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”

Prenatal treatment of ADD on the horizon

With anticipated widespread acceptance of revised diagnostic criteria in DSM-5, the bible of psychiatric diagnoses, researchers are now keen to examine the efficacy of treatment for prenatal attention deficit disorder (ADD-PN).

“We’ve already got the drugs. This will allow us to study the incidence and treatment of ADD in the womb (ADD-PN) using only the highest ethical standards in medical research,” said Dr. Erma Kidd, a psychopharmacologist on staff at Slamdunk Medical College and Hospital, one of the few remaining medical institutions in the country not underwritten by the pharmaceutical industry.

Researchers have known for decades that ADD (or ADHD, as it is sometimes called) carries a genetic predisposition. “We’ve been able to track this malady through generations of families. The trouble was that we had no good clinical criteria for prenatal diagnosis of the disease,” Dr. Kidd explained in a recent e-mail. “Publication of DSM-5 changes all of that. Now we can diagnose ADD-PN in the womb. And if we can diagnose it, treatment options are just around the corner.”

This late-breaking news comes on the heels of recent announcements that child psychiatrists, general practitioners, pediatricians and maintenance personnel working in their offices have been given the green light to treat preschoolers with powerful stimulant medications in an effort to improve quality of life—for them and for their parents.

Off the record, preliminary studies examining the efficacy of prenatal pharmacologic treatment for ADD-PN have been underway since last year. “It’s been exciting, but extremely tough on our research team,” Dr. Kidd wrote. “After devising modalities to administer methylphenidate-like drugs to a cohort of fetuses, we were forced to wait until the babies were born before we could adequately study their behavior and development.”

Nevertheless, preliminary data is promising. “Mothers who had methylphenidate infused into their amniotic fluid reported considerably less fetal movement during the third trimester of gestation,” Dr. Kidd said. “Indirectly, we infer that the drug was helping these fetuses to calm down, to become less impulsive and more focused in the womb.”

Subsequently, some of the subjects have been born; and the data so far is impressive. Developmentalists report that when compared with their peers, many infants in the research cohort seem to be able to rest comfortably in feeding chairs in front of daytime television game shows for longer periods of time. They also exhibit less interrupted sleep, and coo and babble only when prompted.

“Imagine, babies genetically destined to suffer from ADD throughout their lifetimes, who now at only 2 months of age show less impulsivity when vocalizing with their parents. They wait to be recognized before speaking; and even then, their remarks seem to be much more age appropriate.”

The future looks bright for these children. “No more food fights at the dinner table, no more negative behavior at bedtime,” Dr. Kidd added. “We’re working hard to make it a better world for parents, for all of us.”

Still, some clinicians exercise a word of caution. “When it comes to the grey matter of the human brain, nothing is black and white,” one researcher commented. “In these clinical trials, nothing is a slam-dunk.”

Apart from stock options which she has yet to exercise, Dr. Kidd has disclosed no contractual relationships with any of the major pharmaceutical companies who market methylphenidate in their product lines.

God Rest His Soul

Father Bloom is dead; God rest his soul.

His obituary states that he died from “shortness of breath.”  As I recall, he was never a long-winded man to begin with.

Father Bloom spoke every year at the Memorial Day celebration in our town.  The parade always assembles at the village green and marches up the hill to the Catholic cemetery.   It takes all of fifteen minutes to complete the trek.

One year Father Bloom approached the microphone to greet the crowds assembled on the hillside.

“Welcome to our Memorial Day celebration,” he began, “the most popular annual event in our town.  As a matter of fact, it has the distinction of being the only annual event in our town.”

I used to walk our black Labrador retriever down the street past Saint Bernard’s Catholic Church on the corner.  Sometimes we would cut through the walkway between the church and the rectory.  Father Bloom kept watch from the window.

One time I returned with the dog and encountered Father Bloom standing on the walkway by the lawn.  “Good day, Father,” I said, mustering a weak smile.

“Is this your dog’s business?” Father Bloom growled, pointing to the pile of canine excrement at his feet.

I bent down to study it carefully.  “Oh, no, Father.  That’s not my dog’s; I’m certain of it.”

“Make sure you keep him out of the cemetery,” he said.  “Hallowed ground is no place for dogs.”

I wondered if Father Bloom had ever seen the movie, “All Dogs Go To Heaven.”

On another occasion my wife and I were out with the dog when Father Bloom stepped out of the side door of the rectory.  “Is that dog Catholic?” he asked.

“No, Father, he’s Protestant through and through,” my wife said.

“Then get him the hell out of here,” he muttered.

Once, when out for an afternoon stroll, I walked past the church and looked up to see Father Bloom’s Buick sedan shoot out from between the rectory and the house next door and skid to a halt on his front lawn.  Slowly the door opened, and Father Bloom careened out.

“Don’t mind me, son,” he grinned.  “I just went out for a few beers and missed the garage.”

Tongue in Cheek

Olga opens the door that leads to the reception area, careens her neck to scan the empty waiting room and calls my name. I rise to my feet, drop the magazine onto the corner table and follow Olga’s massive frame through the doorway and down the narrow corridor that leads to the open room at the back where the dental chair waits.

She motions for me to sit down and fastens a paper napkin around my neck with a small beaded chain. The metal chain is cold on my neck; instinctively, I reach up and adjust it so it rests on the outside of my shirt collar.

“The doctor will be with you shortly,” Olga says in her heavy Eastern European accent.

Sometimes I find myself involuntarily fantasizing about people. Secretly, I’ve got Olga pegged as an ex-KGB agent.

Soon the dentist appears. His lanky frame strides into the room with a hand extended in greeting. “How are you?” he says. “Here to have that tooth restored today?”

I nod my head. “I think that was the plan.”

“Ah, yes—well, let’s have a look.”

I open my mouth wide to accommodate the instruments that he inserts to pick at my molar.

“Good,” he says, matter-of-factly. “We’ll put a little numbing medicine on your gum before injecting the anesthetic. This new preparation is really neat. It’s manufactured with a vasodilator, so it’s cleared from the area quickly. Instead of walking around with a numb jaw for three hours, the time is cut in half.”

Once again I open my mouth and close my eyes. I feel the needle stick into the back of my mouth. Slowly, the solution is pumped into the tissue. Soon my cheek begins to feel heavy. “Now then, we’ll give that a few minutes to work.”

“I understand you were in research before you went to dental school,” I say, recalling a little known fact that his hygienist divulged to me at my last cleaning.

“That’s right. I worked in steroid hormone research with male hamsters for two years. After that I switched to molecular research. My boss was credited with decoding the genome for retinoblastoma.”

“Interesting stuff.”

“Well, yes and no. Research is very tedious. The thing I remember most was having to extract the food pellets from the cheek pouches of the male hamsters after anesthetizing them. These pellets were as big as your thumbnail.”

He picks up the drill and slips it into the back of my mouth. “Olga, suction please.” Olga inserts the plastic tube into the back of my throat. The drill whirrs like a tiny jackhammer. I can taste the fragments of newly pulverized tooth enamel on my tongue.

“I couldn’t believe how many pellets some of those males could salt away in their cheeks at one time,” he explains as he works. “I used to have to dig them out with my thumb. Suction, Olga.” Once again the plastic tip darts into my throat.

“Now open wide,” he says. “I’m going to pack the back of your mouth with cotton.” He inserts a pledget under my tongue and tucks another one inside my cheek. “Now we’ll slip this little metal collar around your molar.” He cinches it down tight. “O.K., Olga—mix.”

I hear a small whirring sound behind me, then Olga hands the dentist a miniature version of a caulking gun. Afterwards, he inserts a pen-like instrument with a blue light at the tip. It emits a small beeping sound every few seconds. I half expect my body to be atomized, molecularly transported to another dimension.

“Everything O.K.?” he asked. “How are you feeling?”

I utter the first phrase that pops into my head: “Like a male research hamster,” I say, making an effort to smile; but, like the patient suffering from Bell’s palsy, only one side of my mouth turns up.

I am eternally grateful that he doesn’t use his thumbs to pop the cotton pledgets out of my mouth.

“Notes from a Healer” — Sticking to the Treatment Plan

Persistence is a virtue—even if it is sometimes misapplied.

My latest installment of Notes from a Healer — Sticking to the Treatment Plan — 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.

An Old-Fashioned Boyhood

This boy, now ten years old, comes to the office for his annual physical exam.  His mother relaxes quietly in the corner chair.  This is her second child, the younger of two sons.  She’s been through this drill before.

“How are you doing this year?” I ask him.

“Fine,” he says.

“Fine up until a month ago,” his mother chimes in.  “He used to be a straight A student.  Lately his grades have dropped a bit.”

I raise my eyebrows.  “What happened?” I ask the boy.  He merely shrugs his shoulders.

“Spring, that’s what happened,” his mother says, smiling.  “Really, I’m not too concerned.  He’s outside every day now that the weather’s nice.”

“You like to go outside?” I ask the boy.  He nods his head.  “What do you like to do?”

“Catch frogs,” he says with a big grin.

“Really?” I say.  “What kind of frogs do you catch?  Bullfrogs?”

“Any kind,” he says.

“How do you catch them?”

“I’ve got a net.  I scoop them out of the pond in the woods behind our house.”

“What do you do with them—make frog legs for dinner?”

He laughs.  “No, I put them in my terrarium and feed them bugs.”

“He likes to play outside,” his mother says.  “I think it’s good for him.  We enrolled our first son in every extracurricular activity available.  He played soccer in the fall, basketball in the winter, baseball in the spring, went to camp in the summer.  We were literally exhausted from running here and there every night of the week.  It’s different with your second child; you learn to let go.  In a way I think he’s happier, too.”

“Good for you.  Sounds like everyone is benefiting from your new approach.”

I complete the exam and pronounce the boy to be in good health.  “You can get dressed and head out,” I tell him.  “There’s still plenty of daylight left to play outside.”

