Conversation in the time of digital communication

According to a recent New York Times article, “more than half a million college students now use wireless devices to register class attendance and take quizzes.” Not only has digital communication gone wireless and mobile; it now dictates our ability to participate in the public domain.

In the beginning there was e-mail, of course. That technological touchstone quickly morphed into instant messaging. Online chat rooms eventually gave way to My Space and Facebook. Nowadays, virtually every online publication accepts open comments from anonymous readers, which has further served to alter the course of our electronic discourse (it’s become blatantly more coarse, of course).

When I was a kid, every boy’s dream was to have a walkie-talkie. You could converse with a friend wirelessly within a reasonably close proximity—something much better than tin-can telephones on a string. Walkie-talkies morphed into cell phones, which eventually allowed the user to capture and send digital photographs and text messages. Nowadays such devices permit limitless access to online services—we surf the web, check our e-mail, capture digitalized documents, listen to radio broadcasts, and even view TV programs, as well as keep up the chatter with our colleagues and friends.

Hand-held devices have evolved into thinner, more compact units, capable of ever-increasing data storage. Two years ago, when I replaced my Nokia cell phone with a more modern (and instantly out-of-date) Motorola, I elected not to purchase the higher end model with a built-in camera. Meantime, my colleagues send instant messages from their BlackBerries, Droids and iPhones.

Apps are the latest big thing, of course. Download them for free at the iTunes or Windows store online, or pay for the more sophisticated versions. Another New York Times article highlights a “fistful of iPhone apps that will save you time, make your life easier and make you smile.”

More and more, it seems that we spend less and less time interacting with our fellow human beings face to face, in the flesh.

Recently, I awoke with the thought that what we really need in the next generation of digital communication is the I-Thou Phone (marketed as the ithouPhone)—a device that would allow two people to speak together face to face at table over coffee in a quiet parlor, far from the madding crowd.

A Mozart murdered

The world was stunned and silenced on that bright November day,
When a mad assassin’s bullet took that gallant heart away.

Last Saturday my daughter called to report that she and my son-in-law had made it to Dallas in good stead.  Their flight was on time, smooth, uneventful.  “We walked over to the grassy knoll to see the site of the Kennedy assassination,” she told me.  “I guess the anniversary is coming up on Monday.”

Her words momentarily shocked me.  I had forgotten all about it.  Without thinking, I said:  “Did you see the Texas School Book Depository, the building where Oswald lay in wait for Kennedy’s motorcade to pass by?”

“Yes,” she said.  “They call it something different now.”

I could see it in my mind’s eye:  a seven-story brick structure, a grassy knoll in downtown Dallas, a November day forty-seven years ago.  I was ten years old at the time, peeking at slides under a microscope which a classmate, the son of one of the town’s doctors, had brought to our fifth grade room, when the announcement came over the PA system:  “The President of the United States has been shot.”

At the time I had no words to describe my reaction. The announcement seemed surreal, as though it had come from another place and time light-years away.

It was only later that day when we were sitting in the cafeteria that the final faltering words of our principal struck home:  “The President of the United States is dead.”

If that announcement defined a horrendous act that occurred at a moment in time, it also foreshadowed a decade of violence.  Soon the war in Vietnam would escalate, civil rights workers would be murdered, race riots would break out in Los Angeles.  By the end of the 1960s two additional national leaders would be struck down.  Within a few short years another president would resign in disgrace.

Those of us coming of age in those turbulent times lost not only the innocence of youth; unconsciously, we witnessed the loss of national potential and promise.  By the end of that decade, if we had sent a man to the moon and returned him safely to earth; as a country we had also stained our hands with the blood of thousands of innocent lives.  The torch had been passed to a new generation—a generation of promise—and somehow we had failed to carry it forward.

In the concluding lines of his classic, Wind, Sand and Stars, Saint Exupéry writes:  “I am not weeping over an eternally open wound.  Those who carry the wound do not feel it.  It is the human race and not the individual that is wounded here.  What torments me is not the humps nor hollows nor the ugliness.  It is the sight, a little bit in all these men, of Mozart murdered.”

A walk in the woods

In the corner of the mud room I found an old walking stick, peeled and varnished with a leather thong knotted at the top end, which I selected on my way out the door. It wasn’t long before I entered the woods and followed the trail along the old wagon road to the top of the ridge.

