Single eye furiously blinking, Phillips world looked a lot like an old turn of the century film. A fraction of every second hidden, lost. Again and again. Everything looks strange when you see only parts of what you’re meant too. The doctors prying face flickering from his computer to the little ascending numbers on his sphygmomanometer. That thing sitting on every doctor’s desk. The little cuff wrapped around Phillip’s upper arm, the doctors stethoscope placed in the hollow of his elbow, listening to the relative silence of a collapsed brachial artery.
The doctors dark brown hands, covered in thick puffy veins slowly undo the valve on the pump, the little mercury measuring stick dropping from 180mmHg down to 120mmHg. The doctor listened intently to the sound of Phillips artery reaching systolic pressure, of volatile flows of blood rushing home; vibrating the artery walls, playing Phillips doctors’ favorite tune.
Korotkoff sounds they call them. Phillips current best friend, this bed-manner ridden relic. He says there are 6 phases for the Korotkoff sounds; the silence just before systolic pressure is reached at 120mmHg, that’s phase one.
Then as the blood forces the artery walls enough open to allow a trickle of velvety blood there’s a tapping sound as the artery walls bang shut again. Sort of the way that milk glugs when you tip a new carton out over your cereal, so much liquid crowding the doorway. That’s phase two.
This trickle balloons out to a flood characterized by a swishing sound as currents of blood swirl and collide. That’s phase three. Sometimes, says this old doctor, with his eyebrows like fat silver caterpillars. Sometimes if the sphygmomanometer cuff is deflated too slowly, the sounds vanish for awhile. This happens when the blood vessels beneath the cuff become congested (think London traffic at 5pm); this is a sign of hypertension he says. The congestion eventually clears and sound resumes. The intervening period is called the auscultatory gap. Auscultation; the practice of listening to organs.
Phillips single bloodshot eye continues its’ ceaseless blinking, watching those gnarled old fingers move like a rough sketch cartoon. One frame at a time he watches the Velcro separate with its trade mark sound. Watches the doctors chapped lips move from open to close with no hint of the movement in between. His rambling jargon seemingly disconnected from those scabby pillows of flesh. A disembodied voice offering up useless information about the day to day chores of some sad old life saver. Everything looks strange when you see only parts of what you’re meant too.
A few frames later and Philips doctors has rubber covering his hands, hands that are wrapping around his otoscope. He leans in to press it deeply into Phillips right ear. Phase four, he continues, is a return to crisp tapping as blood flow increases further and pounds against the artery walls. Then you hear an abrupt muffling of the sound. The little line of mercury, dropped down to 80mmHg. Blink, blink, blink and Phillips doctor is now looking in his left ear, his rhetorical conversation unbroken. Turbulence lessens as blood returns to its stately pump that ethereal voice continues. Some in the medical community record this point as diastolic pressure he says. The low pressure, the pressure in between successive heart beats. Flow is now normal and there’s no sounds left to hear. That’s phase six.
The otoscope is now hovering less than a centimeter from his cornea, flashlight sending its beam through to the back of Phillips eyeball. Rubber covered fingers overriding twitching muscles to keep lids stretched open. Some people, says Phillips doctor, sour whisky breath scaling yellowed misaligned teeth, some people say there are only four stages to the Korotkoff sounds. They forget that the spaces of silence around the notes are just as important to the music as the notes themselves he says with a smile.
Clovis McEvoy © 2008
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