Today a Consultant asked us what heart failure was. Us, as in a group of 13 well-educated medics with access to a wide range of resources and in the penultimate year of our education. One girl started listing the symptoms. In my mind, I was running through the typical pharmacological management. People brought up the long-term risks and complications. Someone started talking about renal failure.
Tsk, tsk, tsk, the Consultant kept shaking her head disapprovingly. All (or at least most) of what we were saying was correct, but it wasn't answering the question. What is the essence of heart failure? What does it mean? A diagnosis which we have heard and seen tens if not hundreds of times. May or may not have been the first condition I made a note on in my Notion app. What the God damn hell is it???
Well, as it turns out, heart failure is, to put it simply, when the heart pumps inefficiently. I think that was surprising to us, because we NEVER see patients on the wards or in GP or in any clinic known to man who present with a diagnosis of 'inefficient pumping'. There is no way to detect this change as it happens (not that I know of anyways) and we only ever see it in medical practice once it is bad enough that things downstream have started to also break down, i.e. the patient has symptoms.
It is also very difficult to pinpoint the transition from efficient to inefficient pumping, because the heart has many different mechanisms to respond to different demands appropriately (hello Starling mechanism of the heart). It can compensate, it can buffer, it can adjust.
And therein lies the problem. As a heart, if you can pump faster and harder, you will do it every time there is a demand for it, but how can you know when that extra heart beat has become counterproductive?
Yeah, I get it, you don't want to disappoint your fellow organs and the human you're responsible for wants to go run a marathon. I understand the pressures. But you, fickle heart, must understand that if you get damaged, everyone else will also suffer, fellow organs and human included.
And isn't that a picture-perfect description of burnout? Yes, my mind can handle stress and yes, it has coping mechanisms it can deploy in answer to increasing demands. But, much like the heart, the mind also doesn't inherently know when to stop until a sequelae of symptoms slap you in the face one morning and your sizzle for life will never be quite the same. I find that quite heartbreaking.
PS: If anyone has this figured out, pls let me know.
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