The Art of Medicine: The source of your strength

She appears in the hallway outside the laboratory, spray bottle in hand. Dressed in hospital scrubs, she’s just arrived for the evening shift, while I’m zipping up my coat to go home. more»

Interested readers can now access my latest Art of Medicine column — The source of your strength — 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.

Away from all pests

“[W]e understood that our vocation, our true vocation, was to move for eternity along the roads and seas of the world. Always curious, looking into everything that came before our eyes, sniffing out each corner but only very faintly – not setting down roots in any land or staying long enough to see the substratum of things; the outer limits would suffice.”

— Ernesto ‘Che’ Guevara, The Motorcycle Diaries

“The pest guy is here!” my wife announces from where she stands by the kitchen sink, hands immersed in soapsuds.

I peer out the side window. A white pickup truck sits in our driveway with the engine idling. The magnetic sign on the driver’s door advertises a local pest control company. They are here to do the bi-monthly pesticide applications to our house and garage. This will be their last scheduled visit to our home until spring.

I slip my arms through my bulky vest, reach for my cap and step out the kitchen door onto the stoop. A brisk breeze shoots across the back yard and stings my cheek. I zip up the vest and raise the padded collar around my neck.

A young Latino sits in the driver’s seat of the vehicle, head down, jotting notes on a clipboard resting in his lap. He looks up as I approach and rolls the window down.

“Hello,” he says with a wide smile. “I’m here to do the pesticide application to your house and garage. Is this an okay time?”

“No problem,” I say. “I’ve got the day off. Do you need to access the basement? I’ll open the hatchway for you.”

He descends from the truck and reaches a portable sprayer from the rear. He pauses to don a heavy camouflage coat before following me around the house to the other side. “It really got cold,” he says with a shiver.

“It’s almost Thanksgiving,” I say. “Winter is just around the corner.”

I bend down to open the hatchway, then descend the concrete steps to the basement. In the dim grey interior my hand finds the switch , and the cellar floods with light.

The young man proceeds to make his way around the periphery of the stonewall foundation, pumping the tank, applying a fine spray as he moves along.

“I haven’t seen you before,” I say. “Have you worked for the company long?”

“This is my first season,” he says. “I picked it up as a part-time job. Actually, tomorrow is my last day.”

“Really? You don’t much care for the work?”

“Oh, the work is fine; but it’s seasonal. We all get laid off for the winter. Next week I’m heading out to California on my motorcycle until spring. I’ve got some good friends out there. If I can find a full time job, I might not come back.”

“I imagine they’ve got pest control services out there too,” I say.

“Oh, I wouldn’t work in pest control,” he says. “Actually, I’m a trained massage therapist. I used to have a good job working at one of the local hospitals, but that fell through. I picked up this gig just to get me through the summer and fall. I figure I can probably find work as a massage therapist in California.”

“I’d wager the odds would be pretty good in your favor,” I say.

He finishes the application, and we retreat back up the concrete stairway. I secure the hatchway doors. “The garage is out back,” I say. “I’ll open it up for you.”

The wind cuts against our faces as we round the back corner of the house.

“It’s cold,” he says. “Glad I’ve got my heavy coat. I don’t care much for winter.”

“That’s New England,” I say, as I pull up the garage door.

He sprays an application along the perimeter. “I’ll treat the outside of both buildings,” he says. “You don’t have to wait outside. I’ll just pop the receipt in your mailbox when I’m done.”

“I don’t mind,” I say. “I just got back from a morning walk myself.”

He sets off and shortly finishes his assigned task. He stows the sprayer in the back of the pickup and reaches into the cab for the receipt. “Here you are,” he says with a smile.

“Thanks,” I say. “Good luck on your cross country motorcycle trek.”

“Yeah,” he grins. “I’ve never done anything like that before. It’s a little scary, but it should be fun. I like to explore; I like to meet new people. I just hope I can beat the snow.”

I watch him back the white truck out of the driveway and disappear down the street.

To be young and free, I reflect; unencumbered, looking ahead to a cross country trek to California, where sun and surf await one’s arrival; away from all pests, if only for a season.