It was a bright and brisk autumn afternoon. The path lay covered with a bed of newly fallen leaves, all brown and crisp, the kind that smell of autumn when crushed underfoot. Overhead, the sky was speckled with wisps of high-flying clouds. I soon encountered two female joggers decked out in the latest spandex suits followed by an English setter, who was too busy to offer more than a passing sniff as he padded by.

I walked the old 4-mile loop which I used to do at least twice a week when our black Lab was still whinnying with us. The trail provides pleasant vistas at several points along the way. I’m pleased to report that the vernal pool nestled at the base of the far hill still retains a good portion of black water where it lies behind the rocky outcropping that provides a breathtaking view of the entire valley to the south.

On my return I passed through a century old hemlock forest, now decimated by the adelgids, those tiny insects that camp on the underside of the needles and suck the lifeblood from the tree. Like splintered mainmasts on old clipper ships, these huge trunks tower above the forest floor, their topmost branches now only stubs silhouetted against the November sky — the last remnants of a faded woodland empire.

I passed one old giant, the victim of a lightning strike two decades ago. (I remember the day it was hit). You could still make out the spiral gouge where the bark had been burned off, now grey and faded over the years. A tiny red-breasted nuthatch flitted about on the lower branches, knocking off bits of decayed bark as it searched for a sparse edible morsel.

I returned home refreshed, with a cache of treasures: several pieces of peeled white birch bark, an old white oak leaf now brown and half decayed, a golden maple leaf with a bright red stem and a stalk of tiny wildflowers gone to seed.

A Pupil of Picasso

“I’m worried that my son might have a lazy eye.”

Seated in the chair by the exam table, this mother wears a concerned look as she produces a photograph from her purse.  “There—you see what I’m talking about?”

She points to the left eye in her son’s recent school picture.  By a narrow margin, it appears to be slightly smaller than the right one.  I study the color portrait and note that the light from the camera’s flash reflects off each cornea at the exact same spot.

The medical assistant has already checked the boy’s visual acuity on the Snellen chart:  20/20 vision in each eye.

“Anyone with lazy eye in the family?” I ask, reaching for a penlight to peer at the boy’s pupils.  “No?  Anyone in the family ever have eye muscle surgery?”

I ask the boy to follow the light: over, up, across, down, back to center.  I check for lid lag; I perform a cover test.  Finally, I use the ophthalmoscope to peer through the boy’s pupils to study his retinas.

The entire exam is normal.  I expected as much when I first glimpsed the photograph.

I find such encounters gratifying, because I’m able to reassure families that everything is fine purely on the basis of a thorough clinical exam.

“Then why does his one eye look smaller than the other?” his mother asks.

“It has to do with the distribution of the fatty tissue below the surface of the skin around the eyes,” I tell her.  “Have you ever studied Picasso’s works?  If so, you know that Picasso almost never rendered his subjects’ eyes as mirror images of one another.  They are usually of different size, location and proportion in his drawings and paintings.”

The mother seems pleased with my explanations.  She’s also happy that there is nothing wrong with her son’s vision.  All in all, it has turned out to be a good visit—for everyone.

In the Adventure of the Copper Beeches, Sherlock Holmes remarks: “To the man who loves art for its own sake, it is frequently in its least important and lowliest manifestations that the keenest pleasure is to be derived.”

Over the years I have taken keen pleasure in the art of medicine—and in the art of Picasso as well.

From the Patient’s Perspective

Most of us who spend our days in clinical practice focus on establishing proper diagnoses, formulating evidence-based treatment plans and following up closely with care of our patients. Seldom do we consider illness from the patient’s perspective. Yet viewing illness through the patient’s eyes gives us invaluable knowledge that we can use to help the patient heal—if only we would pause to listen and reflect.

Lately, I’ve come across three poignant pieces on the web which provide deep insight into what living with illness is like for the individual patient and the family unit. more»

Two Rivers, Two Towns

The drive to Weehawken turned out to be less harrowing than I had imagined. Google mapped the route; I chose the time of departure. As it turned out, a mid-morning drive to Manhattan is not necessarily unpleasant.

My heart rate accelerated as I maintained my speed through the Lincoln Tunnel, then slowed as I surfaced into the late morning light. Soon I pulled up to the curb outside the Sheraton Lincoln Harbor hotel. They gave me a room on the 7th floor that overlooked the Hudson. Like a string of multi-sized cardboard cutouts, the Manhattan skyline rose up on the far side, the Empire State Building immediately opposite.

