“Notes from a Healer” — Lunch To Go

Those of us who spend our days practicing medicine for a living find it difficult to get a break. Even ducking out of the office for a quick lunch may present its own set of challenges.

The latest installment of Notes from a HealerLunch To Go — 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.

Speaking on Writing: the Lecture Circuit

Today’s New York Times book review carries an essay by Rachel Donadio entitled “More Bang for the Book.” In it Ms. Donadio makes the point that “in recent years, a growing number of writers, from the best-selling to the less so, have hit the rubber-chicken circuit, speaking at colleges and businesses, chambers of commerce, trade fairs and medical conventions.”

“The most lucrative public speaking tends to be motivational,” she explains, citing Doris Kearns Goodwin’s success at commanding $40,000 for each engagement. These days there is money to be made on the lecture circuit.

In a journal entry dated January 11, 1857, at 39 years of age, American author Henry Thoreau wrote about his experience as a lecturer. He had already had two books published: A Week on the Concord and Merrimack Rivers and Walden.

“For some years past I have partially offered myself as a lecturer; have been advertised as such several years. Yet I have had but two or three invitations to lecture in a year, and some years none at all. I congratulate myself on having been permitted to stay at home thus, I am so much richer for it. I do not see what I should have got of much value, but money, by going about, but I do see what I should have lost.…a longer and more liberal lease of life.”

According to the Times article, some writers, like Jim Harrison, author of True North, find book tours exhausting. “It was ruinous to my health and sanity,” Harrison comments. And for other writers, encounters with readers can be trying as well.

In a subsequent entry dated February 8, 1857, Thoreau observed: “The week that I go away to lecture, however much I may get for it, is unspeakably cheapened. The preceding and succeeding days are a mere sloping down and up from it.”

Unlike most modern writers turned lecturers, who “make a great account of their relations, more or less personal and direct, to many men, coming before them as lecturers, writers, or public men,” Thoreau viewed all this as “impertinent and unprofitable.” (January 11, 1857)

“I find it invariably true,” he noted, “the poorer I am, the richer I am.”

Professor Randy Pausch, model and mentor

When we hear of the death of the agéd, we comfort ourselves by saying that they have lived their life; when we learn of the death of a child, we take solace in the notion that only the good die young. But what can we say when news comes of a life cut short in its prime, at the pinnacle of success, when past accomplishments portended perhaps greater things to come? And worse, when that individual was a much loved spouse and father, a mentor necessary for playing an integral part in the rearing of three small children.

News of death numbs us at core: how tragic, how unfair, we think. Yet we are helpless to control the timing of our passing. Eventually, death finds each one of us. How then to deal with this inevitability?

Randy Pausch had an answer of sorts to this question: he evaded it entirely, choosing to view each day, each hour of life as a gift, and striving to live it to the full.

In many ways Professor Pausch was an ordinary person: a child with boyhood dreams; a student struggling to climb the ladder in his chosen field; a professor mentoring his students; a husband loving his wife; a father doting on three lovely children. In his ordinariness, he was an anti-hero of sorts: he embraced what life had to offer; he played the cards he had been dealt; and in the end he faced the inevitable with grace. “Experience,” he said, “is what you get when you don’t get what you wanted.” By example he taught us how to live, seizing each day and wringing from it all that it had to offer.

We mark his passing with sadness, but we refuse to mourn him. Instead we hold up his life as an example of one well-lived, and we resolve to get on with the business of living our own.

Henry Thoreau was another American whose work was cut short in his prime. He succumbed to tuberculosis at 44 years of age. In his philosophical treatise Walden, Thoreau wrote: “I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived.”

I think Randy Pausch would have agreed with those words. In my book, both he and Henry Thoreau succeeded in their quest.

Author to address 2008 graduates of Quinnipiac PA program

Brian T. Maurer has been invited to address the graduating class of the Quinnipiac Physician Assistant program at nine o’clock in the morning on Monday, July 28, 2008.

