The follow-up Echo

Today in the clinic, we pulled up two echoes of the same patient. 

The first one was from last year. Dilated ventricle, reduced ejection fraction- a heart that looked tired. By looking at it, you could almost feel the weight it had been pushing against for years. 

The second one was from this month. Same name on the screen. Same heart. But the cavity was smaller and walls were moving better. The ejection fraction had gone up. My attending just nodded and said, almost like an afterthought, ‘The heart can change,’ and we moved on to the next patient.

After a hectic clinic day and seeing over twenty different patients, that sentence stuck with me. While talking about echos, my attending used a term: reverse remodelling. It sounds very technical and boring. Nothing dramatic is happening. It’s just the heart responding to a slightly better world around it. The patient took their medicines. Showed up to follow-up visits. Listened when the doctor told to restrict salt. Slept a little more. From outside, it looked like life as usual. From inside, the heart was rearranging itself. 

And I thought, how quickly we are to say, ‘I am just like this,’ when it comes to ourselves. ‘I always procrastinate.’ and ‘I am never disciplined.’ These sentences start sounding like diagnoses we have decided are lifelong and irreversible.

If we wrote that kind of thing on an echo report, how strange would it feel: ‘Left ventricle has always been like this and will always will be.’ 

We don’t talk that way about hearts. We expect them to respond to what we do around them. Give them less pressure and they soften. Give them a valve that opens properly and they reshape. Reduce the load and they slowly stop stretching themselves thin. Maybe a lot of the “this is just who I am” stuff actually our emotional equivalent of a dilated ventricle. Measurable. Real. But not necessarily permanent.

On day one, the patient takes their first dose of medicine and nothing changes. On day seven, if you did an echo, you’d probably see the same numbers and feel slightly discouraged. On day ninety or three hundred, suddenly you realise the structure is different. The work was quiet and continuous and deeply unglamorous, and the heart noticed.

We rarely get to see before-and-after images of our own selves, like we get of our hearts. No neat side-by-side comparison. What we get instead are small moments that feel like follow-up scans.

Something that would have broken you last year now just makes you pause and breathe.

You apologise without collapsing into shame. You take a break before your body forces you to. Just a quiet sense of, “I didn’t handle this the way old me would have.” That’s function: improved.

Another thing that I find strangely beautiful is the way we label these hearts. “Heart failure with recovered ejection fraction.” We don’t pretend nothing ever went wrong. The history is still there. There were bad days and hospital admissions. But we hold both truths at once: this heart has suffered and this heart has adapted. 

We can do that with ourselves too.

Somewhere in the EMR, that patient now has two echoes that will always sit next to each other in time: a “before” that explains why everyone was worried, and an “after” that makes everyone breathe a little easier. There will be more echoes after that, and they won’t all show a straight line of improvement. And that`s okay. Life is rarely that ideal, even for hearts.

-Dhruvi Joshi