Sights & Sounds

Leaning in, I listen.
The whoosh resounds in my ears,
Pulsating with each regular beat,
As though an elf were clearing his throat:
Harsh, holosystolic, grade 4 of 6,
A VSD most assuredly:
But this ventricular septal defect
Is coupled with infundibular stenosis,
An over-riding aorta,
And right ventricular hypertrophy.
It takes an echo to follow the flow of Fallot.

Leaning in, I listen.
The whirr-buzz sounds in my ears,
Repeated ad infinitum from the bush.
I scan the wood, raise twin prisms,
Peer toward the sound.
A blue-winged warbler
Drops off a high branch,
Disappears behind spring leaves.
Momentarily I catch
His sine qua non:
The black eye streak;
The whirr-buzz echo
Of his call.

2017©Brian T. Maurer

The clinical encounter: an about-face?

Gradually, over the past decade we have been replacing face to face conversation with virtual interaction through cybervenues such as FaceTime and Facebook. Somehow, our social intercourse has not been not the same.

Face to Face. This slender volume rests on the bookshelf, a remnant from one of my graduate courses in counseling. The course was run as an encounter group. Participants had to work out the particulars of their interactions. Some of it was rough going; some of it wasn’t pleasant. You had to be an astute observer of body language, tone of voice, facial expression. Some of us were pretty adept at guarding our emotions; others wore their hearts on their sleeves. We didn’t necessarily agree with one another, but we heard one another out — at least, those of us who chose to interact.

In a group setting mutual support evolves through empathetic listening. To do so, you must be physically and psychologically present in the moment.

Similar interactions take place every day in the clinical encounter. We clinicians spend most of our day interacting with patients in the physical realm. With the advent and widespread use of the EMR (electronic medical record), face to face time has dwindled. Now the screen competes for our attention. No longer face to face with the patient, we tend to miss or overlook those subtle clues inherent in posture, facial expression, and body language.

Third-party payers are now advocating telemedicine as the latest and greatest means to improve access to healthcare and trim costs. In turning our eyes toward the future, might we actually be performing an about-face, as our physical face time recedes into the sphere of virtual reality?

A picture may be worth a thousand words, a video transcript even more; but I question the degree of meaningful healing that can take place in a virtual universe.

The Art of Medicine: Dispensing empathy in the pediatric setting

Slowly, the student nods her head. On this, the last day of her pediatric rotation, she has learned a valuable lesson: listening to the patient with an empathetic ear will generally hold you in good stead. more»

Interested readers can now access my latest Art of Medicine column — Dispensing empathy in the pediatric setting — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Art of Medicine pieces can now be accessed here.

What’s so memorable about Memorial Day?

For many Americans Memorial Day marks the beginning of the summer season with parades and afternoon cookouts on the grill; yet the roots of this holiday go much deeper than that. Come and learn about the historical significance of this most sacred of secular holidays in a presentation by one of our local veterans, Brian T. Maurer, at the Simsbury Public Library on Wednesday, May 24, 2017, at 1:00 PM.

A veery in the wood

Last Saturday, the penultimate day of the annual spring census, dawned bright and blue. My list of birds had grown over the past week to more than 60 species. I grabbed my binoculars and headed down to the path that runs along the river, anxious to capture whatever sightings I could before time ran out.

Almost immediately, I was greeted by the song of a redstart from somewhere in the canopy overhead. Catbirds darted in and out, mewing from the bushes. The river ran high in the wake of recent rains, and from across the silent swirling eddies the sounds of warbling vireos came sharp and clear.

Up ahead something darted across the trail into the brush. I froze, brought my binoculars up, and focused into a tuft of trembling leaves. A black-masked yellow throat busily gleaned a twig. Momentarily, he sounded his witchety-witchety-witchety call. As I paused to record his name in my notebook, another call echoed through the wood.

Breathless, I strained to listen. There it came again, distant but unmistakable: flute-like notes, slurred together in a series of descending trills.

Carefully, I stepped along the trail, taking care to avoid snapping a branch or twig underfoot. The air was cool and clear; and when the bird sounded again, the refrain became sharper still.

I stood for several minutes, steeped in this song, and wondered at its beauty.

The song of the veery (Catharus fuscescens) has been described in various ways, each a sincere attempt to capture the refrain, each falling somewhat short of the actual performance. The Cornell Lab of Ornithology reports it as “a series of variations on veer, descending slightly in pitch, resonating as if whirling through a metal pipe.” Nineteenth-century observers called it “an inexpressibly delicate metallic utterance…accompanied by a fine trill which renders it truly seductive.”

The best way to experience this woodland singer is to head to the forest on a clear, cool morning in spring and listen. At some point, the patient observer is sure to be rewarded.

Spring warblers in the treetops

I hear, and have for a week, in the woods, the note of one or more small birds somewhat like a yellowbird’s. What is it? Is it the redstart? I now see one of these. The first I have distinguished. And now I feel pretty certain that my black and yellow warbler of May 1st was this. As I sit, it inquisitively hops nearer and nearer. It is one of the election-birds of rare colors which I can remember, mingled dark and reddish.   —Thoreau’s journal, May 10, 1853

One morning this week I wandered through the woods along the path by the edge of the river. Periodically, I paused to focus my binoculars on a short, slight movement in the trees. During these moments I became aware of the cacophony of calls from the canopy overhead. Similar songs emanated from various quarters. It took a bit to tune my ear to pitch and tone. Patiently, I stood, waiting for signs of movement among the budding branches. At last I was rewarded. The canopy was ripe with small black and orange warblers, redstarts most assuredly.

Over the course of these past few mornings I have identified by sight and sound any number of species: the blue-winged warbler, the black-throated blue; the yellow-rumped variety and the black-and-white; the yellow warbler and the chestnut-sided. The warbling vireos have declared their return as well, mostly through their distinctive songs high in the treetops.

Thoreau reveled in the return of the warblers in spring, when the green forest is splashed with dabs of color—

Within a few days the warblers have begun to come. They are of every hue. Nature made them to show her colors with. There are as many as there are colors and shades.  —Thoreau’s journal, April 19, 1854