“Notes from a Healer”—Morning Poetry

A bucolic scene during my morning commute brought to mind the words of W. H. Auden—poetry which played out at the office…

Interested readers can peruse my latest “Notes from a Healer” column—Morning Poetry—in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine acts as an online clearinghouse for manuscripts dealing with humanities in medicine.

Author to speak at second annual Cell2Soul conference

Author Brian T. Maurer will give a presentation at the second annual Cell2Soul conference in Cheshire, Massachusetts, at noon on Saturday, September 29, 2007.

Maurer will address participants on “Teaching through Story: the Wisdom of the Sages” as part of this year’s conference theme, Healing through Music, Story and Community.

“For centuries generations have passed down tales of historical happenings and moral fables, by both oral and written means. Over the past century the celluloid literature has come to the forefront, illustrating tales through dramatic action in film and DVD format. Regardless of whether we listen, watch or read, it is the story itself—the dramatic narrative—that makes a lasting impression on our minds and influences our behavior and outlook on life.”

A Moment of Silence

This morning’s New York Times carries the announcement that Marcel Marceau, the famed French mime, is dead at 84.

My wife and I once had the opportunity to see Marceau perform at a local college campus in the late 1970s, shortly after we were married. For close to two hours silence filled the theater as Marceau mimed a myriad of human emotions on stage through the sad clown character of Bip.

I remember marveling at the way he moved his body to simulate walking against the wind, at his characterizations of the stages in a man’s life, at his portrayal of being trapped in an ever-shrinking room, or discovering a worm in an imaginary apple he pretended to eat.

“Mime, like music, knows neither borders nor nationalities,” he once said.

That was especially true for us that evening.  When we were newly weds, my wife spoke no English.  After we came stateside from Europe, each activity we attended—everything from watching a movie on television to having dinner with friends—required that I translate the gist of the conversation, the meaning of each turn of phrase.

But the evening we attended the Marceau performance, there was no need for translation. Like everyone else in the audience that evening, my wife understood exactly what he was saying—through the movements of his body, portrayed in silence.

Prudence and the Pill

In his recent National Post article Robert Fulford opines that Erik Erikson’s psychotheory of human development is now passé.

As a therapist, Erikson was particularly attuned to youth and adolescence. He advocated a psychotherapeutic approach to the adolescent in crisis, where a young person was prompted to examine his situation in light of his social context and family history. Ideally, the therapist would then be able to lead the enlightened adolescent back to health.

This approach is no longer viable. Most third party payers don’t sanction psychotherapy—it’s too long, too expensive. Something else happened as well: the culture of youth changed. Along with the rest of us, Erikson could not conceive of a paradigm shift where adolescence would be transformed by Madison Avenue and changing attitudes toward sex and authority—and by prescription drugs.

In three decades of general pediatric practice, I have witnessed this transformation first hand. With the advent of newer widely-available psychotherapeutic medications, pediatric clinicians are assuming the mantel of child psychiatrists. Citing a study published in the Archives of General Psychiatry, a recent New York Times article documents a 40-fold increase in the number of children and adolescents treated for bipolar disorder from 1994 to 2003. Has the incidence of this disorder truly increased, or are clinicians more aggressively applying this diagnosis to children? If the latter, then what is driving factor?

Because treatment of childhood psychiatric conditions now almost always includes medication, the spread of these diagnoses has become a boon to the pharmaceutical industry. Drug makers and company-sponsored psychiatrists encourage clinicians to consider these disorders with the advent of newer, more expensive drugs. The diagnostic label gives doctors and parents a quick way to manage children’s behavioral outbursts in an era when long-term psychotherapy and inpatient care have become outmoded.

The Times article quotes Dr. John March, chief of child and adolescent psychiatry at Duke University School of Medicine: “From a developmental point of view we simply don’t know how accurately we can diagnose bipolar disorder.…The label may or may not reflect reality.”

Erik Erikson’s concept of treating the adolescent identity crisis is dead. Psychotherapy has been supplanted with the pill. Given that psychiatric drugs have few proven benefits in children as well as potentially serious side effects, which therapeutic approach seems more prudent in today’s brave new world?

A Compleat Life

I had the morning off; as luck would have it, so did my seven-year-old granddaughter.   

“You want to come with us for a walk?” my wife asked me.  “We have to take the dog out.” 

“Let’s go to Chaugham’s Point,” I suggested.  “We can show her the big boulders along the forest trail.” 

My granddaughter is enamored by rocks.  From the time she could accompany me on short walks, she nearly always returned home with her pockets full of all sorts of stones, anything that took her fancy.  The rocks I referred to were two huge boulders, perhaps fifteen feet in diameter, that had been deposited on the ridge by glacial activity eons ago, with just enough space to walk between them. 

I grabbed my old felt hat and a sleeveless fleece off the coat rack and met my wife and granddaughter and the dog out by our station wagon.  Soon we were heading north on country roads, sailing along under a faultless blue sky.  There was just enough crispness in the air to hint that fall was around the corner. 

