A Story, by Bernard Lown, renowned cardiologist, as it appears in the book Full Catastrophe Living, by Jon Kabat-Zinn.


          The experience still invokes in my a shudder of disbelief. Some 30 years ago I had a postdoctorate fellowship with Dr. S.A. Levine, professor of cardiology at the Havard Medical School. He was a keen observer of the human scene, had an awesome presence, was precise in formulation, and was blessed with a prodigious memory. He was, in effect, the consummate clinician at the bedside. Dr. Levine conducted a weekly outpatient cardiac clinic at the hospital. After we young trainees examined the patient, he would drop in briefly to assess our findings and suggest further diagnostic work up or changes in the therapeutic program. With patients, he was invariably reassuring and convincing, and they venerated his every word. In one of my first clinics, I had as a patient Mrs. S., a well-preserved middle-aged librarian who had a narrowing of one of the valves on the right side of her heart, the tricuspid valve. She had been in low-grade congestive heart failure with modest edema (swelling) of the ankles, but was able to maintain her job and attend efficiently to household chores. She was receiving digitalis and weekly injections of a mercurial diuretic. Dr. Levine, who had followed her in the clinic for more than a decade, greeted her warmly and then turned to the large entourage of visiting physicians and said, "This woman has TS," and abruptly left.

          No sooner was Dr. Levine out of the door than Mrs. S.'s demeanor abruptly changed. She appeared anxious and frightened and was now breathing rapidly, clearly hyperventilating. Her skin was drenched with perspiration, and her pulse had accelerated to more than 150 beats per minute. In reexamining her, I found it astonishing that the lungs, which a few minutes earlier had been quite clear, now had moist cackles at the bases. This was extraordinary, for with obstruction of the right heart valve, the lungs are spared the accumulation of excess fluid.

          I questioned Mrs. S. as to the reasons for her sudden upset. Her response was that Dr. Levine had said that she had TS, which she knew meant "terminal situation." I was initially amused at this interpretation of the acronym for tricuspid stenosis. My amusement, however, rapidly yielded to apprehension, as my words failed to reassure and as her congestion continued to worsen. Shortly thereafter she was in massive pulmonary edema. Heroic efforts did not reverse the frothing congestion. I tried to reach Dr. Levine, but he was nowhere to be located. Later the same day she died from intractable heart failure. To this day the recollection of this tragic happening causes me to tremble at the awesome power of the physicians word.