The girl with the mumble in her heart

She was small for our age but we all ascribed it to the fact she had been born with a mumble in her heart. Sometimes she would let you listen through her T shirt, and though it just sounded like putting a shell to your ear, we knew that we were supposed to be able to hear the mumble and would all claim that we could. Nobody's bluff was ever called, as would later happen in medical school, by being asked to describe what we heard.

"D'you hear it?"
"Yeah."
"Me too."

And that would be that.

Back then, having a mumble didn't seem like a bad thing at all. It was a party trick and "a get out of games note" rolled into one. More, it meant that you knew all about the strange and fascinating world of hospitals and had stories to tell about what went on there.

There were stories about how they had their own school there but you didn't have to go if you were tired; about how they had a camera that, if you lay really still, could take pictures of your bones; about how doctors were bad but nurses were good; about how most medicines made you better but some made you worse; and about how you knew that you were really ill if your parents stayed the night at the hospital.

This is pretty much all that we knew of hospitals when we were eight. They were mysterious places that we instinctively knew we were lucky not to have to visit regularly.

As high school finished, a few of us were still wondering about it, about what those people who worked at the hospital could hear when they put their ears to that girl's chest, how they knew it meant that her batteries were flat.

So at 18, spurred on by proud parents and American television dramas, we bought white coats and stethoscopes that we wouldn't need for at least another two years. They were sold to us by our classmates, attempting to raise funds for a graduation date that seemed as far away as the Moon. Still, the length of coloured tubing and the ill fitting starchy material, when clandestinely modelled in front of a bedroom mirror, somehow provided reassurance: even if we didn't know anything, and wouldn't be doctors until after the millennium, at least we would look the part.

A decade and a half on from when we first listened for that elusive mumble, hospitals have retained the capacity to puzzle. The black magic and ritual witchcraft of the anaesthetics room; what it was that Wernicke and Broca were talking about and how it affects the man in bed three who can't tell you what a watch is; the incomprehensible trial protocols and clinical guidelines; pH equations that once seemed so simple in high school chemistry class; the therapeutic measures taken "because that's what we do here"; the agonists, antagonists, and antiantagonists that exist in uneasy equilibrium.

Though every day these mists clear a little, at times it can seem like they lift only enough to allow others to replace them, denser mists with eponymous names or statistical significance. On some days these mists are powerful enough to make us wonder if we've learnt anything during all these years. Worse, they can fool us into believing that we are learning things simply because we must, blinding us to the fact that, once upon a time, everything was interesting.

As the grisly spectre of finals looms ever larger on the horizon, such that mortal fear carries me to the library more and more nights, and mumbles become not just murmurs, but localised, timed, and graded too, I find myself increasingly thinking of the girl with the mumble in her heart, wondering whether my 8 year old self would be impressed if I could put my ear to her T shirt and tell him that it was a grade five ejection systolic mumble heard best at the left sternal edge.

I have a feeling that he wouldn't, because at that age we could all hear the mumble. Though there probably isn't much I could teach him, I think that I might be able to learn from him about how certain things, like a mumble, are interesting just because, regardless of whether you're listening to it with your friends on the way home from school or reading about it on a Sunday night in the university library.

So if we happen to have a bedside teaching session together, you and I, and I'm taking too long listening to the heart, please don't be impatient. Perhaps I am hearing the most interesting murmur we are ever likely to hear, the pedunculated plop of an atrial myxoma or some such, but more likely I'm hearing normal heart sounds with a distant mumble somewhere in the background, an 8 year old boy mumbling to me that sometimes things are interesting just because.

Simon Stephenson, final year medical student, University of Glasgow
Email: writesimon@hotmail.com


studentBMJ 2001;09:217-260 July ISSN 0966-6494