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.

Cookies

“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.

A glimpse of grace

The morning sun had just broken through the treetops when I saw her standing motionless at the edge of the wood just outside the chain link fence that bordered the ball field. A fine mist was rising from the grassy expanse; and as the mist lifted, suddenly, there she was, standing stock still, ears erect, regarding my frozen form.

Involuntarily, my hand came up to brush a mosquito off my cheek; one of her ears simultaneously twitched. My hand came down; her ear returned to assume its vigilant post.

She turned her head momentarily to scan the forest; I shifted my stance. She dipped her nose as if to scent the grass, then brought her head up. She lifted a slender foreleg and planted a black hoof daintily back down in the grass. Slowly she walked along the edge of the wood, hesitantly high-stepping, as though she were a show horse, striding before a panel of top-hatted judges. Her coat gleamed golden brown in the sunlight against the backdrop of lemon green.

At length she reached the road that stretched before me, stopped, dipped her nose, then raised her head, turning to look at me once more. Shortly, she stepped out onto the tarmac, walked across the expanse and in one smooth leap, vaulted over the high brush into the forest.

Quietly, I edged along the road, peering into the wood. Suddenly she appeared, framed by the forest foliage, looking directly at me. Once again I froze. With a short snort the doe leapt up and disappeared through the trees.

Tightrope

Like a small performance on the high wire, there’s an art to tightrope walking in clinical practice. more»

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

Philippe Petit on the wire

Husking corn

On the morning of this Independence Day I sit on the stoop of my back porch, feet planted firmly on the short stretch of concrete walkway, husking sweet corn. I select an ear from the brown bag, part the dark tassel and strip down the outer husk. Rows of shiny kernels, yellow and white, glisten in the late morning sun. I snap off the base and lay the cleaned ear on the heavy oval plate at my side. High in the trees that tower above my neighbor’s house a vireo pipes his clear, crisp notes. Momentarily, I pause in my labor to look up; but the bird is hidden in the densely leafed canopy.

A chipmunk pops her head up from a crevice in the red stone wall to survey the scene. In a moment she poses prettily on a capstone, watching me work. Sparrows descend to perch atop our weather-worn wooden fence and take turns attacking the birdfeeder. Languidly, our black cat lounges on the driveway below, content to bask in the morning sun.

One hundred seventy years ago on this day, July 4th, Henry Thoreau moved into his small one-room house near the northwest cove of Walden Pond, eight days shy of his 28th birthday. He had begun to clear the site with a borrowed axe four months earlier before ice-out. By mid April the house was framed and ready for raising. Thoreau dug his cellar in the side of a small rise that sloped to the south; and “at length, at the beginning of May, with the help of [his] acquaintances,” he set up the frame of his house. Before the following winter he had built a chimney, shingled the sides and plastered the interior walls. The final structure measured ten feet wide by fifteen feet long, boasted “eight-feet posts, a garret, a closet, a large window on each side, two trap doors, one door at the end and a brick fireplace opposite.”

“There is some of the same fitness in a man’s building his own house that there is in a bird’s building its own nest,” Thoreau wrote. “Who knows but if men constructed their dwellings with their own hands, and provided food for themselves and families simply and honestly enough, the poetic faculty would be universally developed, as birds universally sing when they are so engaged?”

As I reach for the final ear of corn, a catbird calls from its nest in the thicket behind the garage. I have never heard so many catbirds as I have this year. They might be making a comeback, I think, as I strip the husk from the last ear of corn. I pick off the few remaining strands of corn silk and add it to the stack on the plate.

Lessons learned from the brute beast

Before he chose a career in writing, James Joyce was a medical student. He kept a model of the human fetus in the womb on his desk while he crafted the “Oxen of the Sun” episode in Ulysses. We can surmise that the theme of gestational development was constantly before his eyes and in his thoughts as he wrote. more»

Interested readers can now access my latest Art of Medicine column — Lessons learned from the brute beast — 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.

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