Author to deliver 2011 Memorial Day keynote

Author Brian T. Maurer will deliver the keynote address at this year’s Memorial Day exercises on Monday, May 30th, in the cemetery of Saint Bernard’s parish, Simsbury, Connecticut, at 9:00 AM.

Several years ago a woman at work placed a notebook in my hands — the diary of her brother in which he had recorded his daily thoughts while on duty in the early days of the conflict in Iraq.  It was a sobering read.  Like many Americans of that era, he served his country well.  When it comes to war, we are all writers, recorders of deep sentiments in our everyday lives.

Addendum:  A 12-minute video presentation of the 2011 Memorial Day keynote address may be accessed here.

Literary medical weblogs

Dear J.B.,

Your comment on my blog posting The stories we tell came in just as I was re-reading the first chapter of James Joyce’s Ulysses on the front porch.  Previously, I hadn’t run across the Joyce line you quoted about all novelists having only one story, which they tell again and again; but it certainly rings true.  Hemingway said that in crafting a piece of writing he could “cut the scrollwork or ornament out and throw it away and start with the first true simple declarative sentence” he had written. In my book, anyone who takes writing seriously has to start with a desire for truth and the stamina to pursue it, no matter where it might lead.

You also mentioned Dr. Robert Coles.  I too was fortunate to hear Dr. Coles speak two decades ago at a conference on medicine and the humanities.  I recently read Handing One Another Along, a collection of lectures from an undergraduate course which Coles taught at Harvard on literature and social reflection. (The title of the book comes from a line in Walker Percy’s The Moviegoer, one of Coles’ favorites.) Dr. Coles, of course, is an excellent resource for many good works on medicine and literature as well.

Decades ago I got interested in the idea of using story as a vehicle to explore the doctor-patient relationship.  Throughout my medical training (I am a practicing physician assistant) I was appalled at the insensitivity which many clinicians demonstrated in dealing with patients in their time of suffering.  I struggled to understand the source of this coarseness in bedside manner.  Had these clinicians always acted this way, or through years of training had their medical education squelched whatever empathy they might have once had?  Was this perhaps a defense mechanism they had developed over time to shield themselves from the suffering that they witnessed daily in practice?  If so, what could be done about it?  (It certainly wasn’t helping the patient to heal.)  Could empathy be taught, or was it an innate trait possessed by only a minority of individuals who opted for a career in medicine?

As I began to craft narratives of patient encounters, I discovered that the act of writing itself enhanced the way I related to patients.  Somehow writing the story down served to hone an empathetic response.  It also served to help me deal with my own emotions, guilt and grief which I experienced in encounters with patients.  As my perspective developed, I was fortunate to find several like-minded souls in the social ether along the way.  Over the years I worked with other colleagues to create several online sites which continue to function as forums for clinicians and patients alike, Cell2Soul and Dermanities among them.  After reviewing my book Patients Are a Virtue, Dr. Howard Spiro asked me to consider submitting a monthly piece—“Notes from a Healer”— for the Yale Journal for Humanities in Medicine; and I was also invited to write a bimonthly Humane Medicine column for the Journal of the American Academy of Physician Assistants.  I established this weblog to serve as a repository for my writings.

My hope has always been that with ongoing exposure to these sorts of narratives, more and more medical colleagues might come round to recognizing just how intimate and profound the doctor-patient relationship truly is, and come to an understanding that there is much more to the art of healing than just closing a surgical incision, dressing a wound or writing a prescription.  Medical practice is after all the stuff of life; and because literature historically has been an attempt to capture the essence of what it means to be alive, it is small wonder that the two complement each other so beautifully.  As you so aptly put it, medicine and storytelling go hand in hand.

None of us can be all things to all men; but we can certainly make some fumbling attempts to alleviate suffering in the world and bear one another’s burdens as best we can.  As Rilke so aptly put it, perhaps if we learn to love the questions themselves, we can one day live on into the answers.

Blue Collar, Blue Scrubs

It’s a fine spring day, the last of April. I’ve been sitting outside in the back yard all afternoon, plowing through Michael Collins’ memoir Blue Collar, Blue Scrubs: The Making of a Surgeon.

The first-born in an Irish-Catholic family of eight boys, Collins pursued an undergraduate degree in liberal arts from Notre Dame University before taking a job with a construction company breaking concrete for a living. Although he enjoyed the hard work, the long hours, the camaraderie (as well as the beer consumed on the job and in the pubs afterward), Collins reached a point where he needed to make a decision about what he wanted to do with the rest of his life. The answer he hit upon was to become a doctor.

It was an uphill battle. Collins had to spend two years completing pre-requisite courses in chemistry, physics and biology and sit for the MCAT just to be able to apply to medical school. Although he aced his science courses, his MCAT scores were average. Rejected by 7 of the 8 medical schools to which he applied, when Collins pleaded with the Dean of Students at Loyola in Chicago to be given a chance, he got in.

Blue Collar, Blue Scrubs describes his journey through medical school up to the beginnings of his orthopedic surgical residency at the Mayo Clinic. Collins spins the tale with wit, humor and pathos.

Throughout his training, while immersed in the seemingly overwhelming tedious task of rote memorization, Collins lapses into philosophical thought. “What, then, makes us human? A beating heart? A cogitating brain? Or is there something more, something, for want of a better word, we call a soul?”

At the conclusion of the first autopsy he witnesses, a pathologist tells him: “You have now peered into the deepest recesses of the human body and discovered the secrets of life.” As he files out of the room with his fellow students, Collins muses that “we haven’t even come close.”

Throughout his rigorous training Collins somehow manages to hold on to his humanity. He never loses sight of why he wanted to become a doctor in the first place: to render assistance to his fellow human beings, to alleviate their suffering.

It is good for seasoned clinicians to be reminded of such altruistic motives. Whenever I lose a patient to a terminal illness, I gravitate to the family. I sit with significant others, share the information I have at hand and prepare myself to listen to what they have to tell me. To do otherwise would be a disservice both to them and to myself; for in these instances, I’ve discovered that I need such interactions to help myself heal.

Patients are not the only ones who suffer.

“Notes from a Healer” — The Widow’s Mite

She was the last patient on my Saturday morning schedule. I groaned silently to myself when I saw the name. This teenage girl had a myriad of major medical problems. As a youngster she had been diagnosed with pseudotumor cerebri. With the onset of her menses she developed severe migraine headaches. Nothing seemed to blunt the pain; and subsequently, she got hooked on oxycontin. In the midst of all this she spiraled into a clinical depression and was hospitalized for several weeks.  more»

My latest installment of Notes from a HealerThe Widow’s Mite — 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.

Cloud Illusions

We waited on the tarmac in the mid-morning rain. Droplets beaded up and slid down the thick window panes. Outside, men in slickers stowed the last of the baggage into the belly of the plane. As they drove away I watched the air brakes and aileron panels move along the surface of the wing.

Soon we were racing down the runway, picking up speed as the jet engines screamed in our ears. Raindrops morphed into tiny rivulets, streaking back horizontally across the glass. We lifted off and climbed into a thick bolt of white cotton.

It took a while, but finally we broke through the ceiling, jettisoned into the overarching dome of blue sky. Clouds stretched out below us, forming a bed of white furrows, like a freshly plowed and limed field in spring.

Further on, the blanket began to break up into smaller puffy clouds. Below us through the holes you could see the patchwork of brown and green fields cut by twisted muddy river ribbons. Some of the green fields were speckled with yellow—soybeans beginning to flower.

As we neared our destination, we passed over a huge mirrored expanse of lake, then banked and circled again before touching the tarmac at Dallas-Fort Worth. Pink and white clover tops shivered along the edge of the runway in the wind.

Three days later we embarked for home, climbing through the haze above a bed of white cobblestones. The cloud cover resembled arctic tundra, crisscrossed here and there with bluish-grey snowmobile tracks. Crystallized cirrus clouds cut the eastern sunlight into a thousand points of rainbow colors. As the plane banked you could see several large billowy mushroom structures erupting from the tundra base, mounds of white cotton candy. Their shadows hinted that we were flying east, directly into the sun.

We found Springfield-Hartford much as we had left it: overcast, with patches of earth visible during descent.

At 36,000 feet the sky is always blue. The clouds below morph into myriad forms, each one sculpted from misty vapors capable of vanishing as quickly as they condense.

Those visible forms we see are mere illusions, scattered points of light that bounce off microscopic water droplets—of little substance perhaps; but they serve to lift the human mind to greater, loftier levels.

When I think of those hours spent traversing the country, it’s cloud illusions I recall.