Every seed germinates in its own time. Some of the seeds that we plant might lie dormant for months, perhaps even years. Sometimes we might even forget that we planted them. But then one fine day suddenly we see the first tiny shoots unfolding in the light. more»
Interested readers can now access my latest Humane Medicine column — The art of medicine: Having faith in the seeds we plant — recently published in the Journal of the American Academy of Physician Assistants.
Apropos modern medical practice, there’s an old saying attributed to the automotive repair business: “Go to Midas, get a muffler.” Midas is in the business of selling mufflers, of course. If you consult their mechanics about an odd noise in the exhaust system, most likely they’ll replace your muffler and tailpipe. This might not fix the problem, but payment has exchanged hands in the transaction. more»
My latest installment of Notes from a Healer — Guarding Your Heart — 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.
The numbers of maneuvers associated with the art of the physical exam are legion. Most are referred to by specific name—except for this one. Just this morning I was thinking that you might call it “donning the yoke.” more»
Readers can now access my latest musing — Donning the yoke — at the Journal of the American Academy of Physician Assistants Editorial Board blog.
JAAPA is the official publication of the American Academy of Physician Assistants.
I awake in cool morning darkness, slide to the edge of the bed, hang my legs over the side and sit up. Various shades of grey swirl before my eyes as fuzzy shapes begin to form. Instinctively, I reach out in the darkness and find the shirt hanging over the chair by the bed.
I thrust my arms through the sleeves and proceed to button it from the neck down, leaving the throat undone. The chill on my skin subsides, replaced by the warmth of the insulated flannel shirt.
I finish dressing in the dark, make my way down the stairs and grab my fleece off the coat rack. The canvas bag with my workout paraphernalia sits by the corner hutch. I step through the kitchen door into the mudroom and pause to pull on my woolen stocking cap before stepping outside into the pre-dawn cold.
It’s a short drive to the gym. Soon I’m stripped down again, standing in my swimming suit at the end of the pool, stretching my neck and shoulders. I plunge into the cool water and begin to stroke down the lane. As I approach the wall I give a short kick, somersault and spring off the wall. Twenty-four laps later I surface to find the adjacent lanes filled with my companions warming up.
Together we tool through the workout—today, a series of short interval swims repeated in several sets. One hour later we pull ourselves from the water and head for the showers.
In the locker room I towel off and dress. One of the guys notices my shirt. “Nice shirt,” he says. “Where did you get it?”
I turn an answer over in my mind before selecting the words. “It was a gift,” I say, and leave it at that.
I grab my bag, don my stocking cap and step outside. A pair of geese passes overhead, honking in the greyness. The air is cold and still, but I’m toasty inside as I walk to my car, thanks to the insulated shirt on my back.
This shirt was a gift—one of several flannel shirts given to me by the widow of the fellow who used to service my car. Avery was an outdoors sort of guy, one whose idea of a great day was a long walk in the woods with his favorite dog. Gardening was his hobby. He loved to smoke cigars when he worked outside, stacking the wood that he’d cut and split himself.
It’s been two years since Avery succumbed to cancer. I was a pallbearer at his funeral. His wife gave me the shirts several weeks later when she cleaned out his closet.
On these cold grey December days, when the geese pass solemnly overhead, I remember Avery—and those shirts still keep me warm.
The drive to Weehawken turned out to be less harrowing than I had imagined. Google mapped the route; I chose the time of departure. As it turned out, a mid-morning drive to Manhattan is not necessarily unpleasant.
My heart rate accelerated as I maintained my speed through the Lincoln Tunnel, then slowed as I surfaced into the late morning light. Soon I pulled up to the curb outside the Sheraton Lincoln Harbor hotel. They gave me a room on the 7th floor that overlooked the Hudson. Like a string of multi-sized cardboard cutouts, the Manhattan skyline rose up on the far side, the Empire State Building immediately opposite.
I stashed my bag and left on foot to explore the area.
It was a short walk across the bridge to Hoboken, that old industrial city famous for the production of ships during WWI and WW2. Quickly I combed the narrow streets, hemmed in by brick row homes and shops. I made my way to the waterfront and watched as the New York Waterway ferry—the Governor Thomas H. Kean—approached the dock. A lone seagull soared above the water, while several others perched on decayed pilings that marked where piers from a bygone era once stood.
Out in the middle of the broad river a small tugboat nudged a bloated barge along. Several sloops, their sails reefed, motored down the expanse. Overhead a Coast Guard helicopter whirred by on its way down to the harbor.
