Rhetorical persuasion in the clinical setting

It is Friday evening in the after-hours care center. All the scheduled patients have been processed. Each one has departed with a prescription in hand, their precious ticket to procuring a portion of the magic potion they imagine will make them better. more»

Interested readers can now access my latest Art of Medicine column — Rhetorical persuasion 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.

Plato and Aristotle

Author to speak at 2015 Yale White Coat ceremony

Author Brian T. Maurer will deliver the keynote to students, faculty, family and friends at the White Coat ceremony of the Yale Physician Associate Program on October 2, 2015.

Mr. Maurer will address first-year students as they move into the longitudinal clinical tract of their education.

Traditionally, the White Coat ceremony recognizes students as they transition to the ranks of clinicians in their interactions with patients at the bedside.

Mr. Maurer, now in his fourth decade of medical practice, will focus on the role of the clinician as listener and healer.

The 2015 Yale White Coat ceremony will take place in the Harkness Auditorium, 333 Cedar Street, New Haven, Connecticut, on Friday, October 2nd, at 2:00 PM.

Le rouge et le noir

I had just gotten back from my morning walk down by the river, had just finished talking with my neighbor across the street whose dog had come down with kennel cough, just finished telling my wife that what we heard outside the kitchen window last night was most likely the neighbor’s dog’s throaty cough and not the retching of our cat who’s been missing for five days, just finished petting our dog who seems to be particularly in need of attention since the cat’s disappearance, just retired to the upstairs bedroom to stow my binoculars on the bookshelf — I had just done all that, when suddenly my wife stood before me fighting back tears.

“I found Milo,” she sobbed. “Out on the old sofa in the garage. She looks like she’s just fallen asleep.”

It had been five days since we last saw our black cat. She had all but vanished from hearth and home. And now there she was, cold and stiff, lying on the old sofa, unquestionably dead.

Six months ago she started shedding hair from her hindquarters. Gradually, it grew back in; but the new hair was mostly grey. I suppose we should have expected that, given that the cat was 20 years old.

She also started to walk with some difficulty in her rear legs. She ate less and less of her dried food. My wife started feeding her cut up chicken breast by hand. The weight loss became more obvious with the passage of time.

Last week the cat stopped drinking milk and then water. I caught her retching in the family room, but nothing came up. The litter box remained dry.

The last day I saw her, she emitted several cries, the likes of which I had never heard before. I let her out on the back porch, where she sat, waiting for my wife to come home. She allowed my wife to pet her before she slinked underneath the car. No amount of coaxing could induce her to come out. The following morning she was gone.

We searched the yard, we searched the garage, we searched her favorite haunts. We made inquiries to the neighbors. No one had seen or heard anything.

I must say that this cat gave me a run for the money over the years. If someone didn’t immediately acquiesce to her demands, she would systematically knock my wife’s antique teacups off the bureau onto the floor with her paw. She would meow loudly in the middle of the night to be let in, and then meow just as loudly to be let out. I swore I couldn’t wait until she was gone. And now she truly was.

My wife fished some plastic bags from the kitchen drawer to use as makeshift gloves. I followed her out to the garage.

In the end we eased a plastic snow shovel under the carcass to lift it off the sofa. My wife carried it out to one of the flower beds in the back yard under the shade of our neighbor’s maple tree and gently laid the remains into a freshly dug hole. I snapped off a few stalks of red flowers and laid them on top of the black fur. Le rouge et le noirI thought.

My wife filled in the hole with fresh black earth, and I dropped a flagstone on top. We disposed of the plastic bags in the trash, scrubbed up at the kitchen sink and shared the last paper towel in the roll to dry the drops from our hands.

Somehow closure is easier when you’ve got a body.

But now that she is gone, I find myself grieving for this animal that chose to fade away into the night without uttering even so much as a final audible complaint.

