Wanton Proud Irene

A night of pounding rain has run
The gamut of the course,
While overhead the sky has spun
A spiral orb of force.

We wakened to an early breeze
Disturbing bough and branch,
And jostling petticoats of leaves—
The prelude for the dance.

The maples scraped the window sill
And scratched against the pane;
Inside the house the dog lay still,
Ears cocked up to the strain.

Then suddenly she raised her head
And turned a feverish eye;
As severed limbs fell, newly dead,
Their thuds drowned out her sigh.

The fury of the storm unleashed
Destruction from her core;
Wildly, the winds released
The surges from her store.

The peace of tranquil yesterday
Today seems but a dream—
Routed by the flashing fray
Of wanton proud Irene.

2011©Brian T. Maurer

Goodnight, Irene

He knew how to plot storms and the precautions that should be taken against them. He knew too what it was to live through a hurricane with the other people of the island and the bond that the hurricane made between all people who had been through it. He also knew that hurricanes could be so bad that nothing could live through them. He always thought, though, that if there was ever one that bad he would like to be there for it and go with the house if she went.       —Hemingway, Islands in the Stream

Last night to celebrate my birthday my son took me out to a sushi bar for dinner. I flopped into bed early and slept soundly until just before first light.

From the back bedroom window the sky looked uniformly grey and opaque. I read the latest news on the impending hurricane at the Times website and studied the weather maps to see how it was tracking. It would hit the outer banks of North Carolina by mid morning.

I made myself a cup of coffee and stepped outside and looked up at the sky. The air was close and still — not a single leaf trembled.

After breakfast I set myself to clearing things off the front porch: wind chimes, candelabras, hanging flower pots, throw rugs, pillows and cushions. I dropped the porch swing down to the deck and stowed the rocking chairs upside down against it. I made several trips carting the smaller paraphernalia to the garage. Finally, I pulled down the flag and rolled it up and wedged it in between a piece of porch furniture and a throw rug.

By the time I finished up it had started to rain. I lowered the windows in the back and on the north side of the house and looked for the Coleman stove in the basement in case we lost power.

Canned goods were on sale for a dollar a piece. I bought ten cans of soup and two cans of baked beans. No sense stocking up on perishables if the power goes out, I thought.

My folks sent my birthday present up with my daughter from Pennsylvania: a hurricane lantern with a LED light. I unpacked it and leafed through the instructions: two D cells required — batteries not included.

My wife left in the car with the dog in search of batteries. I ran the dishwasher and ate a piece of carrot cake with crème cheese icing. Outside, the rains continued their steady descent.

Sometime in the middle of the night, Irene would hit the Connecticut shore.

There was little else to do now but hunker down and wait.

Talking to a wall

I pad down the back hallway and exit the office through the door marked “Private.”  As I insert my key into the lock to throw the dead bolt, I hear a man speaking in a loud voice.

Not quite twenty yards away, he teeters on the sidewalk in front of the business that abuts our office in this strip mall, head shaven, dressed in a colorful T-shirt, short pants that fall below the knee, white cotton socks and high-top tennis shoes.  Back and forth he ambles, shouting phrases and epithets, gesticulating with his arms as though he were a priest invoking the gods before this makeshift altar of brick and mortar.

The community mental health services agency is housed at the rear of the parking lot.  Many times clients opt for a midday stroll down to the Dunkin’ Donuts for lunch or a coffee.  Mostly they just shuffle by, some seemingly lost in thought; others saunter in pairs or groups of three, quietly murmuring among themselves.  This is the first fellow I’ve seen in a state of heightened agitation.

I step into the parking lot and walk to my car.  He’s still spewing epithets as I fiddle with the key in the lock.  I open the car door and pause momentarily to assure myself that he hasn’t got a gun.

This scenario brings to mind Oliver Sacks’ description of a mentally ill person he encountered one afternoon on the streets of New York.

“My eye was caught by a grey-haired woman in her sixties, who was apparently the centre of a most amazing disturbance, though what was happening, what was so disturbing, was not at first clear to me.  Was she having a fit? . . . [A] slow smile, monstrously accelerated, would become a violent, milliseconds-long grimace; an ample gesture, accelerated, would become a farcical convulsive movement.”  (“The Possessed” in The Man Who Mistook His Wife for a Hat.)

Was this in fact what I was witnessing here in this man acting out before my eyes?

I start the car and drop the power windows.  The man’s shouts become louder, echoing across the expanse of macadam.  Perhaps I should notify someone.  Perhaps I should return to the office and call the police.

As I ponder my civic duty, the man turns and strides up the sidewalk.  Suddenly I see it:  the appendage protruding from his left ear.  He continues to spew venom into the air, but now I know that most likely he’s not mentally ill.

He’s merely carrying on a semi-private conversation through his cell phone with Bluