After work

It was not a particularly stressful Saturday morning to work in the office. Only three prescheduled physical examinations and a handful of sick children came in by morning’s end.

One child, a 1-month-old, my first patient of the morning, had colic. His mother reported that he wanted to feed constantly; whenever she didn’t give him a bottle he fretted, sucking on his fingers and hands. I had evaluated him one week ago for similar complaints. Since then the child gained 1-1/4 pounds, nearly three times the expected weekly weight gain. Obviously, she was overfeeding him. I suspected that part of the reason might have been because her first child was born prematurely and had a difficult time gaining weight.

Mothers nurture through feeding; a thriving baby exemplifies good maternal care, but sometimes too much of a good thing is not best.

As the morning wound down I ruminated behind my desk and reviewed the remainder of outstanding laboratory reports, signed off on a stack of physical examination forms and phoned in prescription renewals. The medical assistants finished with the filing and departed, locking the front door behind them.

I snugged the bow tie at the base of my throat, picked up my blue blazer and stepped out the side door. It was a short drive to the funeral home. By the time I arrived the lot was nearly filled with vehicles.

Inside people milled about, speaking in low tones, touching one another briefly on the arm or shoulder, exchanging whispered words. Some paused before the large displays of photographs mounted on easels in the hallway.

I stepped into the parlor, signed the guest book and found the end of the receiving line. There were stands of flowers everywhere, roses mostly — pink and red and white — done up in intricate arrangements identified by cards signed by family, friends and well-wishers.

A small silver urn stood in the center of the table; a golden crucifix rested against it. On either side lay two stacks of books — three on the left, two on the right. I noted the author of the two on the right — medical titles reflecting her area of expertise.

Most physicians don’t leave any written creative works behind; she had left two — these two texts, in addition to her two teenaged sons, who stood in the receiving line on either side of their father. Each of the three wore a pink tie. Pink, the color of the ribbon supporting breast cancer research; pink, the color of the delicate rose in full bloom; pink, the color of fading rose petals at the close of day.

My words were inadequate — “I’m sorry for your loss” — followed by handshakes and brief smiles.

“How are things at the office?” the father asked.

“Busy,” I said. “Back to school physical exams, you know. It’s the same every fall.”

He nodded. “Thanks for stopping by.”

I left by the side door and stepped out into the heat of the early afternoon sun.

As practicing clinicians we are granted the high privilege of glimpsing the struggles of families entrusted to our care. For brief periods were share in their triumphs, their joys and ultimately, their grief.

But many times it’s the grief that seems to linger the longest.

2012 © Brian T. Maurer

Ten years after

When we left the house as the party broke up last evening, I looked up at the night sky.  “Look!” I said to two of my companions, pointing up at the yellow cracks in the dark grey clouds backlit by the light of the moon.

“Apocalypse now,” one of my friends murmured.

I laughed, shrugged off his words and said good night as I slid into the seat behind the wheel of my car.

Halfway home, the full moon appeared, shining brightly in the midst of the panoramic inkblot of clouds silhouetted against a cream-colored sky.

Early this morning I awoke to peruse the NYT home page and found the words of the headline burning into the retinas at the back of my eyes:  Witness to Apocalypse: A Collective Diary — accounts of “the fall of the trade center told moment by moment and person by person drawn from the more than 600 interviews collected in the September 11, 2001 Oral History Project” — somber reading at best.

We humans mark anniversaries of birth, marriage, and death.  The first two are celebrations of joy, the latter a remembrance of loss punctuated by grief.  As anyone who has ever lost a loved one will tell you, those feelings of grief and loss tend to resurface acutely on the anniversary of the death.

Every generation has memorialized those tragic events that have served to define it in history.  The sunken ships of Pearl Harbor, the eternal flame at JFK’s grave, the black wall bearing the names of our dead in the Vietnam War; and today, ten years after 9/11, the dedication of  the World Trade Center memorial.

Certainly, the string of events on that clear blue morning of September 11, 2001, defined the first decade of the new millennium for Americans.  At the outset it ushered in a brief era of compassionate service.  It changed the way many of us would come to view the world.  It created a national paranoia, which still resides in our collective western psyche.  To a certain degree it eroded our civil liberties, spurred two unwinnable wars, and drained hundreds of billions of dollars from the U.S. treasury.

