“Notes from a Healer” — One Man’s Meat

Sometimes attempting to educate the patient is an education in and of itself.

My latest installment of Notes from a Healer — One Man’s Meat — 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.  Interested readers can access a list of editorial board members and regular contributors here.

A contemporary Socratic dialog

The Greek tragedian Aeschylus encounters the philosopher Socrates lounging against a large rock along the Panathenaic Way.

Socrates:  Greetings, fair Aeschylus!  What theatrical news from the Agora have you this lovely August morning?

Aeschylus:  My best to you, good Socrates.  As for the news, tell me truly: have you not heard of the latest contentious debates in the Senate?  A small select committee of finance has initiated discussions concerning our health care system.

Soc:  What’s this:  discussions on Athenian health care?  But why do you, fair Aeschylus, being a poet and playwright, concern yourself with such matters?

Aesch:  I do as a citizen of Athens, and you would do well to do likewise, Socrates.  “When men are willing and eager, the gods join in.”  But I fear that in the end the fates will dictate that we will all pay dearly for the results of these proceedings in one way or another.

Soc:  Tell me then of the particulars and the arguments of each camp, that I might become a more informed citizen and better understand the issues at hand.

Aesch:  The debate continues to rage, one faction pitted against another.  As I am certain you know, Socrates, there are four major players—the insurers, the sorcerers, the physicians, the solicitors—each at the others’ throats.  Naturally, each faction has a vested interest in the final proposal, for the proposal shall be put forward on the floor of the general Senate, there to be voted upon; and if approved, to become law, which all parties will then be bound to adhere to, not to mention the general populus—the citizenry—which will bear the brunt of the final outcome.

Soc:  Proceed then, fair Aeschylus, for I know you to be a true and noble author of tragedy, to tell me the arguments of each faction and the reasoning behind them, if you know it.

Aesch:  Because I perceive that you are first and foremost a seeker of truth, good Socrates, this I shall endeavor to do.  Well you know our present dilemma—how the citizens of Athens are forced to pay exorbitant sums of drachmae into common pools used to cover the cost of care rendered by our physicians should any citizen fall ill; and how much of this silver coin remains horded in the purses of the insurers, making them rich at the expense of the common folk.  “Human prosperity never rests, but always craves more.”

Soc:  But is not this idea a sound one in that it insures the health of the citizenry?

Aesch:  In theory, yes.  But the problem arises in that, should a particular citizen become ill and require ongoing care, the insurers drop him from further coverage. “Ah, lives of men!  When prosperous they glitter like a fair picture!  When misfortune comes—a wet sponge at one blow has blurred the painting.”

Soc:  How can this be so, Aeschylus?  If a citizen has paid, he is eligible for care.  It is the moral obligation of the insurers to pay for whatever care he requires.  Indeed, that is the reasoning behind such insurance—risk is spread over large numbers of individual citizens, for chance dictates that not all will fall ill at any given moment.  In fact, many will not fall ill until time leaves his grey mark on their temples and they grow old and gnarled like the ancient oaks at the foot of Mount Olympus.

Aesch:  How well the insurers understand this, Socrates.  “But it is always in season for old men to learn.”  If such persons are dropped from the system, or excluded due to preexisting conditions, the profit of the insurers will be maximized—

Soc:  At the expense of the very citizens whom they have sworn to protect from financial ruin!  “There is no sickness worse for me than words, that to be kind, must lie.”  But hear me now, Aeschylus—can not the citizens band together and pay these sums in the form of slightly higher taxes to the government, and could not the government cover the cost of the needs of those who become sick?

Aesch:  There are many citizens who would consider this to be a reasonable option.

Soc:  So, is this public option under discussion?

Aesch:  It has been dismissed as balderdash by the members of the Senate.

Soc:  Dismissed?  How now, Aeschylus—tell me, and by whom specifically?

Aesch:  Those of the sorcerers’ guild and significant numbers of those of the Aesculapian guild have banded together with the insurers to convince the blue dog democratic Senators to look upon the public option with suspicion.

Soc:  For what reason?

Aesch:  They say it smacks of socialized medicine, but in the end it will mean less profit for the members of each of the three guilds.  Know you not that “in every tyrant’s heart there springs in the end this poison”—this craving for greater wealth?

Soc:  But a public option would insure coverage of the cost of care for all citizens!  Morally, why would we not want to make our health care system to better serve the needs of the Athenian populus?  Is that not more important than mere profit?

