The Art of Medicine — Father wounds: Dealing with loss

“This 17-year-old boy is here for a physical exam,” the nurse says, handing me the chart. “He hasn’t been in for 2 years. He needs his meningitis vaccine to start college this fall. His mother’s out in the waiting room. Oh, and there’s a sticky note posted inside: looks like his father died this past spring.” more»

Interested readers can now access my latest Art of Medicine column — Father wounds: Dealing with loss — 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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Dinner break

“I’m heading down to the cafeteria for dinner,” I said.

The charge nurse looked up from the central desk. “Go ahead. We’re good for now.”

I padded down the hallway to the end of the ward, touched the square steel plate on the wall, walked through the open doors and caught the elevator to the ground floor.

The serving line was still open. I picked up a tray, made my selections, paid the cashier and sat down at one of the empty tables along the far wall. There were plenty of vacant seats to choose from.

Methodically, I began to eat. It had been a long afternoon, looking in on the patients on the ward, talking with concerned parents, answering pages from the ED, reviewing labs and x-rays in radiology on the third floor. I was glad for my dinner break, glad for a few moments of down time, glad for the chance to put something in my stomach.

“Mind if I join you?” I looked up at the bald-headed bearded face and motioned for him to sit down. He slid his tray onto the table and pulled out the chair. “You on for the duration?” he asked, reaching for his napkin.

“Until tomorrow morning,” I said. “Twenty-four hour shift.”

“Sometimes Sundays are quiet,” he said.

“You never know,” I smiled.

“You never do,” he said.

We ate in silence. Then he said, “You’re covering pediatrics?” I nodded. “I thought I saw you earlier in the ED.”

“I’ve been around the block a few times since the morning.”

“Haven’t we all,” he said. I noticed the name embroidered in red over the breast pocket on his white coat. “Had a gunshot wound come in mid afternoon,” he said. “Self inflicted.”

I pushed the mashed potatoes around on the plate with my fork. “Did he make it?”

“If you want to call it that,” he said. He held his fork suspended by his side and raised the index finger of his left hand to the side of his head. “Amateurs,” he said. “They don’t know anatomy.”

I lifted a forkful of food to my mouth and chewed slowly.

“The bullet entered the cranium at a shallow angle,” he said. “Spun around the inside of his head like a marble on a roulette wheel. Homogenized his grey matter like whipped jelly. Left the brainstem intact. Not much to do for that.”

I swallowed the potatoes and waited.

“I expect he’s gone by now,” the bald-headed bearded man said. “At least, I hope so.”

Suddenly, the quiet was broken: my pager went off. I pushed the button to silence the noise, read the extension and rose from the table. “Gotta go,” I said.

He raised a silent hand, as though he were offering a blessing. “Hope the rest of your night is quiet,” he said.

For some inexplicable reason, it was.

An accent of local color

I was bending down to bag a pile of dog dirt when Dennis lifted his hand in greeting as he drove by in his big white truck with the backhoe logo on the side panel.

Further along, I noticed the white truck parked by the curb near the old post office. As Daisy and I crossed the village green, Dennis came out of the package store with a number of lotto tickets in his hand.

“I saw you pickin’ up your dog’s shit,” Dennis said. “That’s good to see. So many folks don’t bother. There’s piles of dog shit along the sidewalks all over town. There used to be piles of dog shit in the cemetery, too. Father Flower put a stop to that. You remember Father Flower? ‘Dennis,’ he’d say, ‘you see any people in the cemetery with their dogs, tell ’em to pick up their dogs’ shit and vamoose.’ People ought to know better.”

“Yes, indeed,” I said.

“I take care of the cemetery,” Dennis continued. “I cut the grass in summer, blow the leaves in fall, plow the driveways in winter. I put up a memorial wreath down there this afternoon — donated it with my own money.”

“That was good of you,” I said.

“Paul Duclos used to drive down every day to check on the flag, make sure it wasn’t tethered on the pole. If it was torn, he’d replace it with a new one. Never asked anyone for a dime neither. Now he’s gone, I figure someone ought to tend to it.”

“When did he pass away?”

“Couple of years ago,” Dennis said. He looked off into the distance. You could tell that his salt and pepper beard hadn’t been trimmed in months. “I saw him mowin’ his lawn late one Sunday afternoon. He looked white as a sheet. ‘What’re doing mowin’ the grass on a Sunday?’ I asked him. He said he figured he ought to cut it one last time. Next day I heard he died.”