Of time and the river

Time is but the stream I go a-fishing in. I drink at it; but while I drink I see the sandy bottom and detect how shallow it is. Its thin current slides away, but eternity remains. —Thoreau, Walden

My friend and I both agree: we have never seen the river so shallow as this year.

For the first time in as long as we can remember, certain rocks, previously hidden, are now visible, having risen Brigadoon-like from its watery depths. What was once the beginning of the sluice that diverted river current to power the turbines in the old mill is now clearly outlined by the sweep of river rock just west of the bridge, and the bases of the concrete abutments downstream are readily apparent where the old Tunxis bridge once spanned the gorge.

We dip and swing our paddles beneath the bright sun and faultless blue sky. The old blue wooden-ribbed boat glides silently through the clear water. Arrayed along the sandy river bottom, the last leaves of autumn are clearly visible, a patchwork of yellows and browns.

Shortly, we kick up a gaggle of six Canada geese. Their wide wings beat the air, lifting heavy bodies off the water’s surface in a cacophony of honks and splashes. In formation they fly upriver, then at the last moment diverge at the steel bridge, four birds ascending above, two below.

Gradually, we move upstream against the current; continually, it beckons us back; but still we force our way forward against the flow of water.

Scoured trees stand sentinel-like, guarding the brambled banks. Any number have been undone, strangled and broken by the ubiquitous yellow-orange bittersweet.

Eventually, we turn the canoe in a grand sweep and begin our descent, drifting downstream, no longer fighting the force of the current.

A red-shouldered hawk drops from its perch and silently disappears into the woods.

As the thin current carries the blue boat along through the mirror of blue sky, past the leafless trees, now stark in their late autumn nakedness, soundlessly we become one with the water and the overhead expanse, drifting through momentary lapses of time into the eternity that remains.

river-paddle-11-19-2016-3

Paddle at eventide

It’s been nearly a week since we turned the clocks back. Now that we’ve moved to Eastern Standard Time, the sunlight fades quickly by the end of the afternoon.

My friend figured that if we could launch the canoe by quarter past three, we’d have a good hour’s paddle on the river before dark.

It was a short drive to the access point. We donned our life jackets, eased the boat into the water and climbed aboard. Soon we were gliding downstream with the current. The surface of the river was smooth and flat.

“I fished this section quite a bit this past summer,” my friend said, as we drifted past scoured tree trunks half-submerged along the far bank. “Right here it drops off. Big bass lie in the deep holes under the wood.”

I looked down into the black water. You could see yellow leaves lying in the muck on the bottom; then suddenly, the bottom fell away.

We paddled downstream to the old red-stone bridge abutment on the bank.

“This is where the railroad crossed the river,” my friend said. “You can see the old pilings near the far bank.”

We eased up into the current to survey the stonework.

governors-bridge-abutment

Downstream we picked up speed as we pulled deep and feathered our paddles.

Suddenly, I heard a shout from the stern. “Look!” My friend gestured toward the bank with his chin as he held his paddle firmly in the water.

There, silhouetted at the top of the rise, four dark forms undulated upstream in a line.

“River otters!” my friend cried, as he swung the canoe around.

We watched them bob along in single file. Shortly, without warning, the lead otter careened down the bank and entered the water with a splash. A second followed closely behind, while the other two held steady at the top of the rise.

Heads bobbed up above the surface, then disappeared in rings of water. As we maneuvered closer, I saw a dark form leave the water and disappear into the muddy bank beneath the bare roots of an old tree. Another form soon followed.

Shortly, we heard a series of mewing sounds from inside the bank, as well as from the top of the rise.

“There’s two adults and two kits,” my friend said. “They’re calling the young into the water.”

Silently, we waited, dead in the water.

Suddenly, one of the otters emerged from the hole in the bank and slid into the river with a small splash. The other one was not far behind.

We traced the string of bubbles as they moved toward a stand of wood. Finally, two heads bobbed to the surface.

I held my smartphone up and tapped the button several times.

river_otter1_11-10-2016

Another set of splashes sounded behind us. The two remaining otters had slid down the bank into the river.

