Perspective
Harry's Heart
A snowfall brings a neighborly good deed and a dose of preventive medicine.
By Nancy J. Baker, M.D.
Before showering, I decided to go out and shovel the newly fallen snow from my driveway and sidewalks. Thirteen inches of fresh snow had fallen in 24 hours, superimposed on the 12 inches that had fallen four days earlier. The two pink flamingo ornaments in my back yard were no longer visible, and the surrounding snow drifts were now almost waist high.
When I finished the driveway, I decided to shovel my next-door neighbor’s walk. Before most of us are up, Joe frequently runs his snow blower down the boulevard, making significantly less work for the rest of us. The least I could do was make his job a bit easier.
As I worked, I glanced up and saw my 88-year-old neighbor Harry, who lives across the street, attempting to lift his snow blower over a small drift near his front door. I quickly crossed the street and asked if I could help. He explained that he was hoping to clean up his steps but was having difficulty getting the small machine around the corner of his house. I reassured him that I could shovel the area and that I would carry the snow blower back to his garage.
I asked him whether or not his doctor approved of snow shoveling, and he answered, “He never told me that I couldn’t.” This, I thought, would be my effort, as a family physician, to practice a bit of preventive medicine on my neighbor. No need to risk Harry’s 88-year-old heart with the strain of clearing snow. I set to work, shoveling his steps, the walk along the side of his house, and the entrance to the street from his sidewalk that had been obstructed by the work of the snowplow.
I then returned the unused snow blower to his garage, pulled the garage door closed, and turned to walk back to my house, where I still had a bit of shoveling to finish. Harry propped open his front door to thank me, and said, “You know my heart. You saved my life.”
“Yes, I remember.”
In 1985, as a newcomer to the neighborhood, I’d been impressed how Harry and his wife Lela maintained their home and yard. Harry was always the first to mow and water his lawn. He was the first to hang his storm windows in the fall and remove them in the spring. He always shoveled his walks as soon as the snow settled. During the winter months, he’d walk briskly to nearby Como Lake to skate—his long-blade skates slung loosely over his left shoulder. He told us he’d been doing this all of his adult life.
I became concerned the winter I didn’t see Harry out shoveling his front walk. Although it’s true that one often doesn’t see neighbors during a Minnesota winter, this seemed unusual. I decided to check on him. Lela answered my tentative knock on the door and invited me in. Harry was sitting slumped in the corner, sleepy, a bit confused, and having difficulty breathing. I asked Lela how long he had been like this. She said he’d been having a tough winter. “We saw a new doctor a few weeks ago, and we’re scheduled to return in two weeks.” I asked Lela if I could get my stethoscope and examine him.
As I sprinted up my sidewalk, I quickly ran through a list of possible causes for Harry’s rather dramatic deterioration in health. His Cheynes Stokes respirations suggested heart failure. Given his premorbid vigor, I thought it unlikely that he suffered from significant underlying coronary artery disease. Perhaps he had valvular heart disease.
I returned to Harry and Lela’s home moments later, stethoscope and blood pressure cuff in hand. Harry’s blood pressure was essentially normal. He had a rapid heart rate, and his lung exam confirmed basilar rales and a gallop rhythm. As I suspected, he had a loud systolic heart murmur suspicious for aortic stenosis. I turned to Lela and asked, “Do you mind if I call his doctor? I don’t think he should wait the two weeks until his next appointment.”
Somewhat sheepishly, I confided in the doctor on call that I suspected acute, decompensated heart failure, most likely related to a bicuspid aortic valve, either congenital, or rheumatic in origin. I told her that if I were seeing Harry in my office, I would hospitalize him immediately. She admitted not knowing him, or having after-hours access to his medical history, but recommended we call the medics to transport him to the nearest hospital.
Later that night, Harry underwent coronary angiography and was then taken to the operating room to have his aortic valve replaced. The following day I visited him in the intensive care unit. Harry smiled and squeezed my hand firmly. After a relatively short and uncomplicated hospital stay, he was discharged home on blood thinners. Within weeks, he was back out shoveling snow. That spring he climbed his ladder to replace his storm windows with screens, and by summer, Harry was once again the first to water and mow his lawn.
Yes, Harry, I do know your heart.
As I lifted my shovel onto my shoulder and walked home, I felt a dull ache in my back. My 54-year-old body needed the cardiovascular workout. At work we call this preventive medicine, I thought. At home, it’s simply caring for your neighbor. MM
Nancy Baker is an assistant professor of family medicine and community health at the University of Minnesota and a member of the Fairview University Family Medicine Residency program faculty. She practices at Smiley’s Clinic in Minneapolis.