 02:11 PM   #1
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Lost a metaphor

A trusted old friend left me forever last week. My 40 year-old stethoscope finally disintegrated into a heap of tubes, hardware and failed plastic ear buds. The cause of death was the snagging of a metal part as I carelessly opened my desk drawer. Ironically it had seen little use in recent years as my retirement replaced most of my practice time. But it still saw occasional duty and its unceremonious departure stirred my memory.

When I bought it back in 1971, it raised “important" questions: should I wear it looped over the back of my neck or hang in front hanging like a second necktie? Do I really need to wipe it down with alcohol after every new contact? Can you really hear heart sounds from the left and right ventricles and all four valves? Could I get by without it? (Front, yes, yes, no.)

It was my tool for the laying-on-of-hands more times than I can count. Its flat diaphragm made first contact with patients of all varieties - black, white, young and old, sick, well, and everything combination in between. It assured many a young patient that they could listen to their own heart beat right on the spot, usually eliciting a wry smile. For the more frail, it somehow seemed to impart well-being, along with a brief “everything sounds just fine."

I had to give it a quick cleaning a dozen or more times a day. I sat on it countless times but it never complained. It has been soiled by unmentionable fluids many a time. Always in my lab coat pocket it would nearly jump into perfect position in my ears with a quick tug.

Over the decades this instrument bore witness to death and dying, distress and relief, breathless agony and jittery laughter. It was my sheriff’s badge, the most conspicuous tangible mark of my profession and, to some extent, of my self-image for the past four decades.

The trash can was full this morning so I haven’t gotten a chance to throw it out just yet.
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Old 01-24-2015, 02:47 PM   #2
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OK, Rich. Time to move into the 21st century:


Thinklabs offers a high-tech take on the stethoscope

Littmann® Electronic Stethoscope Model 3200
Attached Images
File Type: jpg steth.jpg (25.9 KB, 7 views)
File Type: jpg steth2.jpg (8.5 KB, 239 views)
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Old 01-24-2015, 02:50 PM   #3
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Someone should play "Taps". That stethoscope had a good, long life.


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Old 01-24-2015, 02:56 PM   #4
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Old 01-24-2015, 02:59 PM   #5
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Rich - it sounds like it was a trusted ally.
I'm sorry for your loss.
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Old 01-24-2015, 03:10 PM   #6
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Rich, you don't have to toss him out just because he's in bad shape. Find a warm corner in the office closet and set him there, gently. Surely he won't take up much space.
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Old 01-24-2015, 03:20 PM   #7
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I have tried an electronic stethoscope once and hated it-I hear better with the traditional stethoscope. I've had to purchase about five in my career. Weather damaged a couple left in my car. Last time I bought two, with my name monogrammed on them, and still one disappeared. I've always bought the same model and the same color.

You must have been very attached to yours.


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Old 01-24-2015, 03:22 PM   #8
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I , for one, am looking forward to dumping my 25 year old stethoscope in March
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Old 01-24-2015, 03:50 PM   #9
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Aww, such a lovely tribute to something I imagine many folks take for granted. Thanks for sharing that, Rich.


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Old 01-24-2015, 03:53 PM   #10
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Made me look...I still have my 33 year old Pediatric Littman stethoscope, my ophthalmoscope, otoscope and tendon reflex hammer. However, because I worked in an ICU specialty where each patient had their individual stethoscope, mine ERd many years before I did and it remains in good shape. I just don't have the same attachment to it that you do, Rich. Personally, I could never hear the more subtle clicks and diastolic murmurs, especially in pediatric patients with rapid heart rates. Maybe I can give my tools away to the local medical school, or something.

I always think it's really staged when a doctor is being interviewed on TV wearing a stethoscope. Many of these doctors never use a stethoscope in their work (they may be anything from dermatologists to psychiatrists), but somehow the stethoscope has become an iconic badge of the medical profession.
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Old 01-24-2015, 04:01 PM   #11
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Rich, you don't have to toss him out just because he's in bad shape. Find a warm corner in the office closet and set him there, gently. Surely he won't take up much space.
Hmm.. I do have a classic Marcus Welby type doctor bag which I used for the infrequent house-call. Might go well together.
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Old 01-24-2015, 05:21 PM   #12
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Another vote for saving it.

