An evening paddle

We pulled the boat off the back of the truck and walked it down across the sand to the water.  My friend held it steady as I planted one foot over the keel and transferred my weight from the sandy shore to the center of the boat.  I felt the boat shift as he climbed in behind me.  He used his double-bladed paddle to push us off.  Shortly, we were stroking in tandem through the clear cool water toward the entrance to Pickerel Cove.

We skirted the beaver dam, using our paddles to force the kayak over the sticks and mud into the still water of the cove, now covered with a veneer of duck weed, New England’s most ubiquitous aquatic plant.

Slowly we paddled through the warm heavy air into the late afternoon sun.  “There must be some sort of subtle undercurrent in the cove,” my friend said.  “The surface debris shifts throughout the day.  When I was here early this morning, this whole section of water was clear.”

I noticed something perched on a wood duck box in the water ahead.  “Belted kingfisher,” I said, lowering the binoculars from my eyes.  At that moment a great blue heron lifted up from the far bank.  I raised the glasses to catch a close up of the long grey wings before it sailed around the oxbow and vanished behind the break of trees.

“There’re usually a couple of them in the cove every time I come,” my friend explained.

We glided through the thin green blanket, skirting the bare branches of a fallen tree.  Dragonflies darted about across the surface.  Presently, a young duck appeared near the boat.  Irregular blotches of dull metallic green on the head identified the immature male mallard.  He approached the boat with a curious caution as we rested our paddles across the gunwales to study him.

At the end of the dogleg we turned and retraced our course.  My friend pointed out the partially submerged log where he had seen four river otters at play several days ago.  “The otters come and go, but the beavers stay here year round,” he said.

We pushed back out into the river and drifted momentarily in the large eddy at the mouth of the cove before heading upstream.  Despite the meandering current, the water was so still that you could see the images of the stately trees and scrub vegetation on the bank mirrored in it.

We caught sight of a muskrat swimming along the far bank, its nose cutting a small V through the water.  The witchety-witchety-witchety notes of a yellow-throat sounded as we passed a grassy meadow on the near shore.

Three wood ducks took flight as we approached the entrance to the small bayou that paralleled the road.  Another great blue heron perched on the bleached branch of a fallen tree, preening his breast with his pale yellow chisel bill.  Three wisps of black hair-like feathers hung from the back of his crown.

As I watched him through my binoculars, I heard a muffled shout behind me.  My friend pointed at the narrow patch of sky in the break ahead.  I barely glimpsed the white tail of a big bird as it disappeared around the bend.  “Eagle,” my friend whispered.

But it was not the eagle that dropped down from another high branch as we rounded the bend ahead; an osprey rather, beating its massive wings to gain purchase through the still evening air.

We paused at the entrance of a secluded pool to observe another heron wading at the far end, its long neck extended above the dappled surface, waiting to strike an unknown prey.

A female wood duck glided beneath the overhanging vegetation at the far end of the bayou, its large eyes accentuated with white-ringed spectacles.

We paddled back past the pool where the heron still hunted.  A pileated woodpecker creased the sky overhead.

As we drifted back downstream, a young doe raised her head from the bank and watched us silently slip by.

Trimming the fat of the land

In their recent JAMA commentary on the problem of malignant childhood obesity (State Intervention in Life-Threatening Childhood Obesity, JAMA, July 13, 2011: Vol. 306, No. 2, p. 206-7), Murtagh and Ludwig advocate the referral of morbidly obese children to state protective service agencies in cases where their families fail to implement and follow plans for effective weight reduction. In short, in the opinion of these authors, morbid childhood obesity should be considered a form of parental neglect.

Having dealt with a good number of child abuse cases over the span of my professional career, I have learned that if proving abuse is difficult, substantiating neglect is even more so.  The burden of proof lies with the clinician.  I for one would not look forward to appearing in the dock charged with supporting the recommendation that a morbidly obese child be removed from the home because the parents were unable to control his weight.  more»

Only to kill

The gun was designed for one reason, and only one:  to kill.

There are those who would suggest a different viewpoint, that the gun is necessary for self-defense.  This might be true, although I would argue that in this instance it’s primary purpose would be the same:  to kill a would-be assailant first.

There are those who enjoy practicing with a firearm.  They take satisfaction in pumping as many projectiles as possible into the central core of a target.  In doing so, they hone their skills with the weapon, making it more likely that, if and when the time comes, the bullet fired will find its mark — and kill.

There are those who use guns to hunt wild animals.  For the most part, these sportsmen have a deep-seated love and respect for the out-of-doors.  Many of our most ardent environmentalists started out as hunters.  They were introduced to the wild through the use of the gun — in this case, a shotgun or hunting rifle.  The object of the hunt, of course, is to pursue the quarry — and kill it.