I stashed my bag and left on foot to explore the area.

It was a short walk across the bridge to Hoboken, that old industrial city famous for the production of ships during WWI and WW2. Quickly I combed the narrow streets, hemmed in by brick row homes and shops. I made my way to the waterfront and watched as the New York Waterway ferry—the Governor Thomas H. Kean—approached the dock. A lone seagull soared above the water, while several others perched on decayed pilings that marked where piers from a bygone era once stood.

Out in the middle of the broad river a small tugboat nudged a bloated barge along. Several sloops, their sails reefed, motored down the expanse. Overhead a Coast Guard helicopter whirred by on its way down to the harbor.

That evening, after dinner, I stood on the second level of the Chart House restaurant and looked out at the city. To the north the George Washington Bridge spanned the blackness; to the south lay the Verrazano Narrows, while directly across the water the city sat, sketched out in a thousand points of light: clusters and strings of precious stones, like rich jewels in an Ethiop’s ear—brilliant diamonds, amber topazes, blue sapphires, red garnets.

Back at the hotel I crawled into bed, letting the curtains open. When I woke several times during the night, the city was still there, wide awake, beckoning.

Because of the time change I arose an hour earlier Sunday morning and departed the hotel in the darkness, driving west, leaving the smokestacks, bridges and concrete highways behind. I turned north and headed toward the upper Delaware, logging miles through low-lying farmland which eventually gave way to stone-capped mountains still draped in rustic orange-brown shades of autumnal garb.

I paid my three quarters to the attendant at the far side of the steel bridge that spanned the river and slipped into the town.

I checked my watch: I had two hours to kill before my friend would arrive. I grabbed a coffee and walked to a small park overlooking the river. You could see the water shimmering through the trees, sparkling in the sun as it meandered along. I noticed the remnants of a trail along the bank and struck out to find it.

Soon I was sitting on a tree stump at the edge of a grassy knoll, watching the last of the autumn leaves drift down from the ancient towering maples into swirling eddies. Off in the distance my eye caught sight of a large hawk circling above a stand of tall hemlocks on the far bank. I estimated the wingspan at six feet and glimpsed the white tail when the bird circled in the sun.

As I retraced my steps back up the hill, I met a man coming down. We paused in greeting, and I inquired about the trail that ran along the river. He told me where it led and asked where I was from. I learned that he made his home in Manhattan. Years ago he had purchased a small house by this river, which he frequented on weekends and holidays. I mentioned the eagle I had seen circling in the sky.

“I know where they perch along a tributary that runs into the river,” he winked, indicating with his head. We shook hands, and I walked back to my car to wait the arrival of my friend.

We had a good long walkabout filled with talk about things that matter to us most, followed by dinner in the old inn that sits on the square at the center of town.

Two rivers, two towns. Both rivers flow to the sea. One town never sleeps, the other is perfectly content to stretch and yawn as the spirit moves it.

The Best in All of Us

Runners whom renown outran,
And the name died before the man.

A century ago the English poet A. E. Housman penned those lines in his tribute, To An Athlete Dying Young.

Admittedly, renown has out run most of us; but, as former athletes, we still gather together to remember.

We remember times, records, individual meets and races. Some of us even recall specific workouts—serial sprints up Sure Kill Hill or long lazy runs on Sunday mornings—when we were young and strong and fast and free.

Some of us remember the rush that came from hitting the final tape; or, at other times, the dejection of defeat.

Although we all ran, none of us consistently won the prize.

Still, running has much to teach us about life and about ourselves—how we respond to challenges that come our way.

Through running, we learn to rise to the occasion. We learn that we can do much more than we thought, that we can go much further than we might have imagined in our calculated dreams.

We learn perseverance; we learn to believe in ourselves. And at those times when defeat arrives—as it invariably does—we learn to accept it with grace.

To my mind, D.W. exemplifies these traits—the very best traits of a fine and gracious athlete.

There are special times when a runner of the highest caliber is recognized in life: at the end of a specific event, at the conclusion of a stellar season, at the finish of a sterling career. And on occasion, we choose to recognize the very best runners in hindsight when we gather together to celebrate—not the races or the record times—but the individuals themselves.