Labor Day reverie

The hummingbirds were already engaged in an aerial dogfight near the trumpet vine when I stepped out onto the front porch with a cup of coffee in my hand. As I eased into the white wicker rocker, a cicada broke the morning stillness. Most of the black-eyed Susans had already shed their yellow summer skirts, but the white rose-bush was still in bloom.

The dog scratched inside the screen door to be let out. I took her for her morning walk, filled her dishes with food and fresh water, reached for my binoculars and headed down to the river.

At the rectory I paused to pick a handful of dark wild cherries from the tree in the front yard, retrieved the priest’s paper from the sidewalk and tossed it onto his porch, then continued down Winthrop toward the morning sun.

Catbirds mewed from dense bushes at the entrance to the park. A cardinal hopped along the low wooden fence. Down on the river just below the red stone bridge abutments a string of ducks took flight.

The goldfinches flitted about in the brush on either side of the old road. I lifted my binoculars to bring a pale blue smudge in the far trees into focus. A big blue heron filled the visual field, preening his breast in the sunlight.

Perched on a branch protruding from the depths of the duckweed-choked pond, a green heron stood his sentinel watch. Further along I paused by the rope swing at the riverbank and trained the binoculars on the far shore to find a sandpiper working his way along the mudflats.

Up at the point cedar waxwings dipped and soared in aerial display above the water. A dark blue fork-tailed swallow darted across the expanse and dappled the surface with his bill. From some secluded spot on the opposite bank the lonely call of a mourning dove echoed in the faint breeze.

Back in the pond the green heron extended his long neck and darted his bill into the green carpeted surface. He threw his head back, opened wide the gap of an orange mouth and tossed his beak from side to side in a silent scream.

As I lowered my binoculars, a battered olive-green pickup truck jostled down the road and slowed to a stop. “See anything good?” the driver asked, leaning toward the passenger window.

“A few birds — this and that,” I said.

“Heard a warbling vireo earlier,” the man said.

“They’re still around, although I judge they’re getting ready to vacate for greener pastures.”

I waved him on and retraced my steps back up the road. Two strings of heavy Canada honkers slid overhead as I approached the village.

Back at the house the hummers were still out, engaged in aerial combat. By the end of the week they would be gone for the year.

I spit the last cherry seed out over the porch balustrade and sunk down into the wicker rocker. High up in one of the trees across the street a cicada ratcheted up another deafening buzz.

Communal grief

“Use’ ta be the fambly was fust. It ain’t so now. It’s anybody.” —Ma Joad in “The Grapes of Wrath”

I pull up to where the town cop stands in the wide expanse of macadam, roll down my window and look up into his face. He’s sucking on something; it might be a plum pit. Whatever it is, he spits it out into a loosely clenched hand. “Just to let you know,” he says, matter-of-factly, “it’ll be at least a two-and-a-half-hour wait. The line runs all the way around the back, and that doesn’t include the folks on the inside.”

I nod my head, drive to the back of the parking lot and pull into an empty space. I leave the windows down a crack, lock the car and walk across the way to the end of the line. The folks at the back acknowledge me with nods of their heads. Shortly, I hear footsteps behind me.

“Dr Brian, we meet again — for the second time in 24 hours.”

I turn and face the father whom I had seen the previous evening at the after-hours care center. He had brought his little girl in after discovering that she had eaten a combination of cough drops and cold tablets. Thankfully, the ingredients were largely inert.

“How’s your daughter?” I ask.

“Oh fine, ornery as ever,” he smiles. Then he says: “Wish we were meeting under happier circumstances today.”

I drop my eyes and shake my head. “I just found out from a former co-worker at the old practice. I missed the obit in the paper.”

“I figured it would be jam-packed,” the father says. “They said that when the doors opened four hours ago, there were already fifty people here.” He glances at his watch. “Seven-thirty now. Looks like it’ll be at least another two hours before we get inside.”

We inch forward as other people step in line behind us.

