Rorschach EKGs

There is an old Yiddish saying: “To a worm in a jar of horseradish, the whole world is horseradish.”  In short, our immediate environment influences our thoughts and perceptions.

Soon I must sit for my 6-year recertification examination in general medicine: a grueling 5-hour test consisting of 240 questions. I’ve been reviewing medicine for the past 4 months; lately, I’ve thought of little else.

I have had a smattering of additional preoccupations. After all, the routine of daily life goes on. Snow must be shoveled, walkways must be kept clean, and the dog must be taken out for daily walks.

Early this morning the dog and I ventured out into the winter cold. As we passed by the church at the end of our street, I noticed salt deposits on the sidewalk left behind after the snow and ice had melted. With scattered thoughts of the impending exam running through my mind, these formations appeared to resemble electrocardiographic (EKG) tracings.

I returned with my camera to take a few snapshots, several of which I’ve posted below. To my eye these represent specific electrocardiographic rhythms or conditions. Perhaps my medical colleagues would like to weigh in with opinions of their own.

First degree heart block

First degree heart block

Atrial fibrillation

Atrial fibrillation

Third degree heart block

Third degree heart block

In the pauses

“Only in the pauses between things, in the brief contemplative spaces of just being, can we catch a glimpse of love itself.”
Gerald G. May, The Awakened Heart

I was up early this morning, clearing the overnight snowfall from the driveway in anticipation of the next storm, which is slated to start tonight and continue through Monday into Tuesday morning. The NOAA site is predicting 8 to 14 inches for our area.

The streets in the village have taken on the appearance of Olympic luge runs, with snow piled high on either side; the surrounding wooded hills sit in sentinel silence, dusted with confectionery sugar.

As I herringboned the driveway with the snow shovel, a gaggle of Canada geese passed by low overhead. You could hear their wings beating the air, and for several seconds the sporadic honking was deafening. I paused to watch them melt into the morning greyness of sky, thankful for a minute of rest before resuming my Sisyphean task.

The long winter of our discontent is not without its moments of common grace.

Snowbound

The master map described our plight:
The snow would start half through the night,
Continue on, come morning light,
And taper not until the night.

We woke to white flakes falling down,
Which blanketed the entire town,
While inside comfort, warmth and bed
Held us in our homey stead.

I donned my cap and coat and boot
And leashed the puppy’s rough cut suit;
Together ready, both astute,
We bounded down the powdered chute.

Being small, she couldn’t abide
The heavy drifts on either side;
We made it halfway down the street
Before she shook on frozen feet.

I picked her up and held her close,
Then turned and headed to the house,
Retracing steps through heavy blow
And biting, needling, stinging snow.

Back inside the kitchen warm,
I paused to brush a whitened arm,
Then headed back outside to clean
The heavy drifts from winter’s scene.

Two hours I worked; with shovel cut
The deepest swaths down to the rut,
While at my back the neat trimmed track
Filled up again with powder flak.

Into the house I frozen stomped
With little circumstance and pomp;
Pulled off my boots and tossed my scarf
Across the chair just by the hearth.

The call came through, announcement made:
Another day of work was stayed.
Elated then, without a sound,
I sat and read his poem, Snow-Bound.

2/2/2015

2015©Brian T. Maurer

When the art of medicine becomes business as usual

It’s Saturday morning, the last day of my 6-day workweek. Twelve hours have elapsed since I finished my previous shift at the after-hours care center. I step in through the front door, valise in hand, to find my assistant seated behind the reception desk. “How does it look?” I ask him.

“Ten appointments so far,” he says, “last one at 10:30 a.m.”

I do a quick mental calculation — roughly 9 minutes allotted for each patient. And there’s no telling how many additional walk-ins might show up over the course of the morning. more»

Interested readers can now access my latest Art of Medicine column — When the art of medicine becomes business as usual — 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.

Snow Ghosts

Morning snowflakes dapple
Gnarled naked branches
Then cascade down,
Deluging the landscape
In white.

I clear the driveway,
Move the car,
Shovel again;
Step inside,
Now numb from cold.

At noon the wind whips up
Over frozen fallow fields:
Snow ghosts
Suddenly rise and swirl
Above rows of cornstalk stubble—

Phantoms form,
Dart, dash, drive—
Then dissipate
Into a windbreak
Of winter trees.

1/9/2015

2015©Brian T. Maurer

Turbulence

As I sit at my desk, pecking out a rough draft on my computer, the small dog paws repeatedly at my thigh. I offer some temporary solace, reaching down to scratch her ears and neck. She drops down on all fours, only to rear up again shortly after my hand returns to the keyboard. Finally, I let out a short sigh and decide to pack it in: nothing short of a walk will do, it seems, even though we’ve just come back from a morning stroll around the block less than an hour ago.