Sometimes the hunter’s prey is used for food; other times parts of it will be preserved as a trophy to demonstrate the hunter’s prowess or courage.  In any case, the once living animal is transformed into a carcass, its life-blood drained, soaking into the soil.

We kill for various reasons:  for food, for sport, for necessity, for preservation.  Is not the law of the wild to kill or be killed?  For these purposes, what better technological tool to take up than the gun?

Lastly, it would appear that some of our species would kill for ideological purposes.  These seemingly random acts of violence perpetrated against members of our own species are committed to make a statement, to draw attention to the fact that an injustice has been done.  And so the perpetrator engages in a destructive act of injustice to retaliate against injustice.  One injustice, the reasoning goes, deserves another.  The problem is that once set in motion, the resultant destructive spiral is difficult to break.

In his short piece Barcelona and Madrid (1936), Antoine De Saint-Exupéry sums it up beautifully.  He writes:

“Human drama does not show itself on the surface of life.  It is not played out in the visible world, but in the hearts of men….One man in misery can disrupt the peace of a city….Let a man in a garret but burn with enough intensity and he will set fire to the world.”

Today’s New York Times features the story of Anders Behring Breivik, the 32-year-old gun-loving Norwegian obsessed with what he viewed as threats of multiculturalism and Muslim immigration.  Breivik planted a bomb in Oslo and subsequently went on a shooting spree at nearby Utoya Island, leaving nearly 100 people dead:

“[Breivik] has said that he believed the actions were atrocious, but that in his head they were necessary,” his lawyer said.

“The time for dialogue is over,” Breivik had written. “We gave peace a chance. The time for armed resistance has come.”

His lone Twitter post — “One person with a belief is equal to the force of 100,000 who have only interests” — suggested what he saw as his ability to act.

Of the Spanish Civil War Saint-Exupéry writes: “The purpose of this struggle was not to rid the country of an invading foreigner but to eradicate a plague.  A new faith is like a plague.  It attacks from within.  It propagates in the invisible.”

“[Breivik] wanted a change in society and, from his perspective, he needed to force through a revolution. He wished to attack society and the structure of society.”

“Here, in Spain,” Saint-Exupéry observes, “a man is simply stood up against a wall and he gives up his entrails to the stones of the courtyard.  You have been captured.  You are shot.  Reason: your ideas were not our ideas.”

[Breivik] was equipped, the police said, with an automatic rifle and a handgun….He gathered the campers together and for some 90 hellish minutes he coolly and methodically shot them, hunting down those who fled. At least 85 people, some as young as 16, were killed.

Today, on the island of Utoya, Saint-Exupéry’s words became prophetic:  “There is no place here for mothers who bring children into the world in ignorance of the faith that will some day flare up in their sons, in ignorance of the ideologist who, according to his lights, will prop up their sons against a wall when they have come to their twenty years of life.”

“We can’t disavow this person,” a Norwegian citizen commented on Breivik, “he’s one of us.”

Or in Saint-Exupéry’s words:  “Solitary he may be; universal he surely is.”

Fundamental Questions

Since the beginning of recorded history philosophers have postulated our origins and reasons for our existence.  More recently, they have highlighted concerns for the survival of our species as well.  Their inquiries can be distilled down to three fundamental questions: Where have we come from, what is the nature of our essence, and what is our destiny?

Modern scientists have attempted to answer these questions through empirical research.  Although the Darwinian theory of natural selection is now universally accepted within the scientific community, in itself it can not address the ultimate origin of our species any more than it is capable of predicting our future evolution.  As to the nature of our essence — what it means to be human — the most Darwinian theory can offer is that we exist in order to reproduce, thereby insuring the survival of our genes.

As Darwinian thought was being formulated in the 19th century, two philosophers — one a transcendental naturalist, the other an avant-garde artist — continued to explore these same questions.  Curiously, though their lives overlapped by a span of some fourteen years, and chances are that neither knew of the other’s work; both formulated similar, if not identical, fundamental queries.

In 1846 Henry David Thoreau encountered what he would allude to as the wildness of nature on his first excursion to Maine’s Mount Katahdin.  In what scholars refer to as the “Contact!” passage in his essay Ktaadn, Thoreau attempts to elucidate the mystical experience he had while standing “deep within the hostile ranks of clouds” on the summit:

I stand in awe of my body, this matter to which I am bound has become so strange to me. I fear not spirits, ghosts, of which I am one,—that my body might,—but I fear bodies, I tremble to meet them. What is this Titan that has possession of me? Talk of mysteries!—Think of our life in nature,—daily to be shown matter, to come in contact with it,—rocks, trees, wind on our cheeks! the solid earth! the actual world! the common sense! Contact! Contact! Who are we? where are we?