We followed them across to the other side, where they disappeared for good.

We turned the canoe around just below the second set of old pilings and paddled hard against the current.

By the time we had the canoe secured to the roof rack on the car, the oaks on the far mountain blazed burnt orange in the last rays of the evening sun.

farmington-at-eventide

The leaves are down

I was up at first light to scour the sky. Yesterday’s promise of blue had faded into thick cloud cover overnight.

In utter disbelief I studied the blanket of impenetrable grey; it was a bit disorienting, to say the least.

Now I sit with my cup of morning coffee, staring out the back window into our yard. There is a stillness in the air. I strain to listen for some still small voice, but only silence echoes in my ear.

Yesterday I raked the lawn and the beds and bagged the golden leaves. The results of my day of labor — seven stout brown bags, filled to the brim — stand quietly along the red-stone retaining wall that I built with my bare hands three decades ago.

Once again the yard is covered with yellow leaves, fallen overnight. One of the maples still retains several clusters: hangers-on that have yet to give up the ghost.

Today I shall resolve to put myself to raking once again. There are more bags to fill; there is a remnant that needs cleaning.

Election Day, 2016

The public elementary school where I vote is just a 2-minute walk from my house. I enjoy a quiet saunter down our short street. The leaves have been falling all morning; a thick golden carpet covers the yards. I remind myself that I have to run to the local hardware store for paper leaf bags after I get back home.

As I approach the school, a red truck pulls into the parking area. I recognize the driver; he’s a neighbor of mine. We’ve known each other for decades; our children grew up together. Although we remain on friendly terms, our political views are different.

One of the local candidates up for re-election stands on the sidewalk, holding a campaign sign across his chest.

“Beautiful day,” he says.

“Sure is,” I say, flashing a non-committal smile.

I enter the building, walk past the table filled with baked goods for sale by the local PTA and pause to survey a large poster on the wall depicting a sample ballot. Another poster adjacent lists 6 town referendum questions on the ballot.

I step into the polling place, show my driver’s license for identification, collect a ballot and find an empty chair at one of the desks in the middle of the room. I glimpse my neighbor, head down, seated at another desk several rows away.

I review the questions and the candidates, make my selections with the felt-tip marker, slip the completed ballot inside the privacy folder and make my way to the front of the room. One of the volunteers collects the folder as he directs me to insert my completed ballot into the machine on the table. “Either side up will do,” he says.

Another man thanks me for voting and places a sticker on my fleece. I step out into the morning sunshine and stroll past the line of smiling candidates on the sidewalk.

Back home I slide into the driver’s seat of my car. It’s a short run to the local hardware store. One of the employees directs me to the stack of paper lawn and leaf bags. I pick up an armful and head to the checkout counter.

“Say, where did you vote?” the woman behind the register asks, pointing to the sticker on my fleece. “My polling place isn’t giving out fancy stickers like that.”

Several other people careen their necks to look.

I reach for my smartphone and tap the photo icon. “That’s the first selfie I ever took,” I say, showing the cashier. “I sent it to my kids with a caption underneath: ‘The triumph of hope over experience’.”

“I like that,” the woman laughs.

I sign my name on the electronic screen and tap the button. The cashier hands me my receipt.

“I hope that tomorrow, as a nation, we can all regroup and get on with things,” I say.

“I’ll second that,” she says.

Back home, as I pull into the driveway, the leaves continue to fall, gently slapping themselves against the hard ground.

By this time tomorrow they will all be down.

election-day_2016

Goldengrove

goldengrove_10-23-2016

to a young child

Márgarét, áre you gríeving
Over Goldengrove unleaving?
Leáves like the things of man, you
With your fresh thoughts care for, can you?
Ah! ás the heart grows older
It will come to such sights colder
By and by, nor spare a sigh
Though worlds of wanwood leafmeal lie;
And yet you wíll weep and know why.
Now no matter, child, the name:
Sórrow’s spríngs áre the same.
Nor mouth had, no nor mind, expressed
What heart heard of, ghost guessed:
It ís the blight man was born for,
It is Margaret you mourn for.

Gerard Manley Hopkins