According to the doctor, a new hospice patient discussed at the weekly team meeting had a “rapid apical pulse.”
“What is the apical pulse?” one of our chaplains asked.
In a room filled with medical personnel, I was glad someone as befuddled as me had wondered about that health care term. Like the chaplain, I didn’t spend years studying medicine. I’m an ordained minister and freelance writer, working in bereavement for a hospice. I don’t understand the world of X-rays, white blood cell levels, or titrating medication.
One of the nurses immediately responded. Soon, at least two clueless people in the meeting learned that taking a patient’s pulse with the stethoscope’s drum (or chest piece) positioned over the heart provided the loudest and most distinctive apical pulse rate. Checking the wrist is known as a radial pulse and pressing fingers (firmly but gently, please) against the neck will detect the carotid pulse.
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When the heart beats, blood flows. There is sound, faint or strong. There is movement, slow or fast. Hearing the heart at work, or working poorly, is arguably one of the oldest ways for discerning health. Some of my earliest memories of trips to the doctor involved him – it was always a “him” in the bygone days of my youth – uncurling the stethoscope from his neck to hear my heart in the anxious silence of the examination room.
Some doctors warmed the drum before touching my skin. Brrrr, some did not. Whether thoughtful or thoughtless about cold metal on exposed flesh, the doctor would then listen to me, to my heart, to the flow of my life.
Our hospice patient had a dangerously fast apical pulse rate. It was one of the most telling clues that her body (or his body, since all things are confidential) had become vulnerable. The patient’s medical chart chronicled other health issues, but the pulse was – quite literally – the loudest and most obvious.
During high school and college, I enjoyed basketball. Once, alone on an outdoor court at Fresno State (probably avoiding studying), another player joined me. Night was coming. The air was cooling. Though I didn’t know him, we played one-on-one in the fading light. We didn’t shoot around for long since my new friend proved to be an excellent athlete. He launched a jump shot: swoosh, score!
He drove by me to the basket: swoosh, score! After my humiliation, we chatted while sweat dried and the campus lights flickered on. He shared about his defensive strategy:
“Always watch the chest area when you guard a player. Don’t focus on the ball. Ignore the head and hands. You can fake with almost every part of your body except” – he touched the area over his heart – “right here.”
Ah, my decades ago companion had indicated the spot where the apical pulse rate was loudest. (Well, at least I now know after the chaplain’s recent question.)
I wear my heart on my sleeve. I know the value of heart-to-heart talks. I believe that where your heart is, there your treasure will also be. I trust good-hearted friends and wonder why some people are so hard-hearted. My heart breaks if someone is hurting. I’ll cry at a heartfelt speech.
Call me a metaphor man. Figurative speech is my gig. Sure, if I wielded a stethoscope, with its (warm, please) drum correctly positioned over a patient’s heart, I could declare, “Your heartbeat is loud.” Or fast. Or slow. Or faint. But I wouldn’t know what my observations meant for the present and future health of a person.
But I’d want to ask any hospice patient, or family caring for a loved one with a life-threatening illness, how is your heart?
Who do you need to have a heart-to-heart chat with?
Where is your heart broken?
What or who lifts up your heart and helps you make it through the day?
The radial, carotid and apical pulse give hints to a patient’s condition. Now, after the chaplain’s question and a nurse’s answer, I understand them a tad more. With a stethoscope or a compassionate question, the heart often reveals our true health. In other words, you can fake with every part of yourself except – I think you know where.