I do not wish to minimize the mourning of those who lost loved ones in the tragic events that unfolded ten years ago today.  An anniversary is a suitable time to pause and reflect on irreplaceable loss.

But perhaps with the dedication of this memorial at Ground Zero, we as a nation can choose to let the tragedy of 9/11 take its place in the queue of similar tragic historical events, and begin to move on.

Expressing the Inexpressible

In his review of The Autobiography of Mark Twain, American humorist Garrison Keillor charges that Samuel Clemens’s belated musings are “a powerful argument for writers’ burning their papers.”

While Keillor is somewhat less than kind to Sam Clemens for baiting the public for a century with the promise of his last hurrah, he recognizes some gems in this massive volume (the first of three).

“What a wee little part of a person’s life are his acts and his words!” Twain writes.  “His real life is led in his head, and is known to none but himself…. The mass of him is hidden — it and its volcanic fires that toss and boil, and never rest, night nor day. These are his life, and they are not written, and cannot be written. . . . Biographies are but the clothes and buttons of the man — the biography of the man himself cannot be written.”

Keillor concludes his review with these words: “The death of the beloved daughter far beyond her father’s love and care is a disaster from which there is no recovery. Boyishness cannot prevail, nor irreverence. The story can’t be written. The man buttons up his clothes and resigns himself to the inexpressible.”

I distinctly recall my high school physics teacher brooding over how to define a problem.  “If you can’t express it in a mathematical statement,” he said, “it simply can’t be understood.”

Some things border on the inexpressible.  While it is difficult to come to grips with grief, making the attempt sometimes pays off.  Our muddled emotions stir about inside our heads.  We define them by turning them into words, fleshing them out, even if in their final form they fall short.

A friend from the other side of the globe writes that she is wrestling with two recent tragedies, one national, one personal.  “Why do these things happen?” she asks.  “I cry deep in my heart.”

Six words that express the inexpressible.

Humane Medicine — A Grief Observed

Turning back the clock is something most of us have wished to do at one time or another. We experience the loss of a loved one, or the parent of a patient under our care takes a turn for the worse. If only we could turn back the clock, we think, everything would be just fine.

Interested readers can now access my latest Humane Medicine column, A Grief Observed, recently published in the Journal of the American Academy of Physician Assistants.

Grief and Mourning

Grief hits us hardest when we least expect it.

I recently returned from the AAPA national conference in San Antonio, Texas, where I helped facilitate a small group discussion in the “Breaking Bad News” workshop. This ground-breaking seminar was the first of its kind sanctioned by the AAPA conference committee. Traditionally, continuing medical education national planners have considered such topics to be soft science, not worthy of recognition for ongoing educational credit.

The workshop was well-attended; over forty people showed up, and most stayed for the entire two and a half hour session.

We used Joan Didion’s book The Year of Magical Thinking as a literary text to facilitate discussion. In the pages of her journal, Didion records thoughts and feelings over the span of a year after her husband’s unexpected demise at the dinner table. Although outwardly she appears to have accepted the fact of his death, inwardly she continues to wait for his return during her year of magical thinking.

Immediately after the event takes place, the death of a loved one changes us forever in ways that we do not understand.

In small groups, participants had the opportunity to consider an instance when they were required to deliver bad news to a patient or receive bad news themselves. Without exception, the folks at our table found that they could readily recall such events with heightened clarity, although in most cases these events had taken place years ago.

Mourning, the process of working through grief, takes time. Sometimes, like a recurrent abscess, it requires periodic incision and drainage to heal.

I felt good about the discussions we had. I was amazed at how little time it takes for individuals to open up to complete strangers when given permission to do so in a safe place.

I returned home exhausted from my three-day trek. I never sleep well on the road. My son met me at the airport. We had a nice dinner together. It was only later after I checked my e-mail that I learned that a close friend’s family member had been brutally murdered by a street gang in another country while I was away.

Grief hits us hardest when we least expect it; mourning takes time.