Evening Descent

The only other sound’s the sweep
Of downy wind and snowy flake. —Robert Frost

I sit on a wooden stool by the window in the kitchen, watching the snow come down. Across the street in a yellow cone of lamplight tiny flakes swirl about as though encased in a snow globe. Each one in its own time descends to rest against the frozen earth.

Forty years ago after the last bell of the day, I sat on a similar stool in a high school classroom, listening to my teacher reminisce about his boyhood. Outside the second-story windows snow lay along the sills in fluffy mounds, muffling the sounds from the street.

“I never had much direction in life,” my teacher mused, taking a sip of coffee from his thermos. “Maybe that’s why I eventually ended up following in my dad’s footsteps.”

He was a tall man with reddish-brown hair that hinted at his Scotch-Irish ancestry.

“My dad was raised on a small farm across the river. My grandfather continued to live there after my dad left home. When I was a boy we would visit my grandfather on the farm. It was tucked away back in the hills off a winding blacktop road. You turned off onto an unmarked dirt lane and followed it a quarter mile to the farmhouse.

“My grandfather was a big man. He and my dad didn’t always see eye to eye. When things went well, the two of them would sit on the porch and talk. Sometimes they took a leisurely stroll out to the orchard, leaving me behind to play in the yard. When they had words, my dad would quietly walk me to the car; and we would head back out the dusty lane to the road.

“One winter day we made the trek to the homestead. The fields lay buried beneath a thick white blanket of snow. It started to snow again shortly after we arrived, and by late afternoon it was coming down heavy. My dad decided we had better go before the roads got bad, so we headed out in the old Chevy down the lane. The plow had already gone by, throwing a big mound of snow at the entrance. We couldn’t get through, and we couldn’t turn around.

“My dad left me in the car with the motor running and the heat on and walked back down the lane to the house. After what seemed a long time, he appeared with my grandfather. Each of them carried an old coal shovel. In the yellow beams of the headlights I could see them working together to clear the pile of snow from the end of the lane.

“When they finished, my grandfather reached out his hand for the shovel my dad had been using. My father hesitated, then surrendered it. Together they disappeared into the darkness through the swirling snow.”

My teacher stood quietly by the lab bench, thermos in hand, staring out through the high vaulted windows. I shifted on the stool. “What happened?” I asked.

“It wasn’t long before my dad came back. He dusted himself off as best he could and slid in behind the wheel. He gave it the gun and we broke through onto the plowed road.”

After a brief moment of silence he said: “That was the last time I saw my grandfather alive. The darkness had swallowed him up; he disappeared into the falling snow forever.”

Although he was a chemistry teacher, we had been talking about writing, how to craft a story, an impression. He was very interested in writing and had managed to produce several stories and the beginning of a work of science fiction.

Somehow I managed to find the words: “Maybe one day you’ll write that down, just like you told it to me.”

Sitting on the stool by the kitchen window this evening as the snow swirls down in the light across the street, I wonder if he ever had.

“Locked-in syndrome” revisited

Three years ago I posted a series of reflections — The Eye of the Beholder, Paralysis, and Father Figures —  on The Diving Bell and The Butterfly, an autobiographical work by Jean-Dominique Bauby, a victim of locked-in syndrome.  At 43 years of age, Bauby suffered a stroke which left him completely and permanently paralyzed; the only motor function he retained was the ability to blink his left eye in response to questions posed by his therapist.  Bauby succumbed to his illness shortly after his book was published.

My poem “Locked-in Syndrome,” a tribute to Jean-Dominique Bauby, appeared in the April/May 2008 issue of the American Journal of Hospice and Palliative Medicine.

Today the British Medical Journal published a new study which validates the quality of life experienced by a significant number of patients with locked-in syndrome.

In this study a group of locked-in syndrome patients were asked to assess their global subjective well-being using a comparative scale to rate the best period in their lives before developing LIS with their worst period ever.  Forty-seven patients expressed overall happiness, while 18 expressed unhappiness.  A longer time in LIS correlated with happiness.

Investigators conclude that “recently affected LIS patients who wish to die should be assured that there is a high chance they will regain a happy meaningful life. End-of-life decisions, including euthanasia, should not be avoided, but a moratorium to allow a steady state to be reached should be proposed.”

The authors stress the need for additional therapeutic interventions directed at mobility, recreational activities and anxiolytic therapy in LIS patients.

It appears that even when our physical state is compromised, many of us are capable of enjoying a rich and extensive life of the mind.

Readers interested in accessing my poem “Locked-in Syndrome” may do so by clicking on the link below.

Locked-in Syndrome 151

The rebirth of an idea

Along with most everyone else on the planet I watched the recent popular demonstrations in Egypt and their aftermath—most notably the subsequent downfall of Mr. Mubarak, the dictator who ruled that country for 30 years. And I must admit a certain titillation from observing the revolutionary fervor that has been sweeping across the Middle East in their wake.

The most fascinating thing about these spontaneous uprisings is the relatively peaceful nature of those demonstrating against their oppressive regimes. Granted, there have been armed confrontations; and sadly, people have died; but for the most part the resistance has remained firmly passive.

How pleased I was to learn that some of the basis for this resistance stemmed from the writings of a rather obscure, shy American now in his eighth decade. Prior to reading the New York Times article about Gene Sharp, I had never encountered the man’s name before.

As much as I am for insisting that credit be given where credit is due, I was somewhat bemused that the Times made no mention of former advocates of civil disobedience: Henry David Thoreau, Mahatma Gandhi and Martin Luther King among them.

It was Thoreau who penned an obscure essay in 1848 arguing for public refusal to support an amoral or unethical government—in his day a government that condoned the buying and selling of human beings as chattel. Thoreau registered his protest by refusing to pay his poll tax and was subsequently thrown in jail by the local constable, Sam Staples. He was released the following day when an unknown admirer paid the tax on his behalf. Indirectly, Thoreau’s essay helped to spur on the abolitionist movement, the Civil War and ultimately Lincoln’s Emancipation Proclamation.

Gandhi adopted Thoreau’s idea of passive resistance and used it to bring about effective political change in South Africa and India. “Civil Disobedience” was used as a manual for the Danish resistance against the Nazi invasion during World War II. Martin Luther King built upon the same set of ideas as he led the American Civil Rights movement in the 1960s.

Despite initial fears that the demonstrations in Cairo would lead to the establishment of an Islamic fundamentalist state, it has become apparent that the uprising was spawned by a secular civil base.

The Egyptian people have chosen to embrace their own political destiny, even though the ideas that inspired them have their roots in the writings of an American thinker.

Today the river called me, Come

Today the river called me, Come,
My counterpane’s spread white:
A frozen mold
Formed by the cold
Of winter’s icy blight.

Today the river called me, Come,
Let chores and toil rest;
Browse through my book,
Come close to look
At nature’s wintry vest.

But ice was on the doorstep
And further down the drive;
I laced my boot—
Lips pursed and mute—
Determined to survive.

I spent the morning, afternoon,
And part of eventide
Chipping ice and clearing snow
Opening the paths that flow
Around on either side.

Today the river called me, Come,
Don’t waste this precious day!
The winter snow
Won’t last, although
For now it’s on display.

Today the river called me, Come—
I hovered close to home;
I made my choice,
Ignored her voice,
And turned my heart to stone.

2011©Brian T. Maurer

Humane Medicine — Goethe’s Erlkoenig: A poetic drama at the close of day

It was late winter, the height of RSV season that year. I stepped in to see my last patient of the afternoon, a 6-week-old baby girl brought in by her father for cough and congestion. “She’s not breathing right,” the father said, dispensing with formalities.

I clocked her respiratory rate at 66. The child lay on the exam table in obvious distress, chest and abdomen seesawing back and forth, retractions defining each rib with every short, rapid breath.  more»

Interested readers can now access my latest Humane Medicine column — Goethe’s Erlkoenig: A poetic drama at the close of day — recently published in the Journal of the American Academy of Physician Assistants.

An amazing find

“Look what I found at the Salvation Army store!” my wife beams, holding up a crinkled document in her hand.

The yellowed paper had caught her eye when she dropped off our yearly donation of old clothing that afternoon. She purchased it for two dollars.

I take the heavy paper document in my hand and run my fingers along the edge. It measures six by eight inches. The printing is script, all Latin, except for the calligraphied name and signature at the bottom. I read the title. It appears to be a diploma dated June 6, 1965, conferring an undergraduate degree from Smith College on Francesca Morosani Thompson.

“I researched the name,” my wife continues, showing me the page on her MacBook. “Here—you can read it for yourself.”

A black and white photograph is posted above a few short paragraphs of text. Underneath the picture appear the woman’s name and dates of birth and death—the obituary of Francesca Morosani Thompson, M.D.

My eyes dart rapidly across the lines of virtual type. Francesca M. Thompson was born in Litchfield, Connecticut, in 1945. She attended Smith College where she earned an undergraduate degree in social work, then went on to pursue her M.D. at Cornell University Medical School. Dr. Thompson subsequently completed a residency in orthopedic surgery at the Hospital for Special Surgery in New York, where she served as that institution’s first female orthopedic resident.

After completing a fellowship in foot and ankle surgery, Dr. Thompson became the chief of the Adult Orthopaedic Foot Clinic at St. Luke’s-Roosevelt Medical Center in New York; a co-director of the Combined Foot and Ankle Fellowship at the Hospital for Special Surgery, and a clinical assistant professor of orthopedics at Columbia University’s College of Physicians and Surgeons.

Midway through her promising career she developed multiple myeloma—cancer of the bone marrow—in 1986.

Dr. Thompson received the first autologous bone marrow transplant for treatment of multiple myeloma, at that time an experimental procedure where the patient’s marrow is extracted, irradiated and returned to the body. The treatment bought her another decade of life.

As a physician Dr. Thompson documented the journey of her illness in a book, Going for the Cure.

Shortly before what would be her final hospitalization, Dr. Thompson scrubbed in as attending surgeon with her fellow and resident. She completed the 5-hour surgical procedure on the patient while sitting in a wheel chair.

Dr. Thompson’s life stands as a role model for women in orthopaedic surgery. She was kind yet firm, direct without being confrontational, and intelligent yet not condescending.

I finish the last line of the obit and turn my attention to the wrinkled document in my hand—a small piece of history that speaks to the soul of a courageous individual, one who strove to continue to practice humane medicine to the end.

Francesca M Thompson

“Notes from a Healer” — Hitting the Skids

Temperatures had plummeted into the single digits overnight; the morning sky dawned crystal blue. The roads were dry now, clear after the spate of recent winter storms. I headed north to the office through back country, cruising past the expanse of frozen white fields stretched out beneath the icy blue sky. Shifting into overdrive, I eased the clutch out and gently accelerated along the straight stretch of road. Just as I shot over a slight rise it burst into view: an extensive patch of hard-packed snow jutting across the road.  more»

My latest installment of Notes from a HealerHitting the Skids — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.