Contemporary literacy in literature

This 14-year-old girl has come to the office with her mother. She noticed a blister on the bottom of her foot shortly after running through the mall in sandals two days ago. Her mother is concerned because the blister has black dots in it. She thinks it might be infected.

I examine her foot under magnification. There, at the base of the right second toe, I see the lesion: a common plantar wart.

“It looks like a plantar wart,” I tell the mother. “Are you sure it’s only been there for a few days?”

“I didn’t notice it before,” the girl says. “I guess it could have been there longer.”

“What do we do to get rid of it?” the mother asks.

“There’s any number of ways to treat plantar warts,” I explain. “You might consider a patch kit. You apply a small patch to the wart every night before bed. The acid in the patch will leech down into the wart overnight. It takes a week or so, but eventually the acid kills the wart—problem solved.”

“Where do we get that?”

“You can buy it over the counter at the pharmacy.”

“Should we come back to see you after treatment?”

“Only if you’re not making headway. In that case, we’ll have to talk about tossing dead cats into the cemetery at midnight,” I smile.

The girl looks at me with wide eyes. “What kind of treatment is that?” she whispers.

“An old-fashioned one. It’s described in The Adventures of Tom Sawyer. You can read up on it if you like.”

I’m greeted with a blank look on her face.

“You’ve heard of The Adventures of Tom Sawyer, no? Do you know who wrote it?”

Again, that blank look. After a moment’s thought, she offers a guess: “Tom Sawyer?”

“No, it’s not an autobiography. Surely you’ve heard of—well, let me ask you. Have you heard of The Adventures of Huckleberry Finn?”

She nods her head. “Sure, everybody knows Huckleberry Finn.”

“Good. Do you know who wrote The Adventures of Huckleberry Finn?”

She pulls back, thinks a moment, then says, “Tom Sawyer?”

Her mother covers her face with her hands.

“No, Tom Sawyer didn’t write Huckleberry Finn. Did you ever hear of Mark Twain?”

“Kind of,” she says. “What did he do?”

“He was an American humorist—he wrote a number of funny stories and books.”

She perks up at this news. “Cool,” she says. “So, what did he write?”

The mother’s chin is now buried in her chest.

“Mark Twain wrote The Adventures of Tom Sawyer and The Adventures of Huckleberry Finn.”

“Oh, now I get it. He was the guy who wrote the story about the dead cat in the cemetery!”

“One and the same,” I say. “If you get the chance, sometime you really ought to go to Hartford to see his house.”

“I didn’t know he lived in Hartford,” the mother says.

“Does he usually let people visit?” the girl says.

“Well,” I smile, “I don’t think he’d mind.”

The girl slips into her sandals and pulls her cellphone out of the pocket of her jeans. Soon she’s all thumbs, texting a message at lightning speed.

As I watch her walk down the hallway behind her mother, the thought occurs to me that she might be searching for Mark Twain’s FaceBook page.

Twain is credited with formulating the definition of the literary classic—a book that everyone wants to have read but nobody wants to read. He might just roll over in his grave were he to learn that 100 years after his death, some members of the youngest generation don’t even recognize the title of a classic, let alone the author or the storyline itself.

Huckleberry Finn as illustrated by True Williams for the first edition of “The Adventures of Tom Sawyer”

“Notes from a Healer” — A lot can happen in a year

A lot can happen in a year, and sometimes those changes last a lifetime. more»

My latest installment of Notes from a Healer — A Lot Can Happen in a Year — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

JAAPA’s 25th anniversary poetry contest winners announced

“Why poetry?” you might ask. Why indeed? Of the many venues available to validate the human condition, poetry is perhaps the most poignant. In a poem, we see the pathos of both practitioner and patient laid bare, crystallized before our eyes, whispered under the ebb and flow of our collective breath. Poetry presents the human heart with its joys and sufferings, trials and travails. But what, you might ask, does that have to do with the practice of medicine? more»

Interested readers may access the winning poems in JAAPA’s 25th anniversary poetry competition here. JAAPA is the official journal of the American Academy of Physician Assistants.

Walt Whitman, 1887

The bend in the great river

One generation passeth away, and another generation cometh, but the earth abideth forever. The sun also riseth, and the sun goeth down, and hasteth to its place where it rose. The wind goeth toward the south, and turneth about unto the north; it whirleth about continually, and the wind returneth again according to its circuits. All the rivers run into the sea; yet the sea is not full. Unto the place from whence the rivers come, thither they return again. Ecclesiastes 1:5-7

“He’s had fever for two days. He’s been so fussy, he won’t let me put him down.”