He will speak to the new graduates on “Something of Value: The Art of Medicine.” Maurer’s presentation will include insights from his 29 years of practice in pediatric medicine, crafted in his book, Patients Are a Virtue.

“We learn the practice of medicine through the complex process of integrating knowledge and skills with wisdom and insight in our interaction with the patient. Although the medical record forms a composite history of the patient’s illness; for the clinician, it may be the illness narrative that ultimately imparts some degree of healing to both practitioner and patient alike.”

“You have learned the science of medicine; you have delved into its business. Now it is time to recall the art of its practice, for it is only in the practice of the art of medicine that you will sustain yourselves from day to day over the span of your professional careers.”

A Vase of Flowers

The young Korean lady sitting beside me asks a question. Her words are halting, the syntax broken. Up front at the podium, the speaker leans forward in an effort to understand. Her face is blank. Silence fills the lecture hall.

“She’s asking about Thoreau’s pursuit of truth through the Socratic method,” I explain. “She wants to know if you think he found it.”

The young lady sitting beside me nods in agreement. The speaker now understands her question. Knowing how to answer it is another matter entirely.

“I hesitate answering the question,” the speaker says, “because for Thoreau, truth would have been something entirely different than what we think of as truth today. For Thoreau, truth and beauty and virtue and honesty, although different words, would have all meant the same thing—an ultimate ideal. The ideal itself was the end; the Socratic method was the means to approach that end, even though you never actually got there.”

Always learning, and never able to come to the truth, I think.

The young lady thanks me afterward for clarifying her question. She uses the word translating: “Thank you for translating for me.”

“No problem. I hope that I didn’t put words in your mouth.”

She looks at me, puzzled.

“What I mean is, I hope that what I said is what you meant.”

“Ah, yes!” she nods in approval.

“And now you must tell me about your interest in Thoreau. How did you come to write your doctoral dissertation on him?”

“When I read Thoreau as a young woman, I recognized that he was speaking to me.”

“What did he say?”

“Be pure. Lead a simple life. Be aware. That is very Zen, you know.”

“Live in the present, the here and now.”

“Ah, yes—you know! Are you a Buddhist?”

“No. But I’m familiar with some of the tenets of Buddhism. Tell me, besides Thoreau, what brought you to the United States?”

“I’m here with my husband for one year. He’s a neurophysicist, doing research on the mind at Mass General Hospital.”

“Studying the human brain through MRIs and CT scans and the like?”

“Yes. He wants to know what the human mind is.”

“Deep thoughts,” I muse.

“Exactly,” she says.

“I saw you studying the vase of wildflowers on the table earlier,” I say.

“I was trying to calm myself down,” she explains.

“By looking at the flowers?”

“By trying to see the flowers as flowers only, for what they are. If I am anxious, or fearful, or upset, my emotions do not let me see the flowers. But if I concentrate on the flowers only, the fear and anxiety fall away.”

“Now I understand,” I tell her. “Thanks for the translation.”

She laughs out loud, the sound of one hand clapping.

Branching Out

On my recent sojourn to Concord, Massachusetts, I stopped off at the Tsongas Art Gallery in The Shop at Walden Pond. The current exhibit, “Branching Out,” is a mélange of color photographs by artist Linda Allen. They share the common theme of the natural world. Through the lens of her camera, Ms. Allen captures “gnarled branches and broken stumps, fallen logs and leafless silhouettes, colors that sing and shadows that whisper.”

Ms. Allen started photographing the woods around Walden Pond shortly after completing her final treatment for advanced cancer in 1992. At that time her prognosis was grim. “These photos became my ode to life,” she writes. “Everything I saw was significant; every precious detail of water, woods and wildlife was equally worthy of being held, celebrated and preserved.”

Ms. Allen is turning 70 this year, and her cancer is in remission. “Sixteen years ago I was surviving; today I am thriving,” she writes. “Perception lies in the sense and in the soul.”

Sometimes it takes a major crisis to awaken us to life. The world around us does not change; but rather, it is we who change our outlook, our perspective. How many times do we look and not see; how often do we hear and not listen; how many times do we touch and not feel? Yet each one of us possesses the innate capability to see, to listen and to feel—to experience the natural world through our senses.

It is when we choose to do so that we, like Ms. Allen, truly begin to live.

The Air We Breathe

Any medical practitioner worth his salt knows the ABC’s of resuscitation: airway, breathing, circulation. When approaching the victim, first open the airway; listen for breathing; check the pulse. Even if the heart is contracting, pumping blood to the body’s vital organs, it won’t do much good unless that blood has been oxygenated in the lungs. Breathing is vital to sustain life processes in the body.

The ancients equated breathing with life itself. The Greek root for wind or breath—pneuma—surfaces in our modern vocabulary in words such as “pneumatic” and “pneumonia.” Pneuma also denoted spirit. When you breathed your last, your spirit departed from the body; with that final breath, you expired. Our customary “Bless you!”—said to another person who has just sneezed—stems from the old idea that the spirit temporarily leaves the body during the act of sneezing, and it is necessary to cover the soul from a potential invasion by an evil spirit in the meantime.

Breath is also the vehicle through which we communicate with each other in speech. Exhaled air resonates over the vocal chords to create sounds. These spoken words transmit our thoughts, emotions and ideas. Without breathing—inhalation and exhalation—speech itself would not be possible.

Again, in the ancient economy, pneuma—wind or spirit—transmitted the spoken word. When received by another person, words were incorporated into the psyche or soul. Depending upon the individual’s response, you might see a change in attitude or behavior. The power of speech to teach, persuade or motivate others was recognized early on. Rhetoric was revered as one of the most important subjects in the ancient liberal arts curriculum. The ability to speak well in public enhanced one’s power and influence in the polity.

We have witnessed the deterioration of such standards within our lifetime. Gone is the eloquence of public discourse; words are broadcast like seeds sown haphazardly. Small wonder that many times we fail to understand what our fellow human beings are talking about.

Listening also is a skill that has fallen by the wayside. The ability to read—for comprehension or for pleasure—is in a state of decline as well. In short, we in western society have developed a communication problem—and few of us seem to be paying attention.

I cherish words too much to see them batted about like badminton birdies. It’s high time we got back to our roots—and theirs. Perhaps then we could finally begin to communicate with one another: spirit to spirit, soul to soul.

A poetic death

Ever since Ernest Hemingway popularized the Spanish corrida in his novel “The Sun Also Rises” (published as “Fiesta” in Great Britain), and his nonfiction masterworks “Death in the Afternoon” and “The Dangerous Summer,” it has been the subject of fierce debate among westerners. There are those who adore it for its pageantry and artistry, and those who abhor it for its savagery and senseless killing.

A recent New York Times article suggests that this debate continues—in Spain, of all places. Although nothing could be more Spanish than the corrida, a tradition that dates back several hundred years, many Spaniards detest it. How can a civilized society support a sport that consists of observing the slaughter of perfectly healthy animals for no other reason than the artistry of it? Yet the corrida persists, second only to soccer as a spectator sport in Spain. Why?

Like other facets of the entertainment industry, the Spanish corrida generates revenue. The going rate for a good seat is comparable to the cost of attending a major league American football game. It is also a large draw for tourism. Travelers to Spain flock to resorts on the Costa del Sol to sample the cuisine and the wine; they tour the ancient cities and marvel at the architectural forms of the Alhambra in Granada and the cathedral in Santiago de Compostella; they frequent the tapas bars in Madrid and sit at table to take in the flamenco dancers; and, if they haven’t seen one before, they certainly don’t want to leave the country without experiencing a corrida.

Most tourists are not aficionados, of course. If you have to ask what an aficionado is, mostly likely you aren’t one. But perhaps more than any other individual, it’s the aficionado who supports whole-heartedly the art of toreo.

