Hearing Zebras

Zebra is the American medical slang for arriving at an exotic medical diagnosis when a more commonplace explanation is more likely.^[1] It is shorthand for the aphorism coined in the late 1940s by Dr. Theodore Woodward, professor at the University of Maryland School of Medicine, who instructed his medical interns: “When you hear hoofbeats, think of horses not zebras”.^[2] Since horses are common in Maryland while zebras are relatively rare, logically one could confidently guess that an animal making hoofbeats is probably a horse. By 1960, the aphorism was widely known in medical circles.^[

As planned, my husband was discharged five days after he had open-heart surgery—two valves replaced. The day before he walked three laps around the Cardiac floor with tubes from his chest, EKG leads and wires from an external pacemaker. He leaned on a tall

Swedish walker as he took slow steps and here he was being thrust, tubeless and wireless, out of the door into my care.

Should he be relieved to be sent home in my good hands since I am a retired nurse practitioner? Sadly, I am aware that I know too much—too much outdated knowledge. Plus I have a life long tendency to hear zebras. When my children were young, I over reacted to their illnesses —and do so even now that they are adults. The same with my grandchildren. When my middle grandson, then age four, visited my house, he suddenly became ill with a fever and pain in the back of his neck. I called his father and told him to meet me at urgent care—I was sure my grandson had meningitis. The understanding physician told me ear infections could cause neck pain and calmed my anxiety.

Cardiology was my specialty as a young nurse. However, I haven’t set foot on a cardiac unit in over 40 years. What I found out with my husband’s recent hospitalization was what I had learned to be red flags for life threatening problems are now mostly routine side effects of heart surgery and resolve quickly, albeit with sophisticated equipment, improved lab testing, powerful new drugs and experienced staff.

During my husband’s hospitalization, I anticipated:

• Pneumonia—he had a slightly elevated temp
• Immediate need for dialysis—low urine output
• Trip back to surgery for a permanent pacemaker—irregular heart rate

Now at home, my outdated knowledge of cardiology feeds the anxiety I feel when I wonder if I am seeing life threatening changes in my husband’s health status. I am on the edge of becoming an overbearing, hovering and fretful caregiver. My husband tries to ignore my fisheye looks as I monitor his progress. Frequently, I need to take a deep breath, re-read the information we received on discharge about when to call the surgical resident and admit to myself that I am hearing those damn zebras.