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.)

CUANDO

Cuándo
duerme el mar
mi corazon
descansa…
Cuándo
lo despierta la brisa
algo sucede
en mi alma…
Cuándo
tu no estás
llama el frio
en mi ventana
y al amanecer
cuando te espero
envuelta
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)

WHEN

When
the sea sleeps
my heart rests…
When
the breeze awakens her
something stirs
in my soul…
When
you are gone
the cold wind
calls at my window
and at break of day
when I wait for you
clothed
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.

“Reir hasta el llanto” — Laugh until you cry

It’s been a bit of a rough stretch these past few days after the announcement of Robin Williams’ death by suicide. Like many of my colleagues and friends, I’ve been struggling to maintain myself in the wake of overwhelming sadness.

How could someone so upbeat, so sharp, so funny, have taken his own life?

Robin Williams was the comedian for my generation. His extemporaneous rapid-fire deliveries cracked us up. (I still recall that incomparable line his character uttered when caught behind enemy lines in “Good Morning, Vietnam” — “This isn’t going to look good on a résumé!”) During his hilarious free associations Williams pulled us out of ourselves and made us temporarily forget our troubles. Yet he himself died as a result of overwhelming depression.

A good many comedians harbor hidden sadness; many struggle to maintain themselves in the face of personal despair. I think of Red Skelton and Carroll O’Connor: both suffered the death of a son during their professional careers.

Freud reportedly observed that wherever he went, a poet had been there first.

All of this brought to mind a poem by Juan de Dios Peza, Reir Llorando.

The opening lines allude to Garrick, an English comedian —

el más gracioso de la tierra y el más feliz

— who acknowledged public applause with a hearty laugh of his own. Even the most distraught noblemen would double over, cackling and guffawing during Garrick’s performances.

The poem then goes on to relate the tale of a man suffering from chronic melancholia who consults a famous doctor known for his clinical expertise, hoping for a cure for his depression. The doctor takes a careful medical history, ascertains that his patient is indeed overwhelmingly depressed, and begins to offer suggestions for treatment. But everything he advises his patient to do, the man has already tried, to no avail. Finally, the doctor prescribes an evening out to a performance of Garrick, the world-famous comedian, who will undoubtedly lift his spirits.

“It won’t work,” the man explains. “You see, I am Garrick.”

The proverbial funny man is impotent to lift his own spirits.

Nada me causa encanto ni atractivo;
no me importan mi nombre ni mi suerte;
en un eterno spleen muriendo vivo,
y es mi única pasión la de la muerte.

“Nothing enchants or attracts me;
Neither name nor luck are important;
In an eternal melancholia I live dying,
My only passion is the thought of death.”

The poet goes on to lament those who are downcast in this life:

¡Cúantos hay que, cansados de la vida,
enfermos de pesar, muertos de tedio,
hacen reir como el autor suicida
sin encontrar para su mal remedio!

“How many are there, tired of this life,
Sick of its weight, dying of tedium,
Who goad themselves to laugh like the suicide
Finding no relief for their despair.”

Here are Dios Peza’s last three stanzas with my translation:

¡Ay ! ¡ Cuántas veces al reír se llora!..
¡Nadie en lo alegre de la risa fíe,
porque en los seres que el dolor devora
el alma llora cuando el rostro rie!

“Ay! How often one cries in laughter!…
No one trusts in the happy smile,
Because in those whom pain devours
The soul cries out when the face laughs!”

Si se muere la fe, si huye la calma,
si sólo abrojos nuestras plantas pisa
lanza a la faz la tempestad del alma
un relámpago triste: la sonrisa.

“If faith should die and calmness should flee,
If the soles of our feet tread only on thistles,
Then cast on your face the tempest of the soul
a sad lightning bolt: the smile.”

El carnaval del mundo engaña tanto;
que las vidas son breves mascaradas;
aquí aprendemos a reír con llanto
y también a llorar con carcajadas.

“The carnival of this world well tricks us;
Our lives are masked in brief;
Here we learn to laugh with weeping
and in our laughter hide our grief.”

Freud was right: Dios Peza’s quatrains describe Robin Williams’ soulful life to a tee.

How poignantly they speak to me in this time of collective grief!

Author to address Quinnipiac PA program class of 2014

Brian T. Maurer has been invited to address the graduating class of the Quinnipiac Physician Assistant program at nine o’clock in the morning on Monday, August 4, 2014.

He will speak to the new graduates on “Something of Value: The Art of Medicine.” Maurer’s presentation will include insights from his 35 years of practice in pediatric medicine, crafted in his book, Patients Are a Virtue.

“We learn the practice of medicine through the complex process of integrating knowledge and skills with wisdom and insight in our interaction with the patient. Although the medical record forms a composite history of the patient’s illness; for the clinician, it may be the illness narrative that ultimately imparts some degree of healing to both practitioner and patient alike.”

“You have learned the science of medicine; you have delved into its business. Now it is time to recall the art of its practice, for it is only in the practice of the art of medicine that you will sustain yourselves from day-to-day over the span of your professional careers.”

A primeval scream

Lost in thought, I sauntered along on my morning walk, when out of the corner of my eye suddenly I caught movement. I looked up to the left and there they were: two red foxes romping in the grassy expanse by the forest.

One turned tail and disappeared straightaway into the wood; the second stood stock still in profile — triangular ears, pointy snout, long white-tipped tail.

Immediately, I hunkered down and froze, never taking my eyes off the sleek form.

The fox stared at me momentarily, then opened his mouth and emitted a sound like nothing I had ever heard before: a loud short raspy scream.

The sound brought to mind Dylan Thomas’s description of “noises as of old and unpleasant and maybe webfooted men wheezing in caves”— or

…a small, dry voice, like the voice of someone who has not spoken for a long time…a small, dry, eggshell voice from the other side of the door: a small dry voice through the keyhole.

Shortly, I heard several distinct distant barks from the wood where the other fox had gone. Then this fox responded with a series of short, high-pitched barks before turning tail and trotting down along the tree line toward the river.

Mysteries abound in the forest, of which we seldom catch but a glimpse: here, a phrase or two uttered in an unknown tongue, surging up from the wildness of nature to touch the core of our primeval being.