Christmas Day, 2010: A magical moment

I made French toast from the leftover loaf of coarse bread on Christmas morning.  Everyone gathered in the kitchen and took turns eating at the small table as the toast came out of the skillets, thick and hot and golden brown.

Afterward we opened the gifts.  This year there were useful and useless presents—garments and books, gift cards and money, toys and electronic devices.  I retrieved A Child’s Christmas in Wales from the small marble-topped table in the parlor and read Thomas’s section on the presents.  When I got to the part about the “celluloid duck that made, when you pressed it, a most unducklike sound, a mewing moo that an ambitious cat might make who wished to be a cow,” my granddaughter hugged her stuffed slice of bacon toy to make it say “I’m bacon!” and everybody laughed.

We redd up the boxes and the wrappings and then I took the dog out for a walk up along the ridge to the power line cut where you can look out over the wide expanse of the valley.  Off to the northeast the Barndoor Hills lay nestled in at the base of the far ridges.

The dog and I stood for a moment surveying the scene when a cacophony drifted in from across the valley.  Louder and louder came the cries.  Breathlessly I studied the far ridge line, which began to undulate, as though inked in by an unseen hand in real time.  Then suddenly the whole line lifted up against the backdrop of the overcast sky.  Black dots appeared along the now broken line as bleating and honking reached a deafening crescendo in the cold air.

Closer and closer they came, companies and battalions of geese flying in formation, rising up across the grey sky, a massive ornithological sortie.  There must have been three or four hundred, perhaps more.  In a moment the sky was filled with the deafening cries of geese as they passed overhead.

The dog and I stood stock still with our eyes raised.

A few breathless moments more and the entire gaggle had disappeared over the second ridge to the south, leaving no trace but an occasional stray bleat.

It was only after the last straggler had gone that I realized my heart was in my throat.

Touching Portraits

In 2005 the artist James Esber produced a line drawing of the turbaned bearded face of Osama Bin Laden. He subsequently sent a photocopy of his sketch to nearly one hundred friends, inviting each one of them to reproduce it on tracing paper and enhance the work to their liking with shades of black and red ink. The compiled results form the heart of his exhibition “You, Me & Everyone Else” currently on display at the Pierogi gallery in Brooklyn.

Some of Mr. Esber’s friends were members of his own family. Some were professional artists in their own right; others had no previous artistic training. Yet they all succeeded in expressing themselves in a unique way. In Mr. Esber’s words, “personal touch becomes paramount.” Each person possesses a unique touch, which under the proper circumstances can be drawn out.

When I step into an exam room to see a patient, I enter another world. I offer a greeting—an invitation of sorts—create an ambiance, ask a question or two. If the chemistry is right, the patient begins to talk, expressing concerns, fears, pain; sometimes hope, even joy. I provide the framework, the blank canvas, on which the patient might choose to render a drawing, a portrait—a blend of some segment of existence.

I recognize that any narrative might be slightly different depending upon the nature of the interaction. The technique works best with gentle guidance. As with any work of art, it fails miserably with inadequate time and attention to detail.

Thoreau writes: “It is something to be able to paint a particular picture, or to carve a statue, and so to make a few objects beautiful; but it is far more glorious to carve and paint the very atmosphere and medium through which we look, which morally we can do. To affect the quality of the day, that is the highest of the arts.”

Perhaps, like Mr. Esber, that is what we who work in the helping arts are tasked to do: to draw out the unique touch of those whose lives we touch every day.

The last time I saw Paris

We build our temples for tomorrow, strong as we know how, and we stand on top of the mountain, free within ourselves.       —Langston Hughes

The last time I saw Paris was this past Wednesday night when PBS aired the documentary, Paris: The Luminous Years.  This was a small miracle in itself, because my wife usually co-opts the TV remote and calls the shots.  She’s not particularly enamored with French culture.  But for once I had my way.

From 1905 to 1930 Paris became the gathering place for avant-garde artists from all over Europe, Russia and the United States.  It was here that modern art, poetry, dance, music and architecture evolved, beginning with the initial Fauvist exhibitions and ending with the advent of jazz.