This mother looks exasperated, exhausted as well. And she’s not a new mother. This 7-month-old infant was her caboose. Up until today, she’s only brought him in for well-child care.

“Has he been eating?”

“Not well. I could only get him to take 4 ounces all day.”

“Vomiting?”

“No, no vomiting—just extreme fussiness.”

“How high has his fever been?”

“102 to 103.”

I study the infant in her arms while we talk. At this point he seems comfortable. He even smiles at me, always a good sign in my book of clinical diagnoses.

“Any one else at home sick?” I ask, reaching for my stethoscope.

“No, not at home. But we did take him to see my husband’s grandfather in the nursing home a week ago. He was bedridden with pneumonia.”

I nod and listen to the baby’s back and chest. Nothing but normal breath sounds greet my ears, another good sign.

“Let’s lay him down,” I say, standing at the head of the exam table with otoscope and tongue blade in hand. The mother pins her infant son’s arms at his sides while I peer into his ears and throat. The tympanic membranes appear pearly grey, but the throat is red and swollen with a small amount of exudate on the tonsils.

“He’s got a sore throat,” I announce. “Let me swab it and run a quick test.”

“I knew he had a sore throat from the way he was acting,” the mother muses. “He cried every time he tried to swallow.”

Even without running the test, I know that this infant has contracted a virus. It’s exceedingly rare to see strep throat in such a young child. But I need confirmatory evidence to prove it.

By the time I return with the news that the results show no strep, the baby has calmed down. Even his fever has dropped — another good sign. I tell this seasoned mother that in all likelihood her little boy will turn the corner in 24 hours. “Give him some acetaminophen, hang in there and call me tomorrow morning to let me know how he’s faring.”

“By the way,” I say, “what did his great-grandfather think of him?”

“He was pleased to see him. Could the baby have picked up pneumonia from him?”

I pause to ponder her question. “Do they know what sort of pneumonia he had?”

Tears fill the mother’s eyes. “Terminal,” she says. “He wanted to see his great-grandson before he died.”

Pneumonia, the dying man’s friend. It settles into the lungs of the exhausted aged bedridden patient and whisks him away in the night.

“When did he pass away?”

“Ten days ago.”

“I doubt that the baby contracted pneumonia from him,” I say. “The incubation period is too long, and there are no signs of a lung infection on exam.”

The mother seems reassured. She will follow my instructions and call me in morning.

One generation makes its entrance while a former one fades away. Standing at the bend in the great river, I look upstream and marvel at how the new white water cascades down over the smooth rocks as downstream the current meanders around the far oxbow and silently slips from sight.

“Pine Creek” 2011 © Brian T. Maurer

Sound and fury

Ganoga Falls, Ricketts Glen, ©2012

We stood on the narrow trail at the base of the falls in the glen. Nearly one hundred feet above our heads, white water cascaded down the terraced face of the rock, churning the turbulent pool below. The deafening sound of the cataract drowned out all other sounds in the forest. Standing there breathing in the cool moist air, we could almost convince ourselves that we were the last remnant of a long-forgotten race chosen to view this pristine wilderness.

After a hiatus of four years we had come to hike the Falls Trail at Ricketts Glen once again. Except for our compact campsite, the rest of the grounds remained deserted. It was too early in the season; the hoards of summer people had not yet descended upon the lake and the land. We had glimpsed only a small herd of deer — a doe and two of her young — gliding silently through the trees the evening before.

As we resumed our descent through the ravine, two hikers and their dog approached from below. We paused briefly to exchange a greeting, then continued on our way.

“They probably were thinking the same thing that we were thinking,” I whispered to my friend. “How dare someone else invade the privacy of this sanctuary!”

“They looked like seasoned hikers,” my friend replied. “You could tell from the way they were dressed and the way they handled themselves along the path.”

We walked on in Indian time, pausing whenever we wished to view the stream, the forest flora or the rock formations hewn by the pounding water down through the millennia. I pointed out a stand of red trillium and noted yellow and white violets clinging to moss-covered rocks along the trail.

At Waters Meet we read the bronze plaque which proclaims the designation of the Glens as a registered natural lankmark under the provisions of the Historic Sites Act of August 21, 1935. From the trail below the wooden foot bridge at the confluence that forms Kitchen Creek you can view the two streams that descend through Ganoga Glen and Glen Leigh. My friend pointed out the compass chiseled into a flat rock as we prepared to ascend the Glen Leigh Trail.

