You Don’t Know What You Need to Know

My Story About Horace Ashenfelter

Photo Used With Attribution to: Collectie / Archief: Fotocollectie Anefo Reportage / Serie : [ onbekend ] Beschrijving

Not infrequently over my years of teaching medical students and trainees, someone will remark, “I really don’t need to know that.” Honestly, when I was in training that was sometimes my internal conversation as well. But my adult-life experience has been just the opposite; almost anything one has learned can turn out to be important or useful in practicing medicine.

Sometimes the fact is only important in helping to establish a relationship with a patient by knowing something about their work or their hobby. So, this is the story I tell trainees when I get the “I don’t need to know that” look or comment.

My Dad was a Baptist Minister in Danvers, MA, about 20 miles north of Boston. On Wednesday nights he would often go to the Danvers Public Library to research his Sunday sermons, and my mother forced me to go along to get me out of the house. I must have been around 10 when I started going. After reading all the dog books, I was bored until I found the books that the US Olympic Committee published after every Olympics. I always liked to run, so I devoured the track & field sections, and by the time I was 12, I knew the names of almost every American who had won anything in the Olympics.

Fast forward at least 50 years and I am a cardiologist with a special interest in the cardiac problems of athletes. I am about to see a young weight lifter who has had two strokes, and one of the strokes occurred during weight lifting, so I was concerned that he may have an atrial septal defect, with right to left shunting produced by the Valsalva maneuver during lifting. But I also noticed that his last name was Ashenfelter. Ashenfelter made me think immediately of Horace Ashenfelter, a Penn State graduate and FBI agent, who had won the 1952 Olympic Steeplechase in Helsinki. That win was politically important because the fastest steeplechaser in the world was a Russian, Vlamimir Kazatsev, who was a KGB agent, so you had an FBI agent and a KGB agent chasing each other. When Ashenfelter won, it was a big athletic and political victory.

When the patient came in, I introduced myself and said, “Before we begin, I must ask if you are related to Horace Ashenfelter, the 1952 Olympic Gold Medalist in the steeplechase in Helsinki. The patient jumped to his feet and said something like, “They told me you were the sports cardiologist to see. That’s my grandfather!”

The remainder of the clinical story and the clinical lessons are that the patient had had a trans-esophageal echo (TEE), which had not shown an intracardiac shunt. But the sedation required for a TEE can reduce right heart pressures and reduce any intracardiac shunting. The sedation also prohibits performing provocative maneuvers such as the Valsalva to identify the intracardiac shunting from a patent foramen ovale (PFO). I scheduled a transthoracic echo (TTE) with contrast and Valsalva. The saline injection showed a PFO with right to left shunting. The PFO was ultimately closed.

So the clinical lesson is to remember that a TEE alone may miss intracardiac shunting, but another clinical lesson is that almost everything you learn in life about non-medical things can help you establish better relationships with patients. Who would have thought that knowing who won the 1952 Helsinki Olympic steeplechase would turn out to be useful?

So, it’s OK to spend your nights watching ESPN if you have an interest in sports cardiology. Please tell that to my wife. And by the way, the joke at the time about Ashenfelter’s victory was, “That’s probably not the first time a KGB agent has followed an FBI agent home”.

Shared with permission of the patient

Sean McMahon, MD, Director of Echocardiography at Hartford Hospital reviewed this post to ensure my comments on echocardiography were accurate.

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