Many of these early artists formed ad hoc bohemian communities and fed off one another’s work and ideas.  They found the open ambiance to be energizing, stimulating, liberating.  Paris was the place where many of them found themselves.

In 1923 Langston Hughes arrived in Paris from America with seven dollars in his pocket.  He knew no one in the city and had no letters of introduction.  He soon found a job as a bus boy in a jazz club and proceeded to write the poetry for which he would become famous.

In those days Paris was color blind.  Americans who had served in the European theatre in the First World War were eager to return to Paris.  These expatriates rejected their parochial roots and set out to find themselves in the big city.  Paris was where it was at.

Thoughts of that Parisian era swam through my head as I drove to work the following morning.  What it would have been like to amble down the street or sit in a café and mingle with the likes of Duchamp, Breton, Picasso, Braque, Chagall, Apollinaire, Miró, Joyce—a heady feeling at the very least.

My morning reverie dissipated as I started in with my patients.

A pair of new patients appeared on my schedule.  An adolescent boy and his younger sister needed physical examinations to matriculate in the local school system.  I met their aunt, who was in the process of adopting these two children, both of whom had come from the big city.  They had been placed in her care three weeks ago when their mother succumbed to a stroke at age 45 on Thanksgiving Day.

The boy was tall, athletic and polite.  “I’m sorry to hear about your mother,” I told him.

He shrugged his shoulders.  “She had high blood pressure, diabetes and asthma; but she didn’t take care of herself.  She smoked two packs of cigarettes a day and drank coffee all the time.  We figured she wasn’t going to last long.”

I asked a few questions to flesh out the past medical history and proceeded to the exam.  “So what do you like to do for fun?” I asked him as I looked into his ears.

“I like to drum,” he said.  “Down in the city I was part of a drum corps.  We were hot.  We took first place in the statewide competition last summer.”

“Wow, that’s pretty impressive!  Will you be able to continue your drumming with the group now that you’ve moved away from the city?”

“Don’t know.  But I’ll find something else to do.  Maybe I’ll try out for the football team.”

“Did you play sports in the city?”

“No, I wanted to, but there was always a transportation problem.  My mom didn’t drive and we didn’t have money for the bus.”

“Maybe you’ll have more opportunities now that you’re living with your aunt.”

“I hope so.  I’m so glad to be out of the city.”

There you have it, I thought, the great transmigration, only this time it was from the big city to a small provincial town. Maybe this would be the ticket this boy needed to help find himself.

Paris is Paris, no matter where you encounter it.

The Shirt

I awake in cool morning darkness, slide to the edge of the bed, hang my legs over the side and sit up. Various shades of grey swirl before my eyes as fuzzy shapes begin to form. Instinctively, I reach out in the darkness and find the shirt hanging over the chair by the bed.

I thrust my arms through the sleeves and proceed to button it from the neck down, leaving the throat undone. The chill on my skin subsides, replaced by the warmth of the insulated flannel shirt.

I finish dressing in the dark, make my way down the stairs and grab my fleece off the coat rack. The canvas bag with my workout paraphernalia sits by the corner hutch. I step through the kitchen door into the mudroom and pause to pull on my woolen stocking cap before stepping outside into the pre-dawn cold.

It’s a short drive to the gym. Soon I’m stripped down again, standing in my swimming suit at the end of the pool, stretching my neck and shoulders. I plunge into the cool water and begin to stroke down the lane. As I approach the wall I give a short kick, somersault and spring off the wall. Twenty-four laps later I surface to find the adjacent lanes filled with my companions warming up.

Together we tool through the workout—today, a series of short interval swims repeated in several sets. One hour later we pull ourselves from the water and head for the showers.

In the locker room I towel off and dress. One of the guys notices my shirt. “Nice shirt,” he says. “Where did you get it?”

I turn an answer over in my mind before selecting the words. “It was a gift,” I say, and leave it at that.

I grab my bag, don my stocking cap and step outside. A pair of geese passes overhead, honking in the greyness. The air is cold and still, but I’m toasty inside as I walk to my car, thanks to the insulated shirt on my back.

This shirt was a gift—one of several flannel shirts given to me by the widow of the fellow who used to service my car. Avery was an outdoors sort of guy, one whose idea of a great day was a long walk in the woods with his favorite dog. Gardening was his hobby. He loved to smoke cigars when he worked outside, stacking the wood that he’d cut and split himself.