I step out of the exam room and walk to the front office to dispose of the paperwork.  How refreshing to see a kid enjoying an old-fashioned boyhood, I think—plenty of fresh air and activity, eager to explore the natural world, hands-on experiences in the outdoors—far removed from the endless string of video games, TV shows, cell phone chatter and Facebook posts—the kind of boyhood I had myself.

As I turn to retrace my steps, the boy flies by me in the hallway.  Eyes glued to the electronic device in his hands, he almost bowls me over.  My late afternoon reverie is too good to last.

“Checking your e-mail?” I ask, watching his fingers fly deftly across the tiny rows of buttons.

“Naw.  I’m texting my friend to ask if he can meet me at the pond in the woods to catch frogs.”

“He’s all boy,” his mother smiles, as she follows him down the hallway and out the front door.

“Notes from a Healer” — Best Laid Plans

A good bit of life is learning how to deal with contingencies; the same could be said for medical practice.

My latest installment of Notes from a Healer — The Best Laid Plans — 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.

“Notes from a Healer” — Triple Digits

I have cared for Jonathan since he was a newborn; I can recite his medical history like my street address, bank account and social security number. Jonathan was born with a pedunculated tumor attached to the wall of his left ventricle. So far the mushroom-like growth has given him no problems. His cardiologist and I keep our fingers crossed each time we see him.

My latest installment of Notes from a Healer — Triple Digits — 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.

“Notes from a Healer” — Coup d’flu

A recent article in the New York Times caught my eye: Swine Flu Wave May Have Peaked in U.S. Thank God, I thought, heaving a sigh of relief as I scanned the text. According to the Centers for Disease Control, influenza activity is declining across the country. New cases of the flu dropped significantly during the week ending November 13th.

Anyone working in primary care medicine can tell you that the past two months have been a nightmare. Offices and clinics have been bombarded with phone calls and patients scrambling to secure a dose of the H1N1 vaccine for themselves and their children. Initially, no one wanted the vaccine because it was so new. When it became apparent that supplies were severely limited, everyone clamored for a dose.

My latest installment of Notes from a Healer — Coup d’flu — 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.

Jabberwocky

Jabberwocky is perhaps the best nonsense poem written in the English language.  Author Lewis Carroll included it in his children’s book, Through the Looking Glass, and What Alice Found There.  In the poem Carroll makes liberal use of portmanteau, the blending of two or more words (and their meanings) into one.

Although nonsensical, the poem is structured using rules of classic English poetry.  It is written in rhymed quatrain format with iambic metered verse.

On an initial reading, many of Carroll’s words baffle the mind.  What actions, for instance, do the verbs “gyre” and “gimble” signify, or the adjective “frumious”?  Thankfully, Carroll himself offered a few definitions to enable readers to decipher various phrases.  For example, chortle is a blend of chuckle and snort. Armed with this knowledge, the studious reader is able to tease out the meaning of the lines of verse—to a point.  Through repetitive wrestling with the poem the reader begins to infer meaning, much in the same way that the student with a rudimentary knowledge of a foreign language garners the gist of a passage that he doesn’t fully comprehend.

One of the first books I purchased when I embarked on the study of medicine was a text of medical terminology.  Like most professions, medicine has a jargon all its own:  a vocabulary which must be mastered if one wishes to understand its basic concepts.  I quickly learned that the suffix –itis meant inflammation of, while –osis referred to the condition of.  Ectomy denoted an excision or cutting out; hence the treatment of an inflamed appendix—appendicitis—was the surgical excision of it—an appendectomy.  (Incidentally, it is the general surgeon who performs this operation, wielding his vorpal blade in snicker-snack fashion.)

At the outset these words seemed uffishly strange, almost otherworldly.  Initially, it was an arduous task to learn them.  Yet through constant use I gradually mastered their meanings as I grappled with my medical apprenticeship.

One danger all clinicians face is assuming that patients understand medical jargon.  We can be too quick to interject our professional vocabulary into explanations of medical conditions, procedures and treatment, burbling on about borborygmi; and find ourselves met with mimsy stares and vacant looks.  It is always best to explain medical concepts as though speaking to a child.  Even the most complex procedures can be broken down into simple steps.  Otherwise the patient is left groping in the dark, trying to comprehend the incomprehensible.  Sometimes the patient or a significant other might interject some manxome meaning on a par with that of Carroll’s poem.

Here I am reminded of the historical information provided by the wife of a man who presented to the emergency room with an acute myocardial infarction (heart attack).  “Well, doc,” she explained, “it was like this.  First off, he got high blood.  They kept on checking him with the cuff, but it wouldn’t come down, so they put him on a water pill.  When that didn’t help, they x-rayed his chest, which showed he had a big heart.  He got worse and worser, and they took more and more x-rays; and they showed that his heart was getting bigger and bigger, until finally there just weren’t no more room in his chest for his lungs to breathe—and that’s when they put in a spacemaker.”

Later, she was overheard speaking on the telephone, imparting the sad news that her husband of forty years had passed away from a massive internal fart.

This might not be jabberwocky, but to my mind, it comes frabjously close.