Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [19]
Ernesto’s technique is flawless: his grip, firm yet gentle; his bare hand warm. Utterly focused, he studies his wristwatch. He stands so close to me, I can feel his pillowy belly at my arm. I have the sensation of being anchored by this heavyset man as he listens with his fingers to my heart. I stop thinking about what brought me here and what Dr. Knox might say. For thirty seconds I am absolutely grounded in present tense.
Then Ernesto looks up from his watch, releases his grip. “Sixty-eight. Heart rate’s sixty-eight,” he says. “Perfectly normal.”
At which point I feel tempted to compliment him back: How fashion-forward of you to be wearing white clogs, for instance. But no, I could never say that with a straight face. Anyhow, the moment is lost. He’s already jammed a thermometer into a plastic sleeve and has placed it under my tongue. My pulse appears on my chart as a scribbled number at which Dr. Knox will scarcely glance. Dr. Broadbent would’ve been disappointed.
Today pulse palpation is a central part of an exam only in cases of serious cardiovascular disease. What’s more, in hospitals and many doctors’ offices, beats-per-minute is often obtained not by hand but through a monitor attached to the blood pressure cuff or a sensor clipped like a clothespin to the index finger. These digital devices, sensitive enough to detect the heart rate through capillaries in the skin, operate just like the pulse calculators built into sports watches, stationary bikes, and so forth. They’re used in the interest of speed, accuracy, convenience, and, I’m told, patient comfort. Some people do not like to be touched. While there’s no such high-tech revolution yet under way at Dr. Knox’s office, Steve’s doctor visits are different. In an office gone digital, the haste with which his body is stripped of its secrets—weight, body temperature, heart rate—is dizzying. Every second shaved from an exam is, of course, money saved by an HMO. But at a time when patients are encouraged to turn to WebMD with the questions their family doctor didn’t have time to answer, it strikes me that pulse taking by hand remains an uncorrupted tradition, one with strong roots in the classical age.
In ancient Greece the art of feeling the pulse (sphygmopalpation, from the Greek sphygmos, for “throb”) was first taught by the physician Praxagoras, a contemporary of Hippocrates, one of the earliest fathers of Western medicine. Praxagoras’s star pupil, Herophilus (335–280 B.C.), was the first physician to methodically time the pulse. He used a primitive water clock that had been invented to time the speeches of orators. Erasistratus, Galen’s phantom bloodletting rival, is credited with incorporating the pulse into clinical exams. His first diagnosis: lovesickness, in a young man whose pulse quickened dangerously whenever his crush drew near. The attention paid the pulse at that time is all the more impressive given that the ancients were missing huge pieces of the puzzle. Though these healers knew they had their fingers on the pulse of the body’s innermost workings, they did not understand the actual role of the heart in circulating blood any better than they knew the distinction between veins and arteries.
Not until the intellectual watershed of the Renaissance did this begin to change. A major upheaval in how the body was viewed required first the systematic dismantling of the hallowed teachings of Galen. A key figure in this deconstruction was the Belgian anatomist Andreas Vesalius, who, in his illustrated seven-volume masterwork of 1543, soundly disproved two hundred of Galen’s factual errors. No, the liver did not distribute blood throughout the body. No, blood did not “sweat” from the right side of the heart to the left. No, animal anatomy wasn’t interchangeable with human. And on and