Who are we? Where are we? Thoreau ponders, echoing the cry of the natural philosopher.  What are our origins, our nature, our destiny?

Unable to articulate a precise response, Thoreau resorts to poetic prose in an attempt to explain his experience.  Astute readers recognize that Thoreau has passed through some sort of transcendental boundary, although it remains mostly undefined.  As Thoreau scholar Bradley Dean has written:

“The carefully crafted prose of the ‘Contact!’ passage reflects not emotional turmoil but the finer frenzy of Thoreau the transcendentalist prophet straining the capabilities of language to describe the ‘original relation to the universe’ he experienced atop the mountain.”

Dean continues: “A seemingly paradoxical sentence in Walden precisely explains his experience on the mountain: ‘Not till we are lost, in other words, not till we have lost the world, do we begin to find ourselves, and realize where we are and the infinite extent of our relations’ (my emphases). The mountain taught him what he clearly believed all of nature teaches if properly perceived: that each of us is a spirit in a world of matter that we have contact with through the agency of a body. This trinity of spirit, matter, and body — and ‘the infinite extent’ of the relations between them — comprises for Thoreau the Great Mystery.”

In contrast to Thoreau’s excursions from Massachusetts to Maine, the French artist Paul Gauguin traveled half way round the world to paint the colors of Tahiti. In what is perhaps his most celebrated work — certainly the one he regarded as his best — Gauguin inscribed these words in the upper left-hand corner of the canvas: “D’où venons-nous?  Que sommes-nous?  Où allons-nous?” (Where do we come from? What are we? Where are we going?) — questions similar to those posed by Thoreau on his Katahdin ascent.

Gauguin was introduced to a variation of these queries during the his formative years at the Petit Séminaire de La Chapelle-Saint-Mesmin by his teacher, Bishop of Orléans, Félix-Antoine-Philibert Dupanloup.  Dupanloup’s three fundamental questions were: “Where does humanity come from?” “Where is it going to?”  “How does humanity proceed?”  Evidently, Gauguin revisited these queries throughout his life, electing to record them at last in his masterpiece D’où Venons Nous / Que Sommes Nous / Où Allons Nous.

In his description of the painting, Gauguin indicated that he intended it to be viewed from right to left.  The three major figure groups illustrate the questions posed in the title.  According Gauguin, the white bird at the feet of the old woman at the left of the canvas “represents the futility of words,” inferring that written or spoken language is apt to fail us when we attempt to explain those mystical moments we encounter in our lives.

After his experience on Mt.Katahdin, Thoreau determined to dedicate his life to “detect some trace of the Ineffable” in his daily saunterings; Gauguin elected to capture such “traces” in color on canvas.  Both attempted to realize the same end through the use of different media.

What is required to achieve these ends, of course, is attentiveness to the moment in the natural world.  Gauguin found the wild in Tahiti; Thoreau encountered it atop Mt.Katahdin.

The ability to see

“Here is my secret. It’s very simple. One only sees rightly with the heart. The essential is invisible to the eye.” Antoine St. Exupéry in The Little Prince

In keeping with the theme of this year’s annual gathering of the Thoreau Society — Thoreau’s Environmental Ethos — Aldersgate United Methodist minister Greg Martin proposed a new ecologic paradigm for the 21st century. Using Thoreau’s poetic description of Walden Pond as the eye of the earth for a touchstone, Martin developed the idea that we need to cultivate an essential ecological lens through which we can begin to view the planet as a living, breathing organism, one to be cared for rather than exploited.

As the late Bradley Dean, editor of Thoreau’s posthumously published Wild Fruits, has suggested: “If we can realize that we are mysteriously related to matter, we will act to preserve the world because human beings protect what we love or feel related to.”

“[Walden] is earth’s eye,” Thoreau writes, “looking into which the beholder measures the depth of his own nature.”

In “The Ponds” chapter of Walden Thoreau builds upon this poetic vision of Walden. “The fluviatile trees next the shore are the slender eyelashes which fringe it, and the wooded hills and cliffs around are its overhanging brows.”