Compass Points, Waters Meet, ©2012

Further along close to the summit we encountered the two hikers that we had met during our descent. This time we stopped on one of the wooden foot bridges to chat. The man and his son-in-law had been hiking the Falls Trail loop every Thursday for the last several years. They started shortly after the man had a stent put in one of his coronary arteries. “I had what they call a cardiac event,” he chuckled. “I can tell you, it wasn’t indigestion.”

My friend stooped to stroke their dog, a pit bull bitch. “She’s really very mellow,” the son-in-law said, “although she can be temperamental at times.”

“Do you walk the trail year round?” I asked the old man.

“Year in, year out,” he said. “We’ve done it in the middle of winter with crampons when the trail was icy, and nearly went over the edge at Ganoga Falls.”

“You don’t say!”

“Thankfully, it was a short drop to the switchback below. But we had to go back up for the dog — she slipped her collar and wouldn’t budge.”

“Lucky for you — that’s quite a drop into the ravine there.”

“We saw another fellow, a line worker from North Dakota who had come east after the snow storm last fall to help restore power. He was sitting on the wooden bench down at Waters Meet, white-faced and wearing crampons. He told us he had gone over the side.”

“You know the Lake Rose oil scam story?” the old man asked. We shook our heads. “Lake Rose, that’s the dry lake bed up at Ganoga trailhead. Seems one time a fellow found signs of oil there. Convinced any number of investors to chip in to drill. Later they discovered the fellow in Canada — he had absconded with the investment funds,” he chuckled.

We shook hands all round and parted ways. “Be careful going down, the stone steps are slippery from the morning drizzle.”

Stone Steps, Ricketts Glen, ©2012

“That’s when I get the ski pole out of my knapsack,” the old man said.

“I knew I wasn’t wrong about them,” my friend said further up the trail. “You can always tell woodsmen when you see them.”

We had sandwiches for a late lunch back at camp, then walked down to look at the lake. Far out on the grey water you could make out the form of a goose. A pair of mallards rested among the green tufts of water grass near the shore.

"Lake Jean" 2012 © Thomas A. Doty

We looked at the overcast sky. “So far the weather’s cooperated.”

“It might rain yet,” my friend said.

It held off until late evening. The skies opened up shortly after we crawled into the tent. I fell asleep listening to the sound of the rain on the tent fly. It was good to be curled up in my sleeping bag, warm and dry.

The sound of high winds woke me in the middle of the night. I pulled my stocking cap above my ears and listened to the sound of the rushing wind in the treetops. The rain had stopped, but the wind continued to gust periodically through the night.

We arose at first light to find the dining fly demolished. The wind had lifted it up as though it were a toy parachute, pulling the stakes out of the ground. Paraphernalia lay strewn about. We made a survey and found a missing tea towel under the collapsed tarp.

We heated some water on the camp stove for tea and oatmeal, then burned the remaining hickory in the fire ring. It was the best fire of the three-day excursion. As we doused the coals, a plume of heavy smoke rose from the pit.

A few snowflakes stung our faces before we climbed in our cars and headed out. Overhead, the cold wind still blew steadily in the trees.

Glen Leigh, Ricketts Glen, ©2012

La Pluie

"La Pluie" by Vincent Van Gogh, 1889

La Pluie

Even the most sublime canvas
Is but a selective window—
We see what we choose to see,
And the greatest artist
Still filters light and color
Through selective rods and cones.
The rain pours down,
Saturating a freshly plowed field
Bounded by a low wall;
A muddy path traverses the base,
Mountains hover in the distance—
A simple scene captured from
A second-story bedroom view.
What the artist left out,
That which the retina chose to ignore,
Were the wrought iron bars
Embedded in the open window—
No bars embedded in the window of his soul—
At least, he refused to acknowledge them,
Or spared us the pain.

Copyright 2012 © Brian T. Maurer

Funeral blues

Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come. —W. H. Auden

“You going to the wake?”

“I’ll try to get there early. The place will most likely be packed. I’ve known his parents for a long time. I just want to pay my respects and get out. We’ll close up shop tomorrow for the funeral. It’ll just be a graveside service. They weren’t church people, you know.”

I looked at my watch. “I’ve got to run,” I said.

My wife had dinner on the table when I got home. We ate in silence. Finally, she said, “When do you want to go?”