That evening, after dinner, I stood on the second level of the Chart House restaurant and looked out at the city. To the north the George Washington Bridge spanned the blackness; to the south lay the Verrazano Narrows, while directly across the water the city sat, sketched out in a thousand points of light: clusters and strings of precious stones, like rich jewels in an Ethiop’s ear—brilliant diamonds, amber topazes, blue sapphires, red garnets.
Back at the hotel I crawled into bed, letting the curtains open. When I woke several times during the night, the city was still there, wide awake, beckoning.
Because of the time change I arose an hour earlier Sunday morning and departed the hotel in the darkness, driving west, leaving the smokestacks, bridges and concrete highways behind. I turned north and headed toward the upper Delaware, logging miles through low-lying farmland which eventually gave way to stone-capped mountains still draped in rustic orange-brown shades of autumnal garb.
I paid my three quarters to the attendant at the far side of the steel bridge that spanned the river and slipped into the town.
I checked my watch: I had two hours to kill before my friend would arrive. I grabbed a coffee and walked to a small park overlooking the river. You could see the water shimmering through the trees, sparkling in the sun as it meandered along. I noticed the remnants of a trail along the bank and struck out to find it.
Soon I was sitting on a tree stump at the edge of a grassy knoll, watching the last of the autumn leaves drift down from the ancient towering maples into swirling eddies. Off in the distance my eye caught sight of a large hawk circling above a stand of tall hemlocks on the far bank. I estimated the wingspan at six feet and glimpsed the white tail when the bird circled in the sun.
As I retraced my steps back up the hill, I met a man coming down. We paused in greeting, and I inquired about the trail that ran along the river. He told me where it led and asked where I was from. I learned that he made his home in Manhattan. Years ago he had purchased a small house by this river, which he frequented on weekends and holidays. I mentioned the eagle I had seen circling in the sky.
“I know where they perch along a tributary that runs into the river,” he winked, indicating with his head. We shook hands, and I walked back to my car to wait the arrival of my friend.
We had a good long walkabout filled with talk about things that matter to us most, followed by dinner in the old inn that sits on the square at the center of town.
Two rivers, two towns. Both rivers flow to the sea. One town never sleeps, the other is perfectly content to stretch and yawn as the spirit moves it.
Today I placed a tuberculosis test on the forearm of a young lady who is enrolled in nursing school. I’ve known her since she was an infant. She’s all grown up now, striking out on her own. I last saw her several years ago when she came in complaining of panic attacks shortly after her father died from metastatic bone cancer. Back then she was vulnerable; now she’s confident. She’s decided to devote her life to caring for others. more»
My latest installment of Notes from a Healer — The Lives We Touch — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine. Interested readers can access a list of editorial board members and regular contributors here.
“Some things just stay with you, I guess,” our receptionist told me, as she gathered the pile of finished charts from my desk. “Sometimes it’s the little things that turn out to be the most significant.”
My latest installment of Notes from a Healer — Great and Noble Tasks — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine. Interested readers can access a list of editorial board members and regular contributors here.
I spent the greater part of last week delving into quantum electrodynamics, the theory that now forms the basis of our understanding of how the universe operates at the atomic level.
Thanks to solid-state technological advances, through my personal computer I was able to access a number of video lectures on the web—several by Nobel laureates Richard Feynman and Hans Bethe—that enhanced my understanding of quantum mechanics.
Unfortunately, because I lack the mathematical background, I found that I was unable to comprehend both derivations and solutions to complex equations such as the Schrödinger wave functions and the calculations of probability amplitudes. But then, perhaps even this knowledge might not have served to enlighten me further. As Feynman pointed out in his 1979 Auckland lectures, “no one understands quantum mechanics.”
According to Feynman, it all comes down to this: (1) electrons move through space in time, (2) photons move through space and time, (3) electrons and photons collide and separate, absorbing and releasing energy.
Thus far, theoretical physics has managed to integrate quantum mechanics and the atomic weak force. It has yet to meld the nuclear strong force into the equation, and gravitational force is turning out to be elusive as well.
Lately, M-theory, a derivative of string theory, has been proposed as a possible answer to the theory of everything, although we are far from integrating infinity into these equations.
When I made mention of these musings of mine in an e-mail to a good friend, he responded: “My own thoughts about life and the universe have become simpler as I have grown older. Like the flapping of the butterfly’s wing, an act of love reverberates through the universe in a way that goes beyond the phenomenon of the act itself.”
Electrons, photons, butterfly wings—minute reverberations through a complex universe that extend well beyond our ken.