We breezed across the dam breast between the Barkhamsted reservoir and Lake McDonough, then down the big hill to People’s State Forest.  I parked at the trailhead and we stepped out into the morning stillness of the forest. 

I showed my granddaughter the blue blazes on the trees that marked the trail.  Soon we were climbing through the soft cinnamon-colored needles beneath ancient towering white pines. 

I explained about the glaciers as we walked through the forest. “At one time, long ago, this whole area was covered with a sheet of ice so thick that it filled the valleys between the mountains.  As it moved slowly down toward the sea, the ice scoured the mountain tops and pushed the big rocks along with it.  Finally, when the earth warmed, the ice melted and left the rocks behind.” 

“Wow!” my granddaughter cried as we approached the two boulders, “those are big rocks!” 

“What did I tell you?” I said. We stood and stared up the big boulders.  The dog sniffed a nearby patch of moss and squatted. 

Up ahead we stepped out onto a granite ledge overlooking the valley below.  You could see the river with the town in the distance.  Crows cawed from the opposite ridge. 

“They sure are noisy today,” my wife commented, as the dog pricked her ears up and sampled the morning air with her nose. 

“Probably badgering an owl or a hawk,” I mused. 

We continued down the path to the second outlook.  I pointed out some Solomon Seal and false Solomon Seal to my granddaughter along the trail.  “See the difference?” I said, gently lifting the stem to expose the row of dark blue berries.  “The other one has a cluster of red berries at the tip.” 

The second outlook afforded an expansive southern view of the valley.  You could trace the path of the river with your eye by following the stands of dark green pines among the oaks and maples. 

We pushed ahead and found the other trail that would lead us back to Warner Road.  My granddaughter found a small brown toad along the way. 

“Look, a frog!” she said, bending down to capture the tiny creature in her small hands. 

“It’s a toad,” my wife said.  “Toads are brown; frogs are green.” 

“This is a brown frog,” my granddaughter insisted. 

“Maybe we should let him stay here,” my wife said.  “His mommy is probably looking for him, and she will be upset if she can’t find him.” 

“I guess you’re right,” my granddaughter said, reluctantly releasing the small amphibian among the leaves. 

As I picked up the pace to scout out the road ahead, I overheard my granddaughter chatting to my wife: “You know,” she said, “when you’re a little kid like me, having a puppy dog that you can take for walks in the woods and living across the street from your grandma and pop-pops makes your life so”—she searched for the right word—“complete.”

“War’s Annals” in Cell2Soul, Summer 2007 issue, published online

The current controversial war in Iraq continues to drag on, now into its fifth year. The United States finds itself enmeshed in an ethnic conflict that has been going on for centuries. While diplomats continue to discuss the merits of proposed plans for resolution, the numbers of the maimed and the dead rise each day. Meanwhile, those of us at home go about our business, our daily lives seemingly untouched by the conflict—until we read the particulars of one death or listen to the story of one family’s grief.

Interested readers can peruse my “A New England Journal” column in this issue of Cell2Soul, where I offer three musings on the annals of this war—A Wounded Healer, Keeping the Books and A Separate Peace.

Owl’s Well That Ends Well

 

For nearly two hours I stood on the woodland path and watched the big bird through my binoculars.

It had taken flight from a fallen log as I entered the forest path from the meadow.  When I moved from the heat of the midday sun, from the whirring sounds of bees and cicadas, to the cool stillness of the oak and hemlock forest, I caught sight of the broad tail behind silent beating wings.  Red-tail for sure, I thought, as I raised the binoculars to my eyes and nudged the focal knob with a fingertip.  But the tail was barred and the head was round like the moon.  Barn owl, I thought—but the eyes were a deep brown, leaving a barred owl as the only possibility in this landscape.

The bird had perched on the limb of a hemlock where it stared down at me through a tangle of tree branches.  Scarcely breathing, holding the glasses steady, I inched my way down the trail to get a better view.

Its back was dark and mottled with white patches; the head was grey.  Because the bird angled away from me, I couldn’t get a good look at the breast.

For twenty minutes we stared each other down over the fifty yards of forest floor between us.  Periodically the bird would gyrate its head, seemingly to get a better look at me.  Finally it lifted up off the branch and dropped down through the trees.Afraid that I had lost it for good, I stepped steadily down the path, keeping an eye out for the thick silhouette.  Tree trunks shifted as I moved.  Finally, there it was, perched on a fallen birch limb in full frontal view.  No mistake now—I could see the large streaked cream-colored breast to clinch the bird’s identification.

For the next hour we faced each other in silence.  Periodically the owl would hood its eyes for minutes at a time, only to open them at a sudden sound in the woods.  The bird would look up, revealing its flat-faced profile, or turn its head 180 degrees to preen its back.  Several times it extended one wing well below the end of its tail, fanning its feathers in the stretch, or extruded a feathered pantaloon.  Once it lifted a talon to rake the right side of its head, the way a small flea-infested mutt might scratch an ear; three times I saw it yawn to reveal a pink palate below the curve of its yellow beak.  Finally it settled down altogether, closed its eyes and slept.

