AUSTIN, TX – The patient’s lungs never stood a chance. After some idle chit-chat about symptoms of dyspnea and wheeze, hospitalist Miguel Ruiz proceeded to dominate the lung exam and kick its sorry little ass all the way around the bedside until it didn’t know inhale from exhale.
“Once I told him that I was still short of breath when I walked around, I could see him put on his game face,” explained patient Gabriel Campbell, adding that when Ruiz said “Is it okay if i take a listen?” he cracked his knuckles and took the stethoscope out of his white coat pocket like some kind of boss. “I knew then this would be no contest. My lungs didn’t stand a chance.”
Ruiz didn’t start with auscultation. He took the condescending pulmonary exam by surprise by removing the patient’s gown and starting off with good ole fashion inspection. “How do you like them apples?” Ruiz taunted the man’s chest, not breaking concentration while he accessed breathing patterns, accessory muscle use, color, tripodding, pursed-lip breathing, barrel chest, and even digital clubbing. DIGITAL CLUBBING for Pete’s sake. “How do you like me now?!”
The lung exam thought it had Ruiz right where it wanted him. But then Ruiz ducked, weaved, and countered with a nasty bilateral lung exam by palpation. “Chest excursion and tactile fremitus, baby, what what?!” Ruiz brought his A game; he was not messing around.
Auscultation next, right? Wrong. Ruiz sucker-punched the lung exam with his ten-pack of fingers; he started percussing up and down both anterior and posterior lung fields like it was nobody else’s business. “Can you hear me now?!” Ruiz exclaimed, sensing blood in the water.
With the lung exam on its knees, Ruiz administered the final blows as he manipulated his stethoscope. “No wheezes or rhonchi, but I definitely hear crackles,” Ruiz triumphantly declared, even listening to both the right middle lobe and the lingula to put the definitive stamp on a lung exam that he absolutely crushed into an infinite number of irreparable pieces.