It’s been two years since Avery succumbed to cancer. I was a pallbearer at his funeral. His wife gave me the shirts several weeks later when she cleaned out his closet.

On these cold grey December days, when the geese pass solemnly overhead, I remember Avery—and those shirts still keep me warm.

Humane Medicine — Heartache: When the diagnosis is just a click away

The heart has its reasons, which the reason knows not. —Pascal

It has been a particularly trying week. Cracks appear at the edges of my well-ordered world: too many patients, not enough time to devote to difficult cases, staffing issues at the office. Moreover, I feel a cold coming on, a growing discomfort in my chest.

Now here before me sits a 14-year-old boy, my last patient of this busy Friday afternoon. more»

Interested readers can now access my latest Humane Medicine column — Heartache: When the diagnosis is just a click away — recently published in the Journal of the American Academy of Physician Assistants.

“Notes from a Healer” — A Singular Twist

“You’d better go to see this kid right away,” the medical assistant told me. “He’s acting kind of odd.”

I know this medical assistant well. She’s been working at our office almost as long as I have. I took her at her word and dashed into the room.

I found a 6-year-old boy sitting on the exam table, his mother standing by his side, her eyes wide open, filled with tears. I’ve known this mother since she was a little girl. She comes from a dysfunctional family, but she’s a survivor. She’s got a good head on her shoulders. Usually she’s pleasant, calm, in control. But here she was falling apart before my eyes.  more»

My latest installment of Notes from a HealerA Singular Twist — 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.

The Art of Medicine: Learning to capture the human figure

In his series of articles on the art of drawing, artist and author James McMullan speaks to that intuitive intelligence which the visual artist needs to cultivate in order to capture forces inherent in the human body:

Once we tune into these cooperative forces that animate the body, they seem obvious; yet opening up the kind of intuitive intelligence we need in order to see these forces is difficult when we are so used to relying mainly on the simple scanning operations of our eyes. As we draw, we need to record pressures and not just edges, and we need to see relationships between parts rather than just pieces of the body.

Reading these words, I was struck by the similarity between the art employed in drawing the human figure and the art of the practice of medicine. Both require the use of intuition to recognize the forces in play before the eyes of the observer.

In his approach to the patient, the medical student tends to dwell on organ systems—parts or pieces of the human body. This stance follows immediately from the way in which gathering the medical history is taught.

First, the patient’s chief complaint is identified. Many times it centers around pain. The student probes the patient to develop an understanding of the pain itself: its character, its location, its radiation, its severity, its timing—all necessary elements to round out a description that might fit a pattern consistent with a known clinical entity.

The physical examination serves to develop and substantiate the final diagnosis. Sometimes further testing—lab studies, imaging studies, tissue sampling—is deemed necessary to clarify the problem. Throughout this entire process, bits and pieces of data are gathered and assembled into an impression to describe the whole.

Although the master clinician gathers data in a similar fashion, at the same time he or she does more than just probe with questions and scan with the eyes. Intuition comes into play, albeit subtly, informing the clinician on a deeper plane, allowing him or her to discern the complex relationships between the pressures and forces that impact the functioning of the human being before his eyes.

In McMullan’s words, the clinician perceives that “significant energy relationships in the body are often not right next to one another.”

McMullan maintains that “You have to be alive to the possibilities of each pose as you encounter it, and be willing to be surprised and to surprise yourself.”

It is important “to identify the central aspects of a pose in order to give yourself a theme that helps you to organize your thoughts and the order in which you tackle the different parts of the body.”

“The best drawings of the human figure seize on its life force.”

In McMullan’s opinion, “all of these practices will lead you to empathic thinking,” a perspective which benefits both clinician and patient as well as the artist.

McMullan’s line echoes Tolstoy in his essay, What is Art? — “it is upon this capacity of man to receive another man’s expression of feeling and experience those feelings himself, that the activity of art is based.”

Historically, artists have studied anatomy to assist them in their understanding of the rendering of the human figure.

Perhaps clinicians need to consider the perspective of the artist to further an empathetic understanding of the patient.