For a while I watched the way the sunlight caught the edge of the owl’s head and shoulder.  I recalled that owls are nocturnal hunters, and for all I knew this bird might continue to hunker down on its perch until eventide.

Conscious of the pain in my lower back and shoulders, I took one last look at this magnificent bird before gliding silently down the forest path on my own wings of elation.  I reached a hand into my pocket and felt for the penny I had found on the village street at the start of my walk.  It was still there in silent testimony to my good fortune on this last day of summer.

“Notes from a Healer”—After 28 Years

A belated afternoon rendezvous with a doctor friend leads to a discussion of our broken healthcare system and provider burnout—

Interested readers can peruse my latest “Notes from a Healer” column—After 28 Years—in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine acts as an online clearinghouse for manuscripts dealing with humanities in medicine.

Home Again

When I called their home, Avery’s wife answered the phone. “I thought I might drive down for a visit,” I said.

“Come on down,” she said. “Avery could use some company.”

It had cooled off considerably overnight. Some of the leaves on the trees along the interstate had already begun to turn. Fall was just around the corner.

I found the house number on the mailbox and pulled into the driveway. Avery and his wife were sitting out back with their yellow lab mix puppy. The dog was busy chewing on a plastic toy. He was all over me as I walked up.

“Down!” Avery’s wife shouted in a stern voice. The dog paid no attention.

“He’ll settle down in a bit,” Avery said. “He’s a bundle of energy.”

“What’s his name?”

“Low-key.”

I laughed and took a seat in the chair next to Avery. His wife pulled the plastic toy from the dog’s mouth and tossed it across the yard. Low-key bolted after it.

“You’ve got a nice spread here,” I mused, looking out over the expanse of yard with its fenced-in flower garden and tall trees.

“About three and a half acres,” Avery said. “We didn’t know the lot was that big when we bought the house. It was in rough shape, but we got it for a song. It still needs some work, but no telling when I’ll get to it now.”

“When do you start chemo?”

“Next Wednesday. Once a week for three weeks, then they’ll reevaluate to see if it’s worth proceeding or not.”

“How are you feeling?”

“Not bad, really. I keep the oxygen on for several hours a day. And the pain medication keeps me comfortable.”

“Would you like some coffee?” Avery’s wife asked me.

“If you’ve got it made, sure.”

“I just brewed a fresh pot.” She disappeared into the house.

We sat and looked out over the yard. Chickadees and goldfinches flitted back and forth from tree branches to the feeders. I saw a nuthatch making its way headfirst down a tree trunk. Two small whirling gyros caught my eye. “You’ve got hummingbirds there,” I pointed.

“That’s the last of them for the season,” Avery said. “They’ve been swarming at the feeders for the last week. They’ve been going through a quart of sugar solution a day—it’s unbelievable how much they can eat. They’re tanking up for the flight across the gulf to South America.”

“What are those tall flowers in the garden?”

“Purple cones,” Avery said. “And those bushes on the far side are butterfly bushes. I’ve got a purple one and a white one.”

“They’re a pretty good size,” I said. “Did you raise them from seed?”

“I raised one from a seedling; the other from seed. They grow like wildfire. I prune them back, but the harder they’re pruned, the more they grow.”

“That’s not a monarch, is it?” I said, pointing out the big orange butterfly on one of the white flowers.

“No, that’s a fritillary. There’s a number of different fritillary species. That one may be a great fritillary; I’m not sure.”

“Coffee’s ready,” Avery’s wife said, returning with two big white mugs. “Afterwards, I’ve got some fresh baked apple dumplings, if you’d care for some.”

We sat and talked about Avery’s brother, an electrical engineer who spent one year researching microwaves in Antarctica and another year exploring the arctic. Lately he’s been in the process of buying a farm and a parcel of mountain land in Pennsylvania.

We finished the coffee and walked inside. I helped Avery with the oxygen tank. He pointed out the plants hanging from homemade brackets attached to the eves of the house and garage. “Ordinarily I’d have a full complement of begonias and impatiens up there, but this year I just couldn’t get to it.”

We sat down to bowls of fresh dumplings at the kitchen table. The talk drifted to cars. Avery told me about his first car—a ’52 DeSoto he had inherited from his brother. “It was a great car,” he said. “I drove the wheels off of it.”

When his wife left to take the dog to the neighbors for a run inside their fenced in yard, Avery told me about his stroke. “It was like my left side wasn’t responding to what my brain was telling it to do,” he said. “Someone had thrown away the service manual.”

“It’s a miracle you got all of the function back,” I said.

“Yeah. The steroids reduced the swelling in my brain, but then I had to put up with twenty pounds of fluid in my legs,” Avery said. “Still, it wasn’t all that bad.”

“It could have been a lot worse.”

“For sure. I’m thankful for the way it’s all worked out so far. I consider myself fortunate, all things considered. I really can’t complain. Every day is a new adventure now.”

“Every day always was a new adventure. It’s just that we don’t appreciate it for what it is.”

“That’s true. It used to be hard not to complain. Now I’m just thankful for each day I’ve got.”