“It’s bad enough when an elderly person passes away. He was only seventeen years old.”

“Did you know the family?”

“We all grew up together in the same part of town. I went to school with his uncle. I guess everybody’s a wreck.”

“Rightly so. I can’t imagine….”

“I’m regional director for a hospice program,” he says. “We deal with a lot of veterans. It’s tough when one of them goes. We had one fellow who was terminal, no family, all his buddies were gone. It was sad. We asked him if there was anything he really wanted to do. He said he wanted to ride down Main Street in the town where he grew up. We contacted the local VFW. Over two hundred vets showed up to line the street when they drove him through — quite a moment.”

We stand together in silence. The line inches along. People exit the building. One woman hails the father I have been talking with. I recognize her voice. She looks different from when I last saw her, but the voice is unmistakably the same. Twenty-five years ago we worked together in the same office. I had taken care of her children at that time. She crosses the parking lot and disappears behind the rows of vehicles.

The line moves forward. Finally, we reach the entrance. A man in a business suit opens the door and ushers us into the closeness of the foyer. The line of humanity snakes in and out of rooms adjacent to the hallway.

I study the faces as we inch along: familiar faces, all in line; brief smiles, acknowledgements, nods of the head — former patients, former families with whom I had at one time sat in small examination rooms over the past four decades.

But today I am not their healer; today I am not their doctor. Today I have come as a fellow mourner to pay my respects to the family of man and share in the communal grief.


“We need to have you upload your electronic signature into the EMR,” the office manager tells me. “I’ve got the file stored on my desktop. You can log in, and I’ll walk you through the process.”

I slide into the chair at her desk and log in to my account. “Click on the gear icon at the top of the screen to access the drop-down menu,” the office manager says. A few clicks later the upload is complete.

“Good, another task accomplished,” she says. “Would you like a cookie? I baked them myself: oatmeal-raisin-chocolate chip.”

“Thanks,” I say, reaching an ample specimen from the zip-lock bag on her desk. I push back in the chair and savor the first melt-in-your-mouth bite.

“How are they?”

“Wonderful! Just the thing for a mid-morning pick-me-up.”

“We don’t do a lot of treats in the office — everyone seems to be watching their weight — but it is nice to have a sugar boost every once in a while.”

Thoughtfully, I savor another bite. “You could consider addressing both of those issues by adding a cookie icon to the EMR drop-down menu,” I muse. “Anytime a staff member feels the need for a snack, they could log on, access the menu, click on the cookie icon and voilà! — an instant calorie-free pick-me-up.”

The office manager studies my face with a mixture of awe and disbelief. She opens her mouth, as if to utter a comment; then quietly closes it.

“The only thing is,” I add, happily munching the final few crumbs of my treat, “you would have to be sure to change the browser settings to accept cookies.”

Morning portrait

A cold front had moved in overnight; overhead, wispy cirrus clouds dotted the sky.

The surface of the river lay finely polished at first light. Already the waxwings were flitting about, performing their aerial acrobatics high above the water. Directly opposite, near the entrance to the cove, a great blue heron rose up with a series of sharp squawks.

As I emerged from the trees and stepped out onto the sandy point, a gaggle of Canada geese waddled into the water. Out in the middle of the river a large heavy bird was already bleating a warning.

One by one the geese paddled toward him as he led the gaggle upstream, sounding off with a good deal of regularity. His honks were echoed by another goose close behind. The two took turns, the second playing off the lead, until at one point the honks overlapped and merged into one.

Steadily, the others followed along behind. I counted eleven in all.

I turned and retraced my steps through the woods, skirting the duckweed-choked pond nestled beneath the trees. Nothing stirred the coarse green surface as I sauntered by.

Later, as I ascended the road toward home, a frenzied honking rose from the river behind me, filling the air. I turned and shielded my eyes.

Overhead in single file the Canada geese flew, eleven in formation, silhouetted against the rising sun.