— NARRATIVE ESSAYS —

This Is Your Heart

Anna Dovre

Fam Med. 2022;54(1):58-59.

DOI: 10.22454/FamMed.2022.732745

Autumn sunlight flooded Beatrice’s eighth-floor room. On the bedside table, a plate of breakfast potatoes cooled next to a styrofoam cup of ice water. I shook the bottle of ultrasound gel, felt the bulk of it slam into the tube’s bottom. My supervising resident was explaining the cardiac ultrasound to Beatrice, the phrases “fluid volume” and “ejection fraction” floating through the air like motes of dust. 

Earlier that morning, with the dawn coming in, Beatrice had told me she was in Germany; the year, 1970. I wondered whether, through the fog of dementia, she would be able to comprehend the sound waves slicing through her heart, their blurry echoes sliding across the screen. I, with my (mostly) alert and oriented mind, was having a hard enough time keeping up. Hence, gel duty.

I leaned over the bed and squirted a line of gel across the transducer in the resident’s outstretched hand. She set the tip gently alongside Beatrice’s sternum. Beatrice drew a sharp intake of breath, staring at the image of her heart’s vaulted rooms, laid out in dimensions of black, white, and gray. The resident tilted and fanned the probe with minute precision, bringing different structures into focus. 

Beatrice had a low ejection fraction, her aging heart engaged in a Sisyphean struggle to push out enough blood to keep her tissues alive. I watched the silver-lined chambers fill with black blood, her flailing valves dancing their intricate waltz of systole and diastole. 

And in the midst of it all, Beatrice looked up at us, eyes wide, to ask: “Is that my baby?”

I felt a bubble of mirth rise in my chest, imagining that this 65-year-old woman was joking with us. But I noticed the way her face had softened, the wrinkles in her brow smoothing out like a bedsheet. The loosening of the lines around her edentulous mouth. Her hands, swollen and stark against the coarse white hospital blanket. I wanted to reach out and hold them in my own.

“This is your heart, Beatrice,” the resident said. Her voice was soft, but her eyes remained fixed on the screen, wrist guiding the probe doggedly across the angular, bony planes of Beatrice’s chest. 

Beatrice seemed to accept this response, leaning back against the pillow and closing her eyes. I was disappointed, somehow. I’d wanted to live in the delusion with her, to imagine that we were showing her the blooming structures of an early life, rather than the flagging myocardium that marked the end of hers. The resident pointed out Beatrice’s inferior vena cava, a black oval on the screen, gaping wide with backed-up blood. She pressed a button on the machine to capture a snapshot, a black-and-white slice frozen in time, evidence of the fluid trapped in Beatrice’s veins. 

I took a turn with the transducer, fumbling blindly through gray horizons of tissue, seeking something vaguely recognizable. Beatrice’s heart slid in and out of focus on the screen, flopping and slippery like a fish. I couldn’t replicate the resident’s tiny, precise movements of the wrist, the stillness of her images; the shapes I brought to the screen, fuzzy and insubstantial as dryer lint, seemed to mock me.

Beatrice had fallen asleep, her jaw agape and tilted slightly off-center. Her white hair had settled around her like a halo, catching the light from the window. I could feel the notch of each rib as I slid the probe down the middle of her chest. It was so strange, the way her body seemed to have flipped backward on itself—fluid pooling under the skin of her legs, swelling her ankles to twice their usual size, while the bones of her face and chest stuck out in sharp lines beneath her flaky skin.

The resident took the probe out of my hands, bringing me back to reality and mercifully ending my display of sonographic incompetence. She went back over the same structures once more, snapping a few more photos, then lifted the probe away. The final image remained on the ultrasound screen: a cross-section of the heart, its chamber walls stretched thin. I began to wipe the ultrasound gel from Beatrice’s sunken chest. She opened her eyes.

“Is my baby okay?” Her voice was thin and reedy, cracking on the last syllable.

The resident and I looked at each other across the bed. I raised my eyebrows at her. She turned to Beatrice and patted her on her bony shoulder.

“Yes, it’s okay.”

We left, rolling the ultrasound machine through the doorway, and as I closed the door behind me I took one more look at Beatrice: eyes closed, her blanket-clad form gleaming in the sun, a soft smile playing at the edges of her mouth. Positively beatific.

Acknowledgments

The author thanks Trisha Paul, Ben Trappey, and Maren Olson for their mentorship, insights, and feedback on the writing of this piece.

Lead Author

Anna Dovre

Affiliations: University of Minnesota Medical School, Minneapolis, MN

Corresponding Author

Anna Dovre

Correspondence: University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455. 715-864-4002.

Email: dovre008@umn.edu

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By Corey Fogleman  /  Posted 1/6/2022

This is a very fine essay. It brightened my day; I can tell you worked hard on it, and I appreciate your effort. Nice job. :)

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