Shattered leaves

The crickets continued to chirp late this year, well into the weeks when the leaves turned golden scarlet. The evening sun streamed through the yellow-orange leaves as they fell from the trees like shattered stained glass from ancient cathedral windows.

A huge icon of the Madonna and Christ child towered above the paneled altar, its entire background set in gold leaf. An arch depicting Christ and the Apostles at the Last Supper framed the dome above the open casket where the wooden remains of an adolescent girl rested. Just to the right of the casket another framed icon rested on an easel draped in crimson cloth. The people who filed in to pay their respects to the family focused on the framed icon, and some cast fleeting glances at the brown form before turning away.

We sat on the hard wooden pews and stood as the priest directed, following the lead of the family, front and center before the casket. The priest intoned the words in English; an elderly cantor echoed in Greek. At some point a censer was swung on either side and at the head and foot of the casket, and the odor of burning incense wafted back through the pews.

One of the cantors read a passage from Saint Paul’s Epistle to the Thessalonians, then the priest read a selection from the Gospel according to Saint John.

Afterwards the priest brought out a small lectern and stood to deliver the eulogy. He spoke about the need to peel back our layers of pain to see the image of God in another person. He spoke of the need for heightened awareness: to be attentive to warning signs we might see in others to allow for timely interventions before it was too late.

Then he spoke about the artistic gift that the girl had had: the innate ability to capture light in color and line to create an image — an impression, an icon — the way the world looked to her. At the end I suppose she could no longer see the goodness of it, could no longer bear the pain of living in it; and the light inside went dark.

Again the words, again the prayerful chant. One by one we stood and filed forward one last time, then filtered out through the doorways into the morning brightness.

The golden leaves tumbling down from the blue-grey trees shattered in the brightness of the noonday sun.

Van Gogh_Wheatfield with Crows


My recent diagnosis of onychomadesis in a 5-year-old boy led to an online search of the medical literature for verification of the most likely etiology — with favorable results. more»

Onychomadesis is the spontaneous, complete shedding of the nail from its proximal side, without pain or inflammation, following nail matrix arrest.

Interested readers can peruse my case report — Nailing down a diagnosis — recently published in the Online Journal of Community and Person-Centered Dermatology.

The Online Journal of Community and Person-Centered Dermatology (OJCPCD) is a free, post-publication peer-reviewed, full text open-access online publication that addresses all aspects of skin disease that concern patients, their families and practitioners.

The medicine of art: A picture’s worth

A mother and her 12-year-old son stand with their backs to me in the corridor just outside my office, studying the framed print that hangs on the wall. As is the case with most works of art, there is a story behind this one. more»

Interested readers can now access my latest Art of Medicine column — A picture’s worth — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

Back to the future

I smiled when I read the comments of the CEO of the existing hospital holding corporation: “We are excited to pursue this relationship with [healthcare corporations X and Y]. Like ours, these organizations are committed to providing high-quality, low-cost, person-centered care.”

As you follow the money, always look for the spin. more»

Interested readers can now peruse my latest Musings blog — Back to the future — at the Journal of the American Academy of Physician Assistants (JAAPA) website.

JAAPA is the official publication of the American Academy of Physician Assistants.

­­¡Que Peña!

Several days after returning from a summer sojourn in Spain, my wife handed me a bound volume entitled “Dietario 1993.” It turned out to be a daybook that she discovered in an old house in Santa Marta, previously owned by members of the extended family of one Vicente Peña, a published poet, now deceased for some years.

The diary contains any number of poems that Peña crafted on specific days in certain locales. They are sporadically numbered, almost as though he were organizing them to appear in a published volume.

Peña wrote under the pseudonym “Ortiga.” Here is an example of one of his spontaneous drafts, handwritten in the first page of the diary. (My translation follows.)


duerme el mar
mi corazon
lo despierta la brisa
algo sucede
en mi alma…
tu no estás
llama el frio
en mi ventana
y al amanecer
cuando te espero
en la luz del alba,
tu música
de rosa y mar
me lastima
con dulce calma.

[Escrito] en mi casa de Ortigueira, 01 Enero 1993

V. Peña (Ortiga)


the sea sleeps
my heart rests…
the breeze awakens her
something stirs
in my soul…
you are gone
the cold wind
calls at my window
and at break of day
when I wait for you
in the light of dawn,
your music
of roses and sea
pricks me
with a sweet calm.

01 January 1993

I have no idea if these poems were ever published. From a cursory reading, I can attest to their poignant beauty.

What a treasure, this book! It will be a delight to peruse its contents!

2014 Vicente Peña 9-8-2014 001

“When we know” republished

Nothing jolts the mind more deeply than glimpsing the subject line of an unexpected e-mail as you simultaneously come to the sudden realization that someone you had at one time known and respected is now no longer counted among the living….

Originally published on this blog (May 11, 2014), “When we know” has been reprinted in the 2014 summer issue of the Journal of Dermatology for Physician Assistants (JDPA), Volume 8, Number 3, page 58.

Interested readers can also access this piece here.

CHAT rooms revisited

My editor alerted me to a recent article in Pediatrics“Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)” — and asked if I might provide a bit of commentary. I obliged with a few revised thoughts on developmental surveillance and screening in the pediatric patient. more»

For those readers who aren’t familiar with the tool, the M-CHAT is a screening instrument designed to identify toddlers at risk for ASD — that’s Autistic Spectrum Disorder, not Atrial Septal Defect, which is a different problem entirely, diagnosed using the grey matter between the ear pieces of a stethoscope in lieu of a parental questionnaire.