No act of kindness, no matter how small, is ever insignificant.
Whitman’s verses come to mind:
When I heard the learn’d astronomer,
When the proofs, the figures, were ranged in columns before me,
When I was shown the charts and diagrams, to add, divide, and measure them,
When I sitting heard the astronomer where he lectured with much applause in the lecture-room,
How soon, unaccountable, I became tired and sick,
Till rising and gliding out I wander’d off by myself,
In the mystical moist night-air, and from time to time,
Look’d up in perfect silence at the stars.
As I scanned the overnight fax reports clipped to the pile of medical charts on my desk this morning, I learned that one of our teenaged patients had been discharged from a residential psychiatric facility. The girl was admitted for observation after voicing suicidal ideation, thoughts that surfaced after she was informed that she would have to testify against the perpetrator who raped her a year ago. In spite of the fact that the perpetrator admitted his guilt, the legal system dictated that the girl would still have to face him once again—this time in the public setting of a courtroom.
Modern psychological theory has it that a victim who has suffered intense trauma needs to tell her story in order to heal. Healing is a process that takes place over time. Some of us heal faster than others, and some of us need to tell our story more than once to work through it.
There are those theorists who maintain that reliving a traumatic incident ad infinitum might serve to sear the trauma into the victim’s memory to such an extent that it will never be erased. In short, the more we relive a traumatic event, the more likely we are never to forget it.
Communal groups, whether small or large, might also find that collectively revisiting traumatic events serves to heal. As human beings, we do have the need to commemorate those fellow creatures victimized by some tragic event—a war, an attempted genocide, a terrorist attack. In some ways it does us good to ponder and reflect. It helps us work through our collective grief—something we need to do in order to heal as a community, as a society, as a nation.
Yet there is a danger that lies in revisiting such events ad infinitum. That danger has to do with rekindling our anger and hatred for those who perpetrated the horrendous act. When our collective anger flares, we relive not only the trauma of the historical event itself—it also serves to harden our hatred and prevent us from allowing ourselves to heal as a community, as a society, as a nation.
On this 9th anniversary of 9/11 I arose early to read through several opinion columns in the press. Largely, columnists fall into one of two camps: those who prod us to maintain our vigilance “lest we forget what happened on that day,” and those who advocate a sincere attempt to separate the perpetrators—the militant fanatics—from the major religion with which they have come to be identified. Some advocate the use of “free speech” to decry the enemy, while others strive to emphasize the need for peace and reconciliation.
As a nation, how do we commemorate the victims of 9/11 without fanning once again the flames of hatred?
Such thoughts ran through my head as I began my day seeing patients in the office.
I spoke at length with a father about his obese son, giving him some practical tools to help the boy move toward a healthier lifestyle.
I counseled a young man suffering from depression, attention-deficit disorder and drug use.
My last patient of the morning was the youngest daughter of a Muslim family that I have known for more than a decade. Her mother brought her to see me because the child was complaining of a sore throat and belly ache. During the course of the visit the mother pointed out the nits in her daughter’s hair. Suddenly, she began to cry.
“I don’t know how she get this,” the mother told me through her tears. “None of my other children ever have such a thing. She bathe every day. I make sure she have clean clothes to wear to school. We are a clean family.” And then, exasperated, she sobbed, “I am so ashamed.”
Here the daughter began to cry as well. “She don’t want to tell her teacher because she afraid that the other children will make fun of her,” the mother said.
I reassured the mother that head lice was a common malady in young school-aged children, that it had nothing to do with personal hygiene, and that it was fairly easy to treat. I wrote out a prescription and explained to the mother how to apply the preparation. “You’ll have to comb the nits out afterwards,” I told her, “but she will get over it.”
As I handed her the prescription I noticed an intricate henna tattoo on the mother’s left hand. “Today is holiday in my religion,” she explained. “Eid-ul-Fitr, the day after Ramadan ends—a day of forgiveness, a time of giving and sharing. That is why I do this, to remember.”
All of us set aside special days to remember—some to commemorate, some to ponder and reflect, some for feasting and celebration.
Perhaps the time will come when one day we will agree to set aside a special day to reflect on one more thing: forgiveness.
Frequently I glimpse their faces when I dash through our front office between patients—mothers standing at the check-in window above the receptionist’s desk. Mothers waiting for forms; mothers stopping by to pick up prescriptions; mothers who drop in for an informal chat with the women in our office.
My latest installment of Notes from a Healer — Mothers at the Window — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine. Interested readers can access a list of editorial board members and regular contributors here.