Aesch:  That all depends on which camp you find yourself in, good Socrates. Sometimes “it is a profitable thing, if one is wise, to seem foolish.”  Moreover, “it is an easy thing for one whose foot is on the outside of calamity to give advice and to rebuke the sufferer.”

Soc:  But then the original concept of insurance—all citizens paying into a large pool to cover the expense of all those who fall ill—is thwarted.

Aesch:  You have struck the head of the forged nail with the hardened hammer truly, Socrates.  It would all appear comic, were it not so tragic.  “Who, except the gods, can live time through forever without any pain?”

Soc:  Tell me, Aeschylus:  is there no remedy then?  Is there nothing that can be done to insure the overall health of the citizens of Athens without bankrupting the state?

Aesch:  I hear that those Senators of the general democratic persuasion have put forth the idea of health care cooperatives that would compete with those of the insurers’ guild in an effort to drive down the cost of health care.

Soc:  And does this seem a viable alternative?

Aesch:  No one fully understands the concept as yet; hence, no one can explain how it might function.  “He hears but half who hears one party only.”  Furthermore, rumor has it that the republicans of Plato will not support it.

Soc:  Plato!  Why, he was a former student of mine.

Aesch:  “Even the wisest of the wise may err.”

Soc:  Perhaps I should pay him a visit and open a friendly dialog with him.

Aesch:  I wish you luck, good Socrates.  “His resolve is not to seem the bravest, but to be.”  Yet I surmise that there are more things in heaven and on earth than are dreamt of in his philosophy.

Soc:  How poetically you speak, Aeschylus!  May I quote you when next I meet with Plato?

Aesch:  Best strike it from the record for now, Socrates.  Who knows but that this turn of phrase might find its way into some future tragedy as yet unwritten.

The Child Psychiatrist

“Abuela, push me on the swing.”

“Not now, Alexi.  I’m not feeling well this morning.”

“Can you please take me out for a bicycle ride?”

“No, maybe later.”

“Abuela—please!”

“No.”

Six-year-old Alexi pouted as Maria brought her hand up to her forehead to shield her eyes. Suddenly Alexi’s face brightened.

“Abuela, come with me.”  She pulled Maria by the hand, leading her into the front parlor.

“Here, Abuela—sit down in the rocking chair.”

Maria sat down in the antique rocker with the caned seat.  It had been a gift from our former octogenarian neighbor years ago.

Alexi climbed onto Maria’s lap and put her arms around Maria’s neck.

“Now, Abuela, put your arms around me and rock back and forth.”

Maria put her arms around Alexi and began to move the ancient rocker back and forth as Alexi settled into her lap.  Neither one spoke for a few minutes.  Then Alexi broke the silence.

“Don’t you feel so much better now after rocking with me?

Maria nodded.

“It’s always good to have a little kid to make you feel better,” Alexi said.

Maria smiled.

“Now, Abuela, can we go outside and play?”

Those of us in medical practice sometimes forget that desirable behavior can be effectively shaped without the use of psychopharmacological substances.

Counting Costs

“I gotta tell you, this Obama character scares the bejesus outta me,” the man in the barber chair said.  “All this talk about death panels deciding when to pull the plug on us older folks. Next thing you know, we’ll have socialized medicine, and then no one will get proper care.”

Peyton pulled the barber drape off the man’s chest and brushed a few freshly clipped grey hairs off the man’s shoulders.  Slowly the old man climbed down from the chair and made his way across the linoleum tiled floor to the ancient cash register.  He handed Peyton a twenty dollar bill and waited for Peyton to count out his change.

“Yessir, if Obama gets his way, this country’s headed to hell in a hand basket for sure.  Government run health care is un-American,” the man huffed.  “See you next month, Peyton,” he said as he shuffled out the door.

I stood up and placed the magazine I had been reading in the rack next to the morning newspaper.  Peyton swept the floor with his push broom and stowed it in the corner behind the curtain.  “You’re up,” he said, dusting off the seat.

I removed my eyeglasses and slipped them into my breast pocket before climbing onto the chair.  Peyton wrapped a white tissue paper collar around my neck and clipped the drape at the back.  “How you been?” he asked, looking at me in the mirror on the wall above the sink.

“Oh, can’t complain.  How’re things with you?”

I saw Peyton shrug his shoulders in the mirror.  “Times are tough,” he said.  “Did you see the morning paper?”

I shook my head.