Thoreau describes the Walden water as “a vitreous greenish blue…like those patches of the winter sky seen through cloud vistas in the west before sundown.” “Walden is blue at one time and green at another, even from the same point of view…Such is the color of its iris.” (my italics)

In the midst of such poetic prose Thoreau interjects scientific observations. In one paragraph he records the temperature of the pond on a given day (the sixth of March, 1846) as 42 degrees, “one degree colder than the water of the one of the coldness wells in the village just drawn.” He comments on the rise and fall of the water level, noting that it corresponds to that of nearby Flint’s and White Pond. He describes the sandy terrain of the bottom near the shore, and publishes his soundings of its depths.

Thus Thoreau the writer couples his poetic vision with that of a scientist. Each perspective nourishes the other. At times it is difficult to separate the two.

At the end of Martin’s presentation a man in the middle of the audience remarked that he had always been of the same mind. “I am a physicist,” he said. “When I do science, I rely heavily upon my poetic insight. Those of us engaged in scientific research treasure the sense of mystery; it pricks our curiosity and generates a sense of awe for the unknown. Any scientist worth his salt will tell you the same. You can’t do one without the other.”

As I turned in my seat to better hear his remarks, I noticed his head cocked to one side with his chin slightly elevated. Even though we sat in the cool basement of the Masonic Lodge, he wore dark glasses.

As the workshop disbanded and disbursed I noticed this man shuffling along hesitantly behind the woman he had been sitting next to. His extended hand clung to her sleeve.

It was only then that I realized that this scientist who was capable of seeing what Thoreau saw was blind.

Sometimes the ability to see is not dependent solely upon our eyes.

Revisiting Walden

The day dawned to overcast skies. I grabbed my raingear from the knapsack and headed out to the rendezvous site. Only a handful of people showed up. The leader arrived as the first raindrops started to fall. Shortly, a bolt of lightning followed by a brisk thunderclap canceled our early morning excursion to the great blue heron rookery. “Too risky,” the leader said. “Maybe we’ll try to work it in to the nature walk tomorrow morning.”

I headed back to the hotel, then decided to drive out to have a look at the pond instead. It was early, it was raining; I was certain that no one else would be there.

Cars lined the side of the road along Route 126. There was not a space to be had in the small lot at the Shop. I pulled into the unmarked driveway and parked by the house at the end. Barbara was in her kitchen, busy with breakfast preparations for her house guests. She greeted me at the door.

“Well, look who’s here. Come in, come in! Sit down; how about a cup of coffee? You’re just in time for breakfast.”

“I’ll take the coffee but I have to take a rain check on breakfast,” I said. “I just ate.”

“Ah, you should’ve let me know you were coming.”

I explained about the rain and the canceled birding excursion. “They’re calling for severe thundershowers,” she told me. “Too bad the weather isn’t cooperating.”

I looked out the window. “If it doesn’t downpour, I thought I might try a walk around the pond. Could I leave my car here for an hour?”

“Certainly. You need a refill on the coffee before you go?”

“No, thanks; I’m fine.” I handed her the empty cup.

“Be sure to stop by again before the end of the weekend.”

I stepped out into the drizzle and pulled the hood of my raincoat over my head. I was glad I had thought to put on the rain pants. I might roast inside the plastic, but I wouldn’t get soaked from the rain.

A lone swimmer toweled off near the stone wall as I descended the long concrete stairway. The water table was high this year; only a short stretch of sandy beach remained below the bathhouse.

I struck out along the north shore, heading west along the ancient path now bounded by wire fencing on either side. Periodically, I passed a break that allowed direct descent to the water on large natural stone steps. Mist was rising from the surface of the water, stirred by a slight morning breeze.

The sandbar at the entrance to Thoreau’s cove lay submerged in the grey-green water. As I paused on the newly constructed wooden bridge to survey Wyman meadow, now flooded, its surface scattered with islands of lily pads, a train sounded in the distance. I turned to glimpse it rolling by through a break in the trees at the southwest corner of the pond.

A short stretch brought me to the house site, where I stepped through the two granite pillars to read the inscription on the stone that marked the location of Thoreau’s chimney.

From there I walked back to the water’s edge and sauntered south along the cove. Out in the water a few yards from shore a lone kingbird perched on the top branches of an alder, preening its breast.

Further along the trail near ice cove I found a stand of four granite markers of varying heights buried in the forest floor. A bit beyond them I passed a grey-haired man standing knee-deep in the water tending his fishing lines. By his single word of greeting — Maanin’ — I judged him to be a New England native.

I climbed the bank and paused by the railway, looking first south and then north to Concord. I marveled at the clean glistening steel rails winding off into the distance. Here I stood in a moment of time, a mere passerby reflecting on the distance I had traveled and the trek that lay ahead.