Story:
About 30 or 40 years ago a young intern got a patent for an electronic stethoscope. Somehow he found me, to make a protoype, based on his patent.

I knew nothing about stethoscopes, the sounds to listen for or what they mean. Spent a many weeks researching the then available info, listened to tapes of various sounds and what they supposedly mean. Not only of heart, but gut noises as well. Read many descriptions of sounds and some then current comparisons of microphones amplified.

Found good many discussions where the electronically enhanced sounds were vey different from the diaphragm, rubber tube conveyed to ears. Turned out that the stethoscope has a very peculiar frequency response. Someone trained the by classic method could not confidently identify the noises which were electronically amplified without applying filters to reproduce the frequency response of the diaphragm/rubber tube combination.

To cut to the chase, I could not make the patent description work. Several problems were that the inventor wanted all to look like a classic stethoscope, electronic amps really small were few and far between, batterys were to big, and earbuds then had real crappy response in frequency band of interst.

But it was wonderful learning experience. I did not charge the guy anything as there was nothing to deliver. For me the great value was in the research and discovery in an area which otherwise I would have never thought of let alone undertake. It was all done evenings and weekends, as I had real job.

NB: Some years ago had a stress test, they asked me if some interns can listen to my ticker. The cardiologist was telling them whre to put the pickup unit and what to listen for. They poked and tried, all had just puzzled looks. One excercise was to put the diagraphm so they could listen at the apex. Seems that is a magic spot for hearing several valves. Not one could get it right. Looked to me like they had to be within a few millimeters else no good. For each the cariologist placed the pickup in the magic sopt and when the interns listened, their eyes really lit up. I asked to listen it, but it was to hard make out anything in good detail of my own ticker.
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Old 01-24-2015, 05:38 PM   #13
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Rich- mount it on your wall like a proud hunter would mount a 12 point buck. It has served you well. It deserves to be displayed.


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Old 01-24-2015, 05:44 PM   #14
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To think medicine evolves so slowly. While not a mechanic, I have all kinds of diagnostic tools that are useless today. Think: dwell meter, vacuum guage, compression tester ...... At least the human body has not evolved like the car.
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Old 01-24-2015, 05:49 PM   #15
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At least the human body has not evolved like the car.
Which is why the low tech stethoscope (first invented in 1816) still works.
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Old 01-24-2015, 06:22 PM   #16
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It's a symbol and a memory. Frame it and hang it on the wall.


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Old 01-24-2015, 09:54 PM   #17
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Hmm.. I do have a classic Marcus Welby type doctor bag which I used for the infrequent house-call. Might go well together.
Perfect! I'd save it there. Some day in future years, you may decide that the time is right to throw both of them out (or not). It is not quite that time yet.

What a great initial post. I think we can all relate to your dismay.
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Old 01-25-2015, 01:59 AM   #18
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I'd save it, for a while. I still have mine plus my mechanical bp cuff, ophthalmoscope and otoscope from 1978. I often use the stethoscope to take my own bp with my old manually inflatable cuff when I don't trust my electronic bp machine.


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Old 01-25-2015, 07:15 AM   #19
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Beautiful post, Rich. All the hearts that you have listened to would say thank you for sharing it.
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Old 01-25-2015, 09:38 AM   #20
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Which is why the low tech stethoscope (first invented in 1816) still works.
Incidentally stethoscopes work real well for diagnosing automotive problems superbly.

Though I use a modified cheapskate version, a three foot fairly stiff hose with a funnel's tip stuck in the hose. Using the free end of the hose to probe around and the funnel's wide end pasted to my ear.

I have diagnosed many problems that the push button parts changer techs could not find, let alone repair. it works on any system or component that makes noise. Bearings, valves, injectors, pumps etc..

Note to budding diagnosticians for automotive, watch where you are poking!

Pretty much like anything that makes a noise in the humam body. Heh, you ever heard a kidney stone passing? A bit hard to hear over the patient's other noises.



So once again RIT's er, Rich by the bay's old stethoscope truly deserves a place of honor.
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