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.

The patient-centered medical home (ain’t what it used to be)

Advocates of the patient-centered medical home tout the desirability of having all of this information in a central repository, readily accessible, complete. Supposedly, such a system will drastically reduce duplication of services, reduce the likelihood of medical error, and subsequently cut the cost of medical care. Conceptually, it all sounds so good—too good, as the adage goes, to be true. 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.

Long day’s journey of the Saturday

At the beginning of this Easter weekend, I will leave my readers the thoughts of George Steiner from the concluding chapter of his book, Real Presences:

“There is one particular day in Western history about which neither historical record nor myth nor Scripture make report. It is a Saturday. And it has become the longest of days. We know of the Good Friday which Christianity holds to have been that of the Cross. But the non-Christian, the atheist, knows of it as well. This is to say that he knows of the injustice, of the interminable suffering, of the waste, of the brute enigma of ending, which so largely make up not only the historical dimension of the human condition, but the everyday fabric of our personal lives. We know, ineluctably, of the pain, of the failure of love, of the solitude which are our history and private fate. We know also about Sunday. To the Christian, the day signifies an intimation, both assured and precarious, both evident and beyond comprehension, of resurrection, of a justice and a love that have conquered death. If we are non-Christians or non-believers, we know of that Sunday in precisely analogous terms. We conceive of it as the day of liberation from inhumanity and servitude. We look to resolutions, be they therapeutic or political, be they social or messianic. The lineaments of that Sunday carry the name of hope (there is no word less deconstructible).

“But ours is the long day’s journey of the Saturday. Between suffering, aloneness, unutterable waste on the one hand and the dream of liberation, of rebirth on the other. In the face of the torture of a child, of the death of love which is Friday, even the greatest art and poetry are almost helpless. In the Utopia of the Sunday, the aesthetic will, presumably, no longer have logic or necessity. The apprehensions and figurations in the play of metaphysical imagining, in the poem and the music, which tell of pain and of hope, of the flesh which is said to taste of ash and of the spirit which is said to have the savour of fire, are always Sabbatarian. They have risen out of an immensity of waiting which is that of man. Without them, how could we be patient?”

The Art of Medicine — A slice of life

“Can I see your first patient of the morning with you?” the new student asks. “It’s a laceration, here to be glued.”

An interesting way to present a patient, I think to myself as I escort the student into the examination room. more»

Interested readers can now access my latest Art of Medicine column — A slice of life — 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.