The art of observation

He explained patience. He said it was the most important thing of all to remember, this: that when you wanted to see something very badly, sometimes you had to stay still, stay in the same place, remember how much you wanted to see it, and be patient.  —Helen Macdonald, “H is for Hawk”

I brought the binoculars up to my eyes and adjusted the knob, easing the fuzzy silhouette into focus.  It was a big hawk: that much was clear from the sheer size and the hooked beak.  The biggest species of hawk in our region is the Red-tail, and the female Red-tail usually outweighs the male; but the colors of this bird didn’t quite fit.

There was a smattering of white spots across the shoulders on either side; they formed a V on the upper back.  The head was dark, the throat lighter in color; and the buff breast was streaked with dark broad patches.

Then there was the tail: dark brown regularly interrupted with black horizontal bars, extending well beyond the folded wingtips.

Majestically, it perched atop the Celtic cross on the pinnacle of the brownstone church steeple, emitting a series of screeching cries.

Another bird, similar in coloring but smaller in size, answered from his perch in the uppermost branches of the tall dead spruce on Winthrop Street.

I eased closer, pausing after several steps to bring the binoculars up and observe the detail of the plumage.

Finally, after twenty minutes, the big hawk lifted its hindquarters, spread its broad wings, and dropped off the steeple, soaring to a cluster of far trees.  I caught a glimpse of the tail against the overcast sky: definitely not a russet red.

Back at the house I studied a copy of Sibley’s Guide and searched online.  Finally, I found it:  a juvenile Red-tail.

There is an art to identification, where perception, perseverance and patience reward the persistent observer.

The Art of Medicine: The big and the little

The patient squats by the step stool in the examination room, peering at pictures as she turns the pages of the little big-book. She squeals with delight at the moo cow; she claps her tiny hands at the puppy dog and looks up at me expectantly to validate her joy.

Her mother sits in the chair opposite, leaning forward, elbows resting on her knees, only the hint of a smile on her face. “So what do we do this time?” she asks in a slightly defeated tone of voice. more»

Interested readers can now access my latest Art of Medicine column — The big and the little — 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.

Impresiones y recuerdos personales de un joven americano

The 4th edition of the Galician periodical Terras Do Ortegal is published this month.

This edition will carry my original article entitled “Impresiones y recuerdos personales de un joven americano durante su servicio militar en la base de Estaca de Bares (1975 – 1976)”.

Fue a finales del mes de abril de 1975, cuando aterrizó un vuelo ibérico procedente de Madrid en el aeropuerto de A Coruña. Siendo un joven de veintiún años, yo tenía mis órdenes militares. Al desembarcar del avión, me encontré con Heriberto Sobel, médico de la base americana de Estaca de Bares, acompañado por un taxista que se llamaba Alfredo. Metieron mi equipaje en el coche, y en seguida circulamos por las carreteras rurales, que me ofrecían unas vistas preciosas de los campos verdes de Galicia. Íbamos a la punta más al norte de España, Estaca de Bares, la cual sería mi hogar durante los siguientes doce meses. En lugar de Heriberto Sobel, yo sería el nuevo médico de la base….

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.