A rare species

Standing in the back yard in the late afternoon on Labor Day, I looked up and chanced to catch sight of a nighthawk darting about against the backdrop of blue sky. Each pointed angled wing displayed a white bar, the sine qua non that clinched the identification.

Here in New England the numbers of nighthawks have diminished precipitously over the past several decades. Some observers have attributed the drop in their numbers to the relative paucity of nesting sites: grey and white crushed stone flat roofs have been replaced with uniform black tar, erasing the element of camouflage necessary for the bird’s survival. Others have suggested that an increased use of insecticides to curb mosquitos might have adversely impacted this bird population.

Excited by my find, I dashed off an e-mail to a seasoned fellow birder, someone I had met while out birding one clear blue morning this past May.

I had ventured forth early that day, following the trail that runs along the river to the park. I had sighted any number of spring warblers and had just focused my binoculars on a Baltimore oriole, when an older gentleman appeared, binoculars up, stalking a blue-grey gnatcatcher in the same tree. We hit it off immediately, comparing notes on the black-throated blue warbler that we had each heard and seen shortly before meeting up.

After a delightful conversation we ambled back along the road to where the man had parked his car. I pointed out some bird activity in a nearby bush. We both raised our binoculars and studied the small specimen: a flycatcher, most assuredly an Empidonax. Consulting the field markings in his Sibley guide, we agreed that it was a least flycatcher, Empidonax minimus.

Roger (for that was his name) invited me to participate in the spring birding census, noting that there were several species of special concern in Connecticut, among them the nighthawk. He sent me the form, which I completed and returned to him at the close of the census. Although I recorded over 60 species, I didn’t see a single nighthawk that month.

Understandably, I was anxious to share the news that I had sighted a nighthawk at last.

Later that day I received a reply from Roger’s wife, thanking me for my note:

Roger would have been very happy that you wrote about identifying the nighthawk. He was, as you know, an avid birder who took so much enjoyment in pursuing his hobby. Unfortunately, he was diagnosed with cancer in May and died on August 7th. He fought bravely as he endured three sessions of chemotherapy. I shall miss him forever — he was an exceptional husband in every way.

An exceptional husband, an avid birder, one of a rare species: I shall miss him too.

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The art of observation

He explained patience. He said it was the most important thing of all to remember, this: that when you wanted to see something very badly, sometimes you had to stay still, stay in the same place, remember how much you wanted to see it, and be patient.  —Helen Macdonald, “H is for Hawk”

I brought the binoculars up to my eyes and adjusted the knob, easing the fuzzy silhouette into focus.  It was a big hawk: that much was clear from the sheer size and the hooked beak.  The biggest species of hawk in our region is the Red-tail, and the female Red-tail usually outweighs the male; but the colors of this bird didn’t quite fit.

There was a smattering of white spots across the shoulders on either side; they formed a V on the upper back.  The head was dark, the throat lighter in color; and the buff breast was streaked with dark broad patches.

Then there was the tail: dark brown regularly interrupted with black horizontal bars, extending well beyond the folded wingtips.

Majestically, it perched atop the Celtic cross on the pinnacle of the brownstone church steeple, emitting a series of screeching cries.

Another bird, similar in coloring but smaller in size, answered from his perch in the uppermost branches of the tall dead spruce on Winthrop Street.

I eased closer, pausing after several steps to bring the binoculars up and observe the detail of the plumage.

Finally, after twenty minutes, the big hawk lifted its hindquarters, spread its broad wings, and dropped off the steeple, soaring to a cluster of far trees.  I caught a glimpse of the tail against the overcast sky: definitely not a russet red.

Back at the house I studied a copy of Sibley’s Guide and searched online.  Finally, I found it:  a juvenile Red-tail.

There is an art to identification, where perception, perseverance and patience reward the persistent observer.

The Art of Medicine: The big and the little

The patient squats by the step stool in the examination room, peering at pictures as she turns the pages of the little big-book. She squeals with delight at the moo cow; she claps her tiny hands at the puppy dog and looks up at me expectantly to validate her joy.

Her mother sits in the chair opposite, leaning forward, elbows resting on her knees, only the hint of a smile on her face. “So what do we do this time?” she asks in a slightly defeated tone of voice. more»

Interested readers can now access my latest Art of Medicine column — The big and the little — 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.

Impresiones y recuerdos personales de un joven americano

The 4th edition of the Galician periodical Terras Do Ortegal is published this month.

This edition will carry my original article entitled “Impresiones y recuerdos personales de un joven americano durante su servicio militar en la base de Estaca de Bares (1975 – 1976)”.

Fue a finales del mes de abril de 1975, cuando aterrizó un vuelo ibérico procedente de Madrid en el aeropuerto de A Coruña. Siendo un joven de veintiún años, yo tenía mis órdenes militares. Al desembarcar del avión, me encontré con Heriberto Sobel, médico de la base americana de Estaca de Bares, acompañado por un taxista que se llamaba Alfredo. Metieron mi equipaje en el coche, y en seguida circulamos por las carreteras rurales, que me ofrecían unas vistas preciosas de los campos verdes de Galicia. Íbamos a la punta más al norte de España, Estaca de Bares, la cual sería mi hogar durante los siguientes doce meses. En lugar de Heriberto Sobel, yo sería el nuevo médico de la base….

Sights & Sounds

Leaning in, I listen.
The whoosh resounds in my ears,
Pulsating with each regular beat,
As though an elf were clearing his throat:
Harsh, holosystolic, grade 4 of 6,
A VSD most assuredly:
But this ventricular septal defect
Is coupled with infundibular stenosis,
An over-riding aorta,
And right ventricular hypertrophy.
It takes an echo to follow the flow of Fallot.

Leaning in, I listen.
The whirr-buzz sounds in my ears,
Repeated ad infinitum from the bush.
I scan the wood, raise twin prisms,
Peer toward the sound.
A blue-winged warbler
Drops off a high branch,
Disappears behind spring leaves.
Momentarily I catch
His sine qua non:
The black eye streak;
The whirr-buzz echo
Of his call.

2017©Brian T. Maurer

The clinical encounter: an about-face?

Gradually, over the past decade we have been replacing face to face conversation with virtual interaction through cybervenues such as FaceTime and Facebook. Somehow, our social intercourse has not been not the same.

Face to Face. This slender volume rests on the bookshelf, a remnant from one of my graduate courses in counseling. The course was run as an encounter group. Participants had to work out the particulars of their interactions. Some of it was rough going; some of it wasn’t pleasant. You had to be an astute observer of body language, tone of voice, facial expression. Some of us were pretty adept at guarding our emotions; others wore their hearts on their sleeves. We didn’t necessarily agree with one another, but we heard one another out — at least, those of us who chose to interact.

In a group setting mutual support evolves through empathetic listening. To do so, you must be physically and psychologically present in the moment.

Similar interactions take place every day in the clinical encounter. We clinicians spend most of our day interacting with patients in the physical realm. With the advent and widespread use of the EMR (electronic medical record), face to face time has dwindled. Now the screen competes for our attention. No longer face to face with the patient, we tend to miss or overlook those subtle clues inherent in posture, facial expression, and body language.

Third-party payers are now advocating telemedicine as the latest and greatest means to improve access to healthcare and trim costs. In turning our eyes toward the future, might we actually be performing an about-face, as our physical face time recedes into the sphere of virtual reality?

A picture may be worth a thousand words, a video transcript even more; but I question the degree of meaningful healing that can take place in a virtual universe.