Cathedral Morning

After an unseasonably warm stretch, temperatures fell overnight, bringing a cool quiet rain.  This morning the grass is wet on the toes; the broad-leafed hosta plants cup shimmering droplets in their green palms.

Further down our street the leaves on the towering maples have begun to turn red and gold; soon the canopies will clear as their summer garments are shed.  All along the far edge of our driveway burningbushes (Euonymus atropurpureus) are beginning to light their crimson fires.  At the edge of the wood the sumac’s scarlet spears stand erect against a backdrop of brown branches.

A catbird darts into our front porch and perches momentarily on the balustrade.  I pause in the rocking chair with my coffee cup halfway to my lips and watch him cock his head to size me up before he scuttles around the corner out of sight.

In the great ash tree across the street, a choir of crows assembles aloft on a bare branch.  They squawk a raspy chorus as the sun breaks over the far hills.  The morning light pierces clusters of yellow-orange leaves high in the canopy like stained glass vitraux in medieval cathedralsMorning has broken.

Rich orange Chinese lantern seed pods dapple the garden beds.  Rusty brown stalks of withered flowers stand motionless in the morning light.  Here Nature is changing her palette from green to more subtle earthen colors.

The hayfields have been mowed; the apples are red, ripe and ready for picking.  We have entered the season of harvest.  In another month the farmers will rest from their labors.  For now there is much work to be done: a gathering in of earth’s bounty suitable for autumnal plates and palates.

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“Notes from a Healer” — Arms and the Man

Sometimes it’s a struggle for the clinician to deliver appropriate health care to the patient—and the system isn’t necessarily the culprit.

My latest installment of Notes from a HealerPhysical Medicine: Arms and the Man — 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 Socratic dialog on health care reform (VI)

Toward the evening of a long day of discussions with Aeschylus, Plato, Aesculapius, Apothos, and Litigius, the philosopher Socrates makes his way to the home of Hippocrates, the father of medicine.

Socrates:  Hail, Hippocrates!  Are you at home?

Hippocrates:  Socrates, good fellow, welcome!  Come in, come in.  But I perceive that you walk with a limp.  What ails you, my friend?

Socrates:  An infection on the sole of my foot, Hippocrates.  I consulted Aesculapius, who cleaned and dressed the wound; then purchased an antibiotic potion from Apothos.  The rubor and dolor have already begun to subside.  But enough of my woes.  I came to consult you on a related matter:  that of the state of contemporary medical practice in Athens.  I desire your opinion on our health care system, as there is much discussion in the Agora and the Senate.

Hippo:  Ah, yes; as of late I’ve had my ear attuned to these myriad discussions myself.  Truly, they have become intricate and arduous, a snare to all who dare to enter into the fray.

Soc:  Fair Hippocrates, if you, the father of medicine, find these discussions convoluted, can the rest of us hope to make any meaningful sense of them?

Hippo:  I dare say that it would be difficult.  But I shall endeavor to enlighten you as best I can, Socrates.  Ask away, and I shall mix you a bowl of wine in the meantime.

Soc:  I appreciate your hospitality and willingness to dialog with me, Hippocrates.  Now tell me, what is your opinion of the system of health care delivery in Athens?

Hippo:  In a word, broken; although it pains me to say it.  The system has devolved from what I had originally envisioned it to be into a massive and complex enterprise of business.  All relationships are now contractual, defined by the solicitors and their ilk.  Products and services are bought and sold in the medical marketplace like milk and meat in the Agora.  All participants profit at the expense of the citizenry.  The cost of care escalates, and from what I read, the system will soon be unsustainable.

Soc:  How did all of this happen?

Hippo:  It is the fate of mankind, Socrates.  All men want just one thing:  a little more than they already have.  More silver, more material things, more pleasure—and longer lives to enjoy it all in.  Health care is no exception.  The more we create, the more we consume.

Soc:  But speak to me of the health of our citizens, Hippocrates.  Is it not vastly superior than it had been when you first formulated the tenets of medical practice?

Hippo:  In some aspects, yes.  We have managed to lengthen the average lifespan of our people through improved housing and sanitation services.  Overall, we enjoy a more healthful diet.  And when it comes to intricate technology, we lead the entire Mediterranean world in procedures such as open heart surgery, organ transplantation, and artificial joint replacement.  Yet this has come at an enormous price to our society.  Many of our citizens are still unable to obtain basic health care.  It grieves me deeply to read of the numbers of children who fail to receive their immunizations and in some instances proper nutrition.  At its inception I had envisioned that the system would care for all of our citizens, not just those who were well off.

Soc:  I perceive a certain sadness in your words, Hippocrates.  There is much wrong with the system, and yet much is to be admired as well.  Certainly you have strived to elevate ethical practice in the healing arts.  Why, look at the oath that you and your students have drafted—an example of high ideals and excellence of care.

Hippo:  True, perhaps; but I fear that the system corrupts many of those who elect to practice the art.  And many of those it does not corrupt experience burnout and choose to depart the ranks of the profession.  You see, Socrates, we have amassed a great deal of knowledge that has allowed us to immensely improve the health and longevity of our citizens.  But what we lack, what we truly lack, is the wisdom to guide us in meting out the resources of care.

Soc:  I understand that 4 out of every 10 Athenian healthcare drachmae are spent on caring for the old and the infirm at the end of their lives.  Is that true, and if it is, can you enlighten me as to how this came to be the case?

Hippo:  Indeed, it is true.  Many families desire that every effort be made to prolong the lives of their elders, even though the situation is hopeless in many cases.  A good deal of silver is spent shunting patients back and forth from assisted living facilities to hospitals, where procedures of questionable merit are performed, instead of allowing nature to take its course.

Soc:  But surely we can not stand by and allow our elderly to die when we have the means to restore them to health!

Hippo:  Restore them to health, or merely prolong their existence?  I need not remind you, my dear Socrates, that unlike the gods, we humans are mortal.  At some point our bodies will wear out and pass away.  Death, merely the last stage of life, will eventually hush us along.

Soc:  I perceive now that your title of father of medicine is one well bestowed, Hippocrates.  You are not only a healer, but a philosopher as well.  But, to return to our previous line of thought, where can we procure the wisdom to guide us in formulating a more just and equitable system of health care delivery?

Hippo:  You, the wisest of all men in Athens, ask that of me, Socrates?  It is I who should be asking that of you.

Soc:  But in truth, Hippocrates, I recognize that I know not the answer to this dilemma.

Hippo:  As you well know, Socrates, admission of ignorance is the wisest place to begin a rational dialog.  If we can come to an agreement on the problems, perhaps then we can hope to ameliorate at least some of them.

Soc:  If we should find a remedy to this medical morass, I must remember to ask Crito to sacrifice a cock to Asclepius.