Daisy jumped up and put her paws on Dennis’s work pants. “Upsidaisy,” Dennis said. He ran a rough hand along the dog’s head.

“My brother had a dog once,” he continued. “Nice Shepherd, got him when he was a puppy, big floppy paws,” he chuckled. “At the time my brother was livin’ in a farmhouse up in Suffield.”

“One day he come home and saw a thread through the high grass in the field behind the house. The thread led through the field over to the neighbor’s place. The neighbor’s lawn mower was sittin’ in my brother’s back yard. The dog was sittin’ beside the lawn mower.”

“Sometime after that, this dog took to trottin’ across the road to the farmhouse on the other side. He’d come home with a rake in his mouth. Next thing you know, he’d show up with a shovel. Eventually, the dog stole nearly every implement that neighbor owned.”

“That dog was so smart, he’d fetch a shovel from the back of a pickup truck on command.”

Dennis climbed up into the cab of the big white truck. He laid the lotto tickets on the seat beside him and coaxed a cigarette from the pack with his teeth. He hit the ignition, lifted his hand in farewell and pulled away from the curb.

Daisy and I watched the old white truck rattle down the street and disappear around the corner.

“Well, Daisy,” I said, “despite it being December, it’s nice to see that there’s still a bit of local color in the neighborhood.”

The Art of Medicine — Weekend call: Sifting the salient points

I can tell that the only way to reassure this young mother would be to see the child. “Where do you live?” She tells me the address in a nearby community. “Could you bring her to our office at 11 a.m.? more»

Interested readers can now access my latest Art of Medicine column — Weekend call: Sifting the salient points — 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.

Milestones

Be they birthdays, graduation days, or anniversaries, we tend to mark our lives by milestones, those significant dates and times that help to define who we are and give meaning to our existence. more»

Throughout 2017 Physician Assistants have been celebrating the 50th anniversary of the profession.

Interested readers can peruse my latest entry on milestones at the Musings blog of the JAAPA Editorial Board here.

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

Down on my knees

Down on my knees
Sanding and wiping
The hard wooden porch deck
Preparing to lay a coat
Of stain
On this clear morning
After rain
A bleating of geese
Breaks through.
I pause, sit back on my haunches,
Careen my neck
To glimpse the V-formation
As they sweep overhead.
Had they heard my prayer,
If indeed I were praying?
No matter.
Grace is grace,
Wherever found.

2017©Brian T. Maurer

Returning to a place

“I’ve read that because of the drought and unseasonably warm temperatures, the fall foliage could be muted this year,” my friend said on a recent day hike.

That certainly seemed to be the case during our annual visit to Ricketts Glen State Park just days before. Although many of the leaves of the deciduous trees remained green, the foliage on most of the maples had turned a rusty brown; absent were the vibrant scarlets and vermillions we remembered from other autumns.

The lake was low as well, likely from the summer drought. The falls along Kitchen Creek, usually spectacular rushing cataracts, had turned to mere trickles over the shale rock formations. A few water striders darted about on the surfaces of shallow pools. Only the sky overhead remained a faultless blue.

I heard a couple of duck calls at eventide, but we saw none on the lake. Once, while sitting by the late afternoon campfire, I caught sight of the white triangular tail of a hawk as it disappeared through the trees. Only the chipmunks were out in force, chasing one another about the campsite. One made a hesitant approach to beg some crumbs, then scurried across the porch of our cabin to hide among the rocks.

Chickadees piped in the early mornings, and twice we noticed flocks of blackbirds rooting among the branches and leaves in the forest thickets.

Overnight the stars shone brightly, much more so than here at home.  We tagged Orion and his dogs, Taurus, the Seven Sisters, Castor and Pollux, Ursa Major and Minor, Cepheus and Cassiopeia. We rcalled the recent photos of Saturn’s rings and moons sent back across the solar system by Cassini before it plunged into the planet.

This morning I read that the fall foliage is supposed to be spectacular. Perhaps this year we had ventured into the wilds too early, I thought.

But no matter the color of her smock, nature still heals.

Sunrise, Lake Jean, 2017 © Thomas A. Doty