I turned west and ambled along the trail, pausing by a dark pool adjacent to little cove. Tiny rings dappled its surface above a submerged log — ephemeral footprints of water striders. Just ahead I stopped to examine a stand of spotted wintergreen on the moss-carpeted forest floor, each plant bearing a tiny stalk of white nodding bell-like flowers.

Two pairs of mallard ducks paddled about in long cove. Each in turn dipped its bill down into the clear Walden water. I thought of Thoreau and the dipper which two visitors had borrowed to get a drink from the pond and never returned.

My eye caught site of several low bushes along the trail near the southwest section of trail. I stooped low to search along the leafy stems and found one solitary round green berry, happy to have satisfied my curiosity that the low-bush blueberry still resides in Concord.

“Notes from a Healer” — Heartbreak

This mother is obviously concerned. I can read the worry in her furrowed brow and unflinching frown. Her 10-year-old daughter, on the other hand, looks anything but upset as she sits quietly on the exam table. She even smiles at me when I greet her as I enter the exam room. more»

My latest installment of Notes from a HealerHeartbreak — 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.

Dark night of the soul

In a real dark night of the soul it is always three o’clock in the morning.  —F. Scott Fitzgerald in “The Crack-Up”

The muffled sounds in the distance started shortly after twilight. Louder retorts came every once in a while, interspersed with runs of pop-pop-pop, reminiscent of machine gun fire. From where we sat you couldn’t see any flashes in the night sky, but you could hear the sounds in the distance.

My wife appeared in the kitchen holding the dog in her arms. “She’s shaking, poor thing,” she said. “She doesn’t know what to do, where to go.” She carried the little white terrier into the TV room and sat with her on the couch. The dog jumped down and paced aimlessly about the room.

I finished my snack and wandered in to where my wife sat. The dog was lying down at her feet, panting furiously. Every so often you could see her shudder. Outside the popping sounds continued in the distance.

“It’s those fireworks,” my wife said. “She can’t handle the noise. Maybe it hurts her ears.”

“They’re probably triggering unpleasant memories,” I said. “No telling what abuse a rescue dog might have suffered.”

“Poor thing,” my wife said.

When I turned to go, the dog followed me up the stairs to the bedroom. I pulled off my shoes and socks and lay down, resting my head against a short stack of pillows. The dog ambled to the far side and leaped up on the bed.

“Jackie,” I said, holding out my hand. She approached in a pant, turned and lay down next to my thigh. I scratched her ears and patted her back. Immediately she rose, circled the center of the mattress and lay down again, this time facing me.

I stroked her chin. “Puppy,” I said in a soft voice, “what did they do to you? Poor puppy.”

Once again she got up and wandered aimlessly about the bed, panting. She couldn’t, it seemed, get comfortable. Outside the muffled sounds continued. For nearly twenty minutes she repeated this ritual, unable to rest, despite my attempts to reassure her by voice or touch.

When I got up, she hopped down from the bed and followed me to the stairs. Normally she would have led, but this night she hesitated at each step, looking up, waiting for my next move. We retraced our path to the TV room.

“Still shaking?” my wife said, eyeing the dog. “Come, Jackie. Up, up!”

The dog stood by the coffee table with her head and tail down.

“I guess it’s a no-go,” I said. I walked back upstairs and the dog followed at my heels.

I lay down on the bed and reached a book from the nightstand. The dog hopped up and began to circle again. Finally, she dropped down and rolled over on her side, continuing to pant on the counterpane. I reached up and turned out the light. I could feel the dog shudder in the darkness when the sounds started up again.

When I woke the next morning, the dog was gone. I got up, pulled on my trousers and made my way to the bathroom. When I opened the bathroom door, there she was, lying down on the throw rug.

She followed me downstairs to the kitchen. I made a cup of coffee, got a plastic bag from the stash behind the basement door, and snapped the leash on her collar. “Let’s go for a walk,” I said. Her ears perked up. Seconds later, she was pulling me down the driveway.

We made it halfway around the loop before the door of a minivan slammed shut with a thud. Immediately the dog froze, turned and headed back up the hill at an accelerated pace.

She didn’t stop until we entered the driveway of our home.

For those traversing the dark night of the soul, time of day makes no difference.

The food we eat

One advantage of having grownup children is that you can reap the benefits of their curiosity. Even though they carry 50% of your DNA, they don’t necessarily subscribe to the same political party or publications that you do. They also don’t necessarily read the same books; but then, when they find a keeper, they’re more than willing to pass it along.  more»

Readers can now access my latest musing — The food we eat — at the Journal of the American Academy of Physician Assistants Editorial Board blog.

JAAPA is the official publication of the American Academy of Physician Assistants.