During the year that I lived in Spain as a young man, back in Franco’s waning days, I traveled to Pamplona that summer for los sanfermines, those seven days of fiesta-ing that Hemingway wrote about. I remember seeing the bust of him in the street outside the Plaza de Toros. I remember the narrow winding streets hemmed in by the ancient buildings with the wrought iron railings on the small balconies and the crowded bars. But mostly I remember the corrida, the first one I ever saw.

The bulls were big, bred for the ring with barrel-sized necks. Small wonder that these massive muscles needed to be pic-ed and bled to weaken them sufficiently to allow the head to drop down to where the man could go in over the horns with his sword. Were there no corrida, such bulls would no longer exist; the breed would become extinct, entirely unnecessary and useless.

A year later, when I took my new bride to see her first corrida in Alcala de Henares, the birthplace of Cervantes, she hated it and vowed that she would never again set foot inside a plaza de toros—and she was (and remains) a Spaniard.

Two summers ago I returned to Spain, this time with my parents. Although they had never been to Europe before, they adapted well. Months before, when we talked about the trip, I asked my father if there were anything special that he wanted to see or do while in Spain. “How about a bullfight?” he asked. My wife telephoned her sister, who purchased the tickets.

That evening we sat in the front row, adjacent to the barrera, so close that during the fight you could almost reach out and touch the matador’s coleta or the flanks of the animal. It was a standard corrida—two bulls a piece for the three matadors, one of whom turned out to be Cayetano Rivera Ordóñez, the same Ordóñez mentioned in the Times article.

Ordóñez performed admirably that afternoon, so well in fact that he was awarded two ears from his second bull. At the end of the evening, they carried him out of the plaza on their shoulders to the admiration and delight of the standing crowds.

I was pleased to read that the current conventional wisdom in Spain is that Ordóñez just might be the one to return bullfighting to its traditional place in the hearts of Spaniards. Bullfighting runs deep in his blood: both his father and grandfather were matadors before him; and his father, Francisco Rivera, was killed in the ring.

Death is the great tragedy, of course. Yet there is something about the man who chooses to stare death in the face, determined to overcome it through the poetry of his art one more time.

Thanks for the Memories

My granddaughter and her mother recently moved to Florida—fifteen hundred miles away from New England. For the past year they lived across the street from us. This year my granddaughter had the opportunity to attend the same elementary school that her father went to when he was a boy.

The move was difficult for all of us, particularly for my wife, who cared for our granddaughter since she was a baby. Knowing that there are no guarantees in life didn’t make this particular transition any easier, but we have learned to accept the hand that we’ve been dealt.

My granddaughter loves to play Memory. You may recall that this game consists of pairs of identical cards shuffled and randomly placed face down in rows and columns. Players take turns selecting two cards at a time. You keep the matches and whoever collects the most matched pairs wins the game. My granddaughter would pout if an opponent scored a matched pair, and brighten each time she picked a match. Invariably, in spite of our best efforts, she would usually win. “You’re one sharp cookie,” I would tell her, counting up my meager score.

The last time she wanted to play Memory, we couldn’t find the game. Later, I asked my wife where she had put it. She couldn’t remember. I guess her memory isn’t what it used to be either.

The other day a lonely card from the Memory game surfaced. It depicted Princess Jasmine, the character from the Disney movie Aladdin, posing in her turquoise bloomers and tank top with a small blue butterfly perched on the tip of her index finger.

I recalled the myriad species of butterflies we had seen on our spring trek to the butterfly conservatory in Deerfield, Massachusetts. The blue ones were my granddaughter’s favorite.

I studied this memento of former carefree play intently, then hid it away in a safe place, somewhere I knew I wouldn’t forget. Memories are what we cherish to fill the void that a child leaves behind.

“Notes from a Healer” — Against All Odds

Success always comes at a price. For some, the cost is dear — particularly when you have to hedge your bets against the odds.

The latest installment of Notes from a HealerAgainst All Odds — 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.