“Front page:  health insurance premiums are skyrocketing in the state, up 20 percent.”

“Twenty percent—that’s quite a jump.”

“Some of the insurance companies wanted to go 30 percent.  It’s highway robbery.”

Peyton picked up a pair of scissors and a comb.  “I got a letter in the mail yesterday,” he said as he began snipping away at the hair on the back of my head.  “My health insurance premiums are going up $300 a month.  Can you believe it—$300 a month!  That’s on top of the $1500 I pay every month just to insure my wife and me, and we’re both in good health.”

“Three hundred dollars a month—there’s your 20 percent increase, just like the paper said.”

“Twenty percent.  It’s outrageous; it’s crazy.  Pretty soon I’m going to be working just to pay my health insurance premiums.”

Peyton combed the hair down over my forehead and trimmed the ends.  “Are we doing your ’stache today?” he asked.

“Go ahead,” I said, lifting my chin.  Peyton snipped the ends of my moustache neatly with his clippers. “So what are you going to do?” I asked.

“What am I going to do?  See if I can move into a plan with a higher deductible to keep the premiums down.  Hang in there as best I can until I reach 65.”

“So you can retire?”

“So I can get on Medicare—if the country doesn’t go to government run medicine first,” he grunted.

“Pediatric Primary Care Case Studies” published

Pediatric Primary Care Case Studies, a collection of pediatric case studies that addresses common health problems of well, acutely ill and chronically ill children, has been published by Jones and Bartlett Publishers, Sudbury, MA.

Author Brian T. Maurer contributed an original chapter on a toddler with language and social delays, in which he reviews the diagnostic criteria and current management of children with autism.

These case studies are designed to help students develop critical thinking and diagnostic reasoning skills as they work through common patient scenarios encountered in general pediatric practice.  Guidelines and evidence-based research support current care recommendations.

Maurer was one of three Physician Assistant contributors selected for their expertise and experience in caring for infants, children and adolescents by editors Catherine Burns, Beth Richardson and Margaret Brady.

Ordering information is available on the web here.

Humane Medicine — Rhyme and Reason

Poetry has fallen out of favor these days, especially in medical journals, where evidence-based outcome reviews and studies have become publishing’s gold standard. Yet three decades of practice have taught me that every patient encounter is a poem yearning to be composed and reflected upon.

Interested readers can now access my latest Humane Medicine column, Rhyme and reason: Searching for poems in medical practice, recently published in the Journal of the American Academy of Physician Assistants.

A Noteworthy Twitter

As I back into the parking space at the edge of the wood and step outside my car, the melodic trills of a veery sound clear and sharp, descending the scale like a xylophone in the early morning air. Punctuated by a pause, the song repeats in flawless fashion. The number of notes I can not count, but the pattern is unmistakable. I stop to listen and find myself transported back in time to another summer day years ago when my friend and I spent an afternoon exploring a stretch of the Connecticut River.

We put in near Gillette Castle and paddled our kayaks north against the current to Chapman Pond. As we entered the expanse of quiet water, we passed a sentinel cormorant perched on a rock, its wings held aloft like a semaphore signaling our arrival. High overhead along the far ridge a pair of red tail hawks sailed on the updrafts. We slipped across the pond, and a gaggle of mute swans descended over our heads, wingbeats whistling through the still afternoon air.

We circled the lake before stopping to eat our snack of fresh blueberries and granola bars. I glimpsed a number of goldfinches in the treetops before we returned to the river. The waves lapped against the kayaks in the current as we drifted downstream past the rocky cliffs where eagles nest in the late winter.

Here we entered the quiet waters of Whalebone Creek and followed the meandering stream back through canals bordered on both sides by tall marsh grass to a beaver dam. It was there, at the edge of a wood, that I heard the clear sharp notes of a veery in the late afternoon shadows.

In her recent piece The Trouble With Twitter, University of Oregon adjunct instructor of journalism Melissa Hart laments: “I worry that microblogging cheats my students out of their trump card: a mindful attention to the subject in front of them, so that they can capture its sights and sounds, its smells and tactile qualities, to share with readers. How can Twittering stories from laptops and phones possibly replace the attentive journalist who tucks a digital recorder artfully under a notepad, pencil behind one ear, and gives full attention to the subject at hand?”

Sound bites — those 140-character tweets — don’t begin to do any story justice, unless they happen to have their origin in the warbled notes of a mystical woodland singer.