I zip the collar of my fleece up to my chin, reach for my coat, don my hiking boots, pull on my wool cap and gloves, snap the leash on the dog’s collar; and we head out the back door at a brisk pace down the deserted street in the winter cold.

We turn right at the end of the block and continue down the long grey ribbon of sidewalk to the center of town. Today the school yard is barren, devoid of children. A solitary car sits in the parking lot outside the barber shop. No one, it seems, wants a haircut on this last day of the year.

We round the corner onto Main Street and wait for traffic to thin out on the highway. Despite the crosswalk, no vehicle slows or stops for us to cross. The dog shivers and lifts her nose in the cold air. Finally, the last northbound car disappears over the crest of the hill, and we scoot across the tarmac to the other side.

I let the dog off leash at the old mill and trudge along the loop of frozen gravel road to the bank of the river. Patches of white water bubble and churn in the current. Overhead, billowy clouds press against the backdrop of pure blue sky.

I snap the leash on the dog’s collar as we approach the mill. Linked together once again, we descend the short slope to the concrete retaining wall, built to withstand the torrents that continuously lash against it.

At the top of the rise we follow the great curve of road to the cul-de-sac, then hop the guard rail and pick our way through the remnants of last summer’s brush to the concrete bulwark where the old bridge once stood.

We peer over the edge into the gorge. Just below our feet white water boils against the old bridge abutments, leaping into the air as it scrubs them clean in its turbulent descent. Mesmerized I stand, unable to tear my eyes from the torrent.

We retrace our steps back to the mill, cross the deserted highway and pick up the road to where it intersects the blue-blazed trailhead. From here we follow the leaf-strewn path through the forest back down into town.

A lone dog barks and pads back and forth behind the invisible electronic fence in a front yard, his cinnamon tail erect, curled into a full arc above his back. Tragedy has come to this house over the course of the past year; the couple that had lived there has dwindled to one.

We cross the street and huff up the hill toward the house. The air is cold on my cheek. Despite the gloves my finger tips have turned numb.

We step through the back door into a warm kitchen. I pull off my cap and gloves and rub my palms together. I unzip my coat and throw it over the back of a wooden chair.

A cup of hot coffee restores feeling to my fingertips, but the turbulence of the white water in the river still churns in my soul.

Christmas presence

Christmas was meant for children; so the old song goes. It comes round every year about this time—the song, I mean—and Christmas too, of course.

When I was a child, the anticipation of Christmas waxed more and more intense as December days waned. Hours of daylight grew shorter and shorter; and the anticipation of Christmas morning became so great, it almost hurt.

Then suddenly it came, that special morning like no other in the year. Presents, picture perfect, magically appeared, nestled beneath the tree. Happily, we tore into the wrappings, then “ooh-ed” and “aah-ed” with delight as we unveiled our treasures. The exercise didn’t take long; in a moment it was all over, the anticipation evaporated. Gift-wrapped presents had morphed into things that we touched, held, played with and hugged. Now, as a grownup, I recognize that these presents were given as gestures of love.

For a week over the Thanksgiving holiday this year we hosted my niece and her husband and their little girl from Spain. My wife began making preparations weeks in advance. The house was cleaned; collections of items were donated to the Veterans and the Salvation Army; the larder was stocked, brimming with food; sleeping arrangements were made; my daughter volunteered to drive to Newark to pick our visitors up at the airport. Anticipation coursed through the household, nearly palpable. You see, my niece had announced that she was pregnant with their second child, due sometime next spring.

At 3 years of age, my grandniece chatted frequently about the coming baby. In the Spanish culture children are revered. Many times I would overhear her parents refer to my grandniece with terms of endearment: “Princesa,” “Amor,” “Vida.” My niece spoke candidly about the pregnancy. “Que milagro, el desarrollo de un niño!” she said. What a miracle, this knitting together of a child in the dark recesses of the womb!

The Spanish refer to parturition—the act of giving birth—as “dar la luz,” literally, “to give the light.” The reference makes sense: at birth the infant passes from the utter darkness of the womb out into the intense light of day.

All mothers know the pain associated with childbirth. It is acknowledged to be some of the most severe pain that a human being can suffer. (Kidney stones are close, I’m told. I’ve never had a baby, but I’ve had several kidney stones, so I feel as though I can relate.) The scriptures refer to the pain of childbirth as travail. It costs quite a bit to move an infant from utter darkness to blinding light; but in the end the suffering is forgotten, replaced by joy—the joy of witnessing the presence of precious new life.

I must confess that sometime ago I lost the delight of receiving presents at Christmas time. It’s not that I don’t appreciate the gesture behind the act of giving; it’s just that, well, at my age I really have no desire for more material possessions.

Now, as Christmas approaches, I reflect on the anticipation of presence instead—you might say the present of presence: the presence of a newborn child, clothed in flesh, which is come into the world that we humans might pass from utter darkness into the realm of exquisite light and experience joy in the morning.