Cutting for Stone - Abraham Verghese [116]
Ghosh guided my fingers to Demisse's pulse at the wrist. It was easy to feel, unavoidable, a surging, slapping, powerful wave under my fingertips. Now I could see that his head bobbing happened in time with the pulse.
“Now feel mine,” Ghosh said, holding out his wrist. It was harder to find, subtle.
He had me go back to Demisse's pulse.
“Describe it,” Ghosh said.
“Big … strong. Like something alive under the skin, slapping,” I said.
“Exactly! That is a classic collapsing or water hammer pulse. Its full name is the Corrigan's water hammer pulse.”
He handed me a foot-long thin glass tube that Id seen lying across his table. “Hold it up. Now turn it over.” The tube was sealed at both ends and had a little water in it. When I flipped it, the water raced down to the bottom of the tube with an unexpected smacking sound and a shock. “There's a vacuum inside, you see,” he said. “It's a toy that kids played with in Ireland. It's a water hammer. Dr. Corrigan was reminded of the toy when he first felt a pulse like Demisse's.”
Ghosh had made the water hammer for me. He had sealed one end of a glass tube with a Bunsen flame. Then he put a few drops of water inside the tube through the open end. He heated the length of the tube above the liquid to drive the air out and quickly sealed the open end under the flame.
“Demisse's heart shoots blood out into the aorta. That's the big highway leading out of the heart,” he said, making a sketch for me on paper. “A valve right here at the exit from the heart is supposed to close after the heart contracts, to keep the blood from falling back into the heart. His doesn't close well. So his heart squeezes blood out just fine, but half of that ejected blood falls right back into the heart between squeezes. That's what gives it the collapsing quality.” How exciting to be able to touch a human being with one's fingertips and know all these things about them. I said as much to Ghosh, and from his expression you would think Id said something profound.
He sent for me often during those holidays. Shiva came at times, but not if it interfered with his dance lesson or if he was in the middle of a drawing. I learned to recognize the slow, heaving, plateaulike pulse of a narrowed aortic valve. It was the opposite of a collapsing pulse. The small valve opening made that pulse both weak and prolonged. Pulsus parvus et tardus, Ghosh called it.
I loved those Latin words for their dignity, their foreignness, and the way my tongue had to wrap around them. I felt that in learning the special language of a scholarly order, I was amassing a kind of force. This was the pure and noble side of the world, uncorrupted by secrets and trickery. How extraordinary that a word could serve as a shorthand for an elaborate tale of disease. When I tried to explain this to Ghosh, he was excited.
“Yes! A treasure trove of words! That's what you find in medicine. Take the food metaphors we use to describe disease: the nutmeg liver, the sago spleen, the anchovy sauce sputum, or currant jelly stools. Why, if you consider just fruits alone you have the strawberry tongue of scarlet fever, which the next day becomes the raspberry tongue. Or how about the strawberry angioma, the watermelon stomach, the apple core lesion of cancer, the peau d'orange appearance of breast cancer … and that's just fruits! Don't get me started on the nonvegetarian stuff!”
One day I showed Ghosh the notebook in which I kept a written cata log of everything he had told me, and every pulse I had seen. Like a birder, I listed the ones I sought: pulsus par-adoxus, pulsus alternans, pulsus bisferiens … and simple drawings of what they might look like. He wrote in the fly leaf: Nam et ipsa scientia potestas est! “That means ‘Knowledge is power!’ Oh, I do believe that, Marion.”
We didn't stop at pulses. I went to Ghosh as often as I could. Fingernails, tongues, faces—soon my notebook was chock-full of drawings and new words.