America the Beautiful

Up the long hill
On our morning walk
We cross a side street,
The dog and I;
A car slides to a halt,
The passenger window descends,
An acquaintance from long ago
Hails me by name.
He’s now moved on
To assisted living,
Misses his work, misses
Young people in the office.
“Growing old is for the birds,”
He says, offering a hand
Devoid of several digits.

Further along,
Within the next block,
My neighbor steps out of his car,
Transfers the smoldering cigarette
To offer me his hand.
I point to the corner house
Across the street.
“Have you seen Paul?”
I ask him.
No, he shakes his head.
“He left without saying goodbye,
The house is in foreclosure.”
“How much they ask?”
“It will probably go to auction,”
I explain, pacing my words so he can follow.
“In Iraq I have much land,
Big wholesale business,
Import-export,” he says.
“In the war I lose everything.”
I wait in momentary silence.
“Now I try to begin again.”
I search my mind for something to say.
“Old biblical proverb:
Get knocked down seven times,
Get up eight.”
He nods his broad head
And smiles.

I sit on the front porch, reading.
The street sweeper whirs by,
Making two moist circuits,
Disappears at the far end of the block.
The postman zips down the street,
Snapping mailboxes open and shut.
His tiny truck coasts to a stop
Before our house,
The ever-present cigarette
Dangling from the driver’s mouth.

Two doors down
A tree climber drops
The topmost branches
Of an ancient copper beech.
Thy hit the ground with a thud.
“How old you think it is?” I shout.
From his eyrie perch he shrugs a shoulder.
“One hundred years at least,” he says.

My wife fills the birdbath and
Waters the irises.
A neighbor pauses with her dog
To admire the gardens.
“Your wife has a green thumb!”
A brown wren recites the liturgy
From his front porch pulpit
On the white wicker chair.

The church bell strikes noon.

My wife chats with the next-door neighbor
Over the scalloped picket fence.
I don my Panama hat
And saunter down to the park.
A white-eye-ringed duck
Escorts her brood of seven ducklings
Through murky still waters
Behind the tennis courts.
Pickup trucks and SUVs
Sprawl along the shoulder
Of the cul-de-sac at
The end of the road.
Dogs leap and race,
Owners bark commands,
Beers in hand.
A red-bearded man rolls a cigarette.
“I can get seventy out of a single pouch
Of American Spirit tobacco,” he says.
“It’s organic.”

The lone Latino man fishes the millrace
For food to feed his family.
Every evening he stands on the bar,
Casting a line into the current.

I retrace my steps up the hill.
Two doors down
Beneath the stately groomed trunk
The tree climber feeds
Dropped branches into his chipper.
“Comin’ down this evening,” he says.

Hot, tired,
I turn into my driveway and pause,
Push back my hat,
Look out over the flowerbeds:

There, in the freshly-manicured lawn,
A sentinel stand of forget-me-nots.

"Copper Beech" 2016©Brian T. Maurer

“Copper Beech” 2016©Brian T. Maurer

2016©Brian T. Maurer

Physician assistants and nurse practitioners in outpatient surgical settings

In the May issue of JAAPA, Salibian and colleagues present an independent research study that examines the use of PAs and NPs in outpatient surgical subspecialty settings. more»

Readers can now access my latest musing — PAs and NPs in outpatient surgical offices — at the Journal of the American Academy of Physician Assistants Editorial Board blog.

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

Wild waters

Earlier this month a friend and I hiked the Falls Trail at Ricketts Glen state park. During the descent through Ganoga Glen, we paused to watch a feeder stream rush down the steep hillside into Kitchen Creek. Although dwarfed by the spectacular falls along Kitchen Creek, the small cataract on this feeder stream exhibited a charm of its own. We debated a name. “Let’s call it ‘No-Name Falls,'” I suggested. “How about ‘Imagination Falls?'” my friend said. I’m unsure what name stuck, but I shall always recall the vibrancy of the clear white water as it tumbled down over the rocks beneath the small wooden footbridge on which we stood.

2016 Ricketts Glen

“Wild water left to itself can never fail to be beautiful,” Odell Shepard writes in his treatise on angling Thy Rod and Thy Creel; “and it will not endure the slightest ugliness about it.”

As I look back over my youth, I am struck by the number of creeks, streams and rivers that formed and deepened my appreciation of the natural world. “We need the tonic of wildness,” Thoreau writes, and what can be more wild in the eyes of a boy than a stretch of free-flowing natural water?