“We can go now.”

I poured myself a cup of coffee while my wife got her coat. We rode to the funeral home without talking. A number of young people were milling about at the entrance. As we arrived, a car backed out of a space and I pulled in.

A man held the door open for us. He directed us to the guest book in the corridor. Afterwards we stopped to look at the pictures before we entered the room.

We paused by the casket. It wasn’t easy to look. I was shocked that it was open.

We waited in line to talk to his parents. I had never met either one of them before. His father had the ruddy complexion of someone from the southwest. I noticed he was wearing spit-shined black cowboy boots.

“Thank you for coming,” his father said. “He was much too young to die.”

“Too young,” I said.

“Much too young, yes sir. Well, we’ll get through this. How did you know my son?”

“He serviced our cars,” I said. “He did a good job.”

“He was a good mechanic,” the father said. “Thanks for coming.”

We shook hands and moved down the line. Someone had brought his dog in at the back. A woman was holding the little dog in her lap, stroking its fur. The dog kept fidgeting, looking from one face to another, not finding what she was looking for. We sat for a while in a row of chairs off to the side, and then we left.

A group of young people were standing outside in the back, smoking cigarettes and playing with the little dog. We climbed into the car, and I backed it around and headed out the driveway. We drove back through the center of town and turned south.

As we dropped down the small hill and crossed the bridge, I noticed a large dark form perched in one of the trees overhead. I looked up as we passed beneath it. A big owl stared down from the branch.

That evening I made myself a cup of tea and sat out on the front porch. The wind came up and stirred the branches of the tall pines across the street. You could see the black branches rising and falling with the windy gusts in the evening air.

I sat for a long time and listened to the wind in the trees. It was there all right. Unlike the owl, you couldn’t see it, but you knew it was there just the same.

A picture’s worth

A recent afternoon amble captured a collage of spring colors.

Humane Medicine — Looking through a glass darkly

The more I looked, the more I began to see. The more I saw, the more the pieces of this complex pediatric puzzle began to fall into place. more»


Interested readers can now access my latest Humane Medicine column — Looking through a glass darkly, then seeing face to face — recently published in the Journal of the American Academy of Physician Assistants.

Through Van Gogh’s eyes

“How long does it take to go through the exhibit?” I asked the docent at the desk.

“About an hour,” she told me. “Be sure to keep your bag in front of you at all times.”

I had taken the early morning train from Connecticut to Philadelphia to see the Van Gogh exhibit at the Museum of Art. Four and a half hours I rode before I caught sight of the stately structure resting on a distant hill, bringing to mind the Parthenon on the Acropolis.

It had been a pleasant walk across the Cohn Bridge to 21st Street. I turned north and followed the bustling traffic to the Ben Franklin Parkway and on to the museum. Inside I collected a reserved ticket and waited in the lengthy line to enter the exhibit. One of a pair of young women draped a listening device around my neck like a traditional Hawaiian lei. I punched in the numeric code on the keypad and listened to the introduction.

The first painting that greets the visitor as he steps into the exhibit hall is Van Gogh’s well-known vase of sunflowers. Immediately to the right he glimpses a smaller study of two dried sunflower heads, vibrant with yellows and browns and tinged with red against a cobalt blue background. Beyond, a series of rooms introduce the visitor to Van Gogh’s fresh perspectives in artistic rendition: still lifes of flowers, blades of grass in fields of green, yellow-brown wheat fields; dancing wheat shocks, studies in the undergrowth, radical still lifes.

In each mini-gallery the visitor can hear explanations of Van Gogh’s techniques of composition as well as what was happening over the course of the final most productive four years of his ten-year career as an artist. He learns for example that the landscape entitled “Rain” was inspired by a view from the artist’s bedroom at the asylum of Saint-Paul-de-Mausolée. What Van Gogh did not depict on the canvas was the iron bars in the window through which he looked.

The exhibit culminates with “Almond Blossom,” the artist’s homage to his infant nephew and namesake. White blossoms scattered on gnarled branches against a backdrop of blue sky leaves the viewer with feelings of joy and hope in new life.

"Almond Blossom," Vincent Van Gogh, 1890

Afterwards I ventured forth into the spring sunshine and managed to capture several Van Gogh inspired renditions of my own: sous bois with two figures and spring blossoms against a backdrop of blue sky.

"Sous Bois" 2012 © Brian T. Maurer

"Spring Blossoms, Rodin Museum" 2012 © Brian T. Maurer