The caliber of such a person was apparent in those early days, days filled with pre-dawn risings for runs down deserted stretches of macadam roads or along leaf-strewn forest paths; late afternoon sets of intervals around a cinder track; easy strides through grassy expanses on cool evenings. Such runners remained firm in their resolve to train hard so they might give their all on the day of the race.

When we move forward from youth toward maturity, we recognize that the race does not stop at the tape on the track or in the funnel to the finish line; for we continue to run our race every day, rising early, stepping into other shoes to face new and more arduous challenges. It is perhaps here that the true colors of the committed runner become apparent.

In the forty odd years that I have known D.W., I can testify that he has shown himself to be an athlete of the highest caliber, both on and off the training turf, on trail and track, in victorious times and times of loss. He possesses that innate quality of a true mensch which I will call grace—grace under pressure, grace on the victory stand, grace among peers at the close of day. In short, he fits the bill.

It is proper and right and a good thing that we should gather together to celebrate not only his former athletic accomplishments, but also to recognize the man who stands before us as an example of an individual of the highest caliber, who ultimately represents the best in all of us.

Remarks on the occasion of the induction of  Rev. Dennis L. Weidler into the Juniata College Hall of Fame, November 6, 2010.

Help me to not be afraid

Like all 4-year-olds, Skipper had his likes and dislikes, his favorite activities and things he would rather not do. Like most 4-year-olds, Skipper’s world consisted of family, friends, pre-school and home. And like few 4-year-olds, Skipper’s world came to a grinding halt when his doctor diagnosed him with a brain tumor.

Because of its location, the tumor was operable. The neurosurgical team labored over him for eight hours and succeeded in resecting the growth. Because the pathologist was unable to differentiate the cellular type, the slides were sent out to a world-renowned regional cancer center for review by the experts.  The results came back equivocal.

The parents were given the option of a short course of local radiation, an extended course of chemotherapy, or observation. Because of the side effect profiles, they elected to watch and wait. Unfortunately, the growth recurred.

This time round Skipper was enrolled in a chemotherapeutic protocol. Periodically, he would receive four days of toxic medications. These rounds were scheduled at monthly intervals. The initial treatment regimen knocked him down, but soon he was up and active again. The second round was worse. The morning before the trip to the hospital, Skipper’s grandmother was helping him to put on his socks when he made his small request: “Please, Grandma, help me to not be afraid.”

What do you say to a 4-year-old? What sort of reassurance do you offer? How far out on the limb do you go?

At that age, reassurance takes on the mantel of love. Words help, touch helps, doing an activity together helps. We work with whatever tools we have.

Sometime later after I heard this story, I drove to a local bookstore to browse the shelves in the children’s section. It proved difficult to locate a specific book, because they are categorized under different genres according to the perceptions of the adults who work in these areas. For the young child, a book is a story—nothing more, nothing less. Its category means nothing—it is only the story that holds meaning.

I made my selection and paid at the register. I laid the parcel on the seat beside me as I climbed into my car. I hand carried the book to the house that I had last visited years ago. Tucked in among the towering pines, it was still there, just as I had remembered it: neat and trim, well cared for.

With a short stammer of inadequate words I placed the gift into the hands of the grandmother I had come to know over the past decade. She invited me to come in, and we sat among the plants in the conservatory and talked a long while about children and grandchildren, parenting and grandparenting, love and tough love.

She gifted me a poem by one of her favorite writers, Wendell Berry.

When despair for the world grows in me
And I wake in the night at the least sound
In fear of what my life and my children’s lives may be,
I go and lie down where the wood drake
Rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
Who do not tax their lives with forethought of grief.
I come into the presence of still water.
And I feel above me the day-blind stars
Waiting with their light.
For a time I rest in the grace of the world, and am free.

At my age, reassurance takes on the form of caring. We learn to care for one another as best as we can, with whatever tools we can muster.

“Notes from a Healer” — The Lives We Touch

Today I placed a tuberculosis test on the forearm of a young lady who is enrolled in nursing school. I’ve known her since she was an infant. She’s all grown up now, striking out on her own. I last saw her several years ago when she came in complaining of panic attacks shortly after her father died from metastatic bone cancer. Back then she was vulnerable; now she’s confident. She’s decided to devote her life to caring for others.  more»

My latest installment of Notes from a HealerThe Lives We Touch — 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.