I think back to the streams of my Pennsylvania childhood: Echo Valley Brook, Trout Run, Indiantown Run, Stony Brook, Swatara Creek, Quittapahilla Creek (the Quittie) — streams in which we played and fished and swam and paddled. Later the circle would be expanded to include others: Broad Creek in Stroudsburg, Pine Creek in Wellsboro; the Musketaquid in Concord; Riga Brook, Salmon Brook, the west branch of the Upper Farmington; and the Rio Sor, which cascades down through the mountains of northern Spain where a good friend from long ago and I fished one summer.

I think of them now with a certain warmth and pleasure, thankful that I had the chance to know them intimately, as a lover knows his beloved.

In the final pages of his boyhood memoir The Old Man and the Boy, Robert Ruark lovingly relates the final trek home back to North Carolina with his aging grandfather:

When we got to a place called Jackie’s Creek, where we had seen turkeys and shot quail, the Old Man said, “Stop the car. I want to took at it.”

When we got to a place called Allen’s Creek, and Moore’s Creek, he said the same thing. We stopped and we looked. The Old Man nodded his head, and said, for no reason at all that I could think of, “I’m satisfied. Nobody owes me nothin’.”

As I look back on these streams, the streams of my youth, the streams of my middle years and those of my older age, I find myself thinking the same thing.

"Galicia Bridge" © Brian T. Maurer

“Galicia Bridge” © Brian T. Maurer

Treating fear itself in the clinical setting

It’s been a tough evening at the after-hours care center. It’s the middle of the cough and cold season, patients are showing up in droves, and I’m the only clinician available to see them. I pick up a clipboard with the next patient’s encounter form attached, take a deep breath and let it out slowly as I step across the threshold into the examination room where a family waits. more»

Interested readers can now access my latest Art of Medicine column — Treating fear itself in the clinical setting — recently published in the Journal of the American Academy of Physician Assistants.

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

Wind advisory

Morning winds whip
Through tops of tall trees—
“The gods must be angry,”
The ancients would have said.

Modern meteorological data
Informs a wind advisory—
The possibility of falling branches,
Downed limbs, local power outages,
Commuter driving challenges
In high-profile vehicles—
Gusts up to 50 miles per hour
Until 2 o’clock this afternoon.

From my window I watch the wind
Lash the tops of towering pines—
“The gods must be angry,”
I murmur to myself.

3/29/2016

Spring cacophony

I paused momentarily at the end of the driveway to check my inner compass, then abruptly turned southeast and headed out on foot. The binoculars bounced off my plaid woolen coat as I climbed the leaf-strewn path past the basalt outcroppings to the far ridge.

Chickadees flitted on bare grey branches by the path; a red-bellied woodpecker cackled from the glen below. A black swallow-tail fluttered down to rest on a lichen-covered rock in the middle of the trail, slowly fanning its wings in the cool spring air.

I stopped at the first power-line cut to survey the valley below. Off in the distance a red-tailed hawk circled in the air high above the river.

Just beyond the second cut I sensed the distant sound of spring peepers. The cacophony grew louder and louder as I approached the vernal pool. Tiny heads, each bearing a set of bulging eyes, bobbed just below the surface. The dark water was littered with hundreds of frogs, each one hovering with legs splayed out in frog fashion behind him. They swam in quick, short strokes, as though they hadn’t yet mastered the power of each purchase. I stood by the bank for some time, enveloped in the orchestral overture.

On my way back along the lower trail I met a man bearing a large tarp full of leaves and pine needles. He slung his oversize bundle down in the middle of the trail as I approached.

“I’m laying down some forest mulch to cut down on the erosion,” he said. “The mountain bikers and dirt bikers have worn the path down to bare rock.”

“I didn’t know they allowed dirt bikes on the trail,” I said.

“They don’t,” he said. “But every evening they come up from below and ride the ridge.”

“That must put the peepers down,” I said.

“To be sure,” he retorted. “Of course, the peepers stop as soon as you approach the pools.”

“I suppose so,” I said.

“Well, I must get busy here. Enjoy your walk.”

I nodded my head and continued along the path. Up ahead a familiar cacophony sounded from the forest. Gingerly, I bushwhacked through the brush to the edge of a swamp.

For a long time I stood, secretly serenaded by another chorus of spring peepers.

2016 vernal pool (2)