Grief and Mourning

Grief hits us hardest when we least expect it.

I recently returned from the AAPA national conference in San Antonio, Texas, where I helped facilitate a small group discussion in the “Breaking Bad News” workshop. This ground-breaking seminar was the first of its kind sanctioned by the AAPA conference committee. Traditionally, continuing medical education national planners have considered such topics to be soft science, not worthy of recognition for ongoing educational credit.

The workshop was well-attended; over forty people showed up, and most stayed for the entire two and a half hour session.

We used Joan Didion’s book The Year of Magical Thinking as a literary text to facilitate discussion. In the pages of her journal, Didion records thoughts and feelings over the span of a year after her husband’s unexpected demise at the dinner table. Although outwardly she appears to have accepted the fact of his death, inwardly she continues to wait for his return during her year of magical thinking.

Immediately after the event takes place, the death of a loved one changes us forever in ways that we do not understand.

In small groups, participants had the opportunity to consider an instance when they were required to deliver bad news to a patient or receive bad news themselves. Without exception, the folks at our table found that they could readily recall such events with heightened clarity, although in most cases these events had taken place years ago.

Mourning, the process of working through grief, takes time. Sometimes, like a recurrent abscess, it requires periodic incision and drainage to heal.

I felt good about the discussions we had. I was amazed at how little time it takes for individuals to open up to complete strangers when given permission to do so in a safe place.

I returned home exhausted from my three-day trek. I never sleep well on the road. My son met me at the airport. We had a nice dinner together. It was only later after I checked my e-mail that I learned that a close friend’s family member had been brutally murdered by a street gang in another country while I was away.

Grief hits us hardest when we least expect it; mourning takes time.

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Age, Beauty and Art

“Age need not destroy beauty. There are people who grow more beautiful as they grow older. If age means to them an expansion and development of character, this new mental and spiritual state will have its effect on the physical. A face which in the early days was only pretty or even dull, will be transformed. The eyes will attain mysterious depths, there will be a gesture in the whole face of greater sensibility and all will appear coordinate.”

So writes Robert Henri, the American painter and art educator, in his book, The Art Spirit. Henri’s observations call to mind a conversation I once had with an attractive thirty-something woman. “It isn’t fair,” she remarked. “When men age, with their graying temples and leathery skin, they just look more distinguished. Women, on the other hand, have to deal with wrinkles and saggy skin. There is no justice!”

Henri continues his one-page treatise: “About the portrait Whistler painted of his mother I have always had a great feeling of beauty. She is old. But there is something in her face and gesture that tells of the integrity of her life. There is nothing wobbly about her face as there is in the faces of those whose integrity has been uncertain. A wonderful record of woman’s beauty would have been lost to the world if her son had seen fit to look for any other beauty than that which was present. There she sits, and in her poise one reads the history of a splendid personality. She is at once so gentle, so experienced, and so womanly strong.

“She may have had other beauty in her youth, but it could not have surpassed this, which charms and fills us with reverence.”

The irony here is that Henri spent his life attempting to capture this inner beauty with brushstrokes of color on a two-dimensional canvas. He applied his paint to the surface in the hope of portraying something intangible: an inner radiance.

For the writer, who is an artist in his own right, the blank page is the canvas; letters supplant the flecks of color, words the brushstrokes, and sentences add tonality and color to form descriptive and emotional impressions. Like a fine portrait or a landscape painting, if the work is ultimately any good, the reader will sense the meaning through the words; and it will speak to him in a profound way.

That, to me, is art.

Magic Wings

Yesterday afternoon we traveled to Deerfield, Massachusetts, to visit Magic Wings, an indoor arboretum housing thousands of butterflies.

As we sauntered through the narrow pathways past all sorts of exotic plants, the butterflies were everywhere: flitting about, soaring up toward the netting overhead, delicately landing on flowers, sucking sweetness from dishes of filleted fruit and colorful sponges.

We passed over a small footbridge and paused to look down at the huge orange fish in the clear water. On the ground at our feet, species of small quail scurried about in search of seedy morsels. An old man sat under the gazebo, butterflies resting on his hat and shirtsleeves.

In the vestibule we marveled at the collection of poisonous dart frogs, walking sticks, cockroaches and leaf bugs from down under. My granddaughter shrieked with delight when she saw the Costa Rican tree frogs poised on curved green broad leaves, staring back through bright red eyes. Her first stuffed animal was an exact replica.

Afterwards we sampled ice cream cones outside in the sun. On the far mountains across the valley the maples were beginning to flower.

Homeward bound, we sang songs as we sped south down the interstate. As our ethereal afternoon drew to a close, my thoughts turned towards Nabokov’s butterflies.

“Notes from a Healer”—Matters of the Heart

Many years ago, as a young clinician, I learned that the practice of pediatric cardiology consists of more than evaluating congenital heart disease.

The latest installment of Notes from a HealerMatters of the Heart — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine.