The Art of Medicine — A Christmas gift

The mother sits quietly beside her husband, holding the swaddled infant in her arms. With pen in hand the father studies the form on the clipboard before him. Their 3-year-old son vies for his attention, then drops to the floor, whining by his feet. more»

Interested readers can now access my latest Art of Medicine column — A Christmas gift — 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.

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Beyond burnout

The issue of clinician burnout may be taken to another level, that of moral injury, defined as an inability to provide high-quality care and healing in the context of healthcare delivery. more»

Read more in my latest entry on the Musings blog of the JAAPA Editorial Board here.

JAAPA is the official publication of the American Academy of Physician Assistants.

The Art of Medicine — Making it up as you go along

“He’s pitching a fit in there!” the nurse goes on. “Won’t even let me take his temperature. The mother’s upset because she said they had to wait too long. It’s only been 15 minutes.”

Silently, I smile as I approach the closed examination room door. I find the boy clinging to his mother’s neck, sobbing. “Oh my, someone’s upset,” I muse. more»

Interested readers can now access my latest Art of Medicine column — Making it up as you go along — 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.

The Art of Medicine — When the dust settles

The young mother sits in one of the plastic chairs in the examination room, struggling to contain her little girl. The toddler writhes in her mother’s arms, throws her head back, then head butts her mother’s shoulder. more»

Interested readers can now access my latest Art of Medicine column — When the dust settles — 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.

How does the moo cow go?

Now nearly fifteen months of age, my grandson adds new words to his vocabulary daily; his linguistic ability continues to blossom, each day filled with new surprising utterances.  Like most toddlers he has learned the names of several body parts.  When asked, he can point to his head, his hair, his eye, his ear, his nose, his tongue.  He also responds when questioned on animal sounds.  “How does the puppy dog go?” we ask. “Woof woof,” he says.  “How does the kitty cat go?”  “Meow,” he intones.  Although he has yet to learn how the moo cow goes, he readily imitates the mourning dove’s call:  “Ooh Ooh, Ooh; Ooh-ooh.”

Just his morning a colleague sent me the link to a NYT article — Cleaning Toilets, Following Rules: A Migrant Child’s Days in Detention — that profiles a number of “illegal” immigrant children separated from their parents at the U.S.-Mexican border and whisked off to any one of a number of detention centers around the country.  Some youngsters have not seen their mothers in over forty days.

Life in these centers is highly regulated according to set routines.  Children undergo strict regimentation; even the very young are expected to perform daily work tasks.  Hugging or touching other children is forbidden.  In some instances children have awoken to find a friend gone, his whereabouts unknown.  One little girl has taken to writing her mother frequent letters, which she keeps until the day when they might be reunited; she is not allowed to mail them; and even if she could, she does not know her mother’s address.

The article also notes that children receive instruction in conversational English, as well as in American civics.  Perhaps they are also taught the democratic process, where legislation is enacted by representatives bought by special interest groups and subsequently signed into law by the President to ensure fairness and justice for all, regardless of race, creed or color.  As a boy I was taught that the marble statue of Justice bore a blindfold for a reason.

As I read through this article, I found myself wondering if these children might also be taught the words enshrined on a bronze plaque in the pedestal of the Statue of Liberty:

Give us your tired, your poor, your huddled masses, yearning to breathe free.

At one point the authors of the article note that the interior of one of the larger detention facilities has been subdivided to accommodate the juvenile residents.  Partitions fall short of the common ceiling overhead, so that sound readily travels from one section of the building to another.  Every so often a child will spontaneously emit a loud mooing sound, picked up and repeated by others throughout the building, the end effect being something analogous to a cacophonous echo, like that of a herd of cattle, penned in and lowing mournfully to one another.

It has been said that the moral conscience of a nation might be measured by the way in which it treats its most vulnerable citizens:  the aged, the infirm, its children.  As one who has made it his life’s work to care for the health and well-being of children, I have come to consider all children to be part of the family of man and citizens of the world order.

My grandson has yet to learn how the moo cow goes, but we’re working on it.  Meantime, when I ask him, he readily recites the lonesome echo of the mourning dove on cue.

The Art of Medicine — Do you believe in magic?

In pediatric practice a sleight of hand might produce unintended consequences. more»

Interested readers can now access my latest Art of Medicine column — Do you believe in magic? — 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.

The worst day of your life

“I suppose you’re going to tell me that this will be the worst day of my life?”

Coming from the mouth of a 10-year-old girl whose mother had just succumbed to an opiate overdose, the child’s words carried unspoken impact.

The priest who was telling me this story said he wasn’t sure how to respond.

This was back in the day when one of his duties was to serve as chaplain for the city fire department. The firemen would call him in on those sorts of impossible cases where no one had any idea what to do; cases like this one: a 10-year-old girl unexpectedly orphaned on the spot with no apparent next-of-kin.

By the time he arrived at the sparse apartment, other tenants in the public housing complex had started to filter in, each attempting in his or her own inept way to offer condolences and comfort.

“It was like something out of a Tennessee Williams play,” the priest said. “Everyone was concerned. No one knew what to do.”

“What did you say to her?” I asked.

Momentarily, the priest’s eyes regarded an infinite point in the distance; then he collected himself.

“I thought of all the bad things that this little girl would be facing in the coming hours, days, and weeks ahead. I thought of all the not-so-good things she might be facing for the remainder of her formative years, maybe even for the rest of her adult life.”

He lapsed into silence. Then the words came again. “Suddenly, I remembered that I had just lost my own mother. I knew how it felt. It felt like the worst day of my life. That gave me the courage to tell her: yes, this would be the worst day of her life; but there was always hope that somehow things would work out for the better.”

The hint of a tear glistened in the corner of his eye.

“Those are the ones that you always remember,” I said.

“Yes,” he said. “They are.”

Sometimes in our struggle to care for others, we must first learn how to care for ourselves, how to lay down our own burdens. In facing our own suffering and accepting our own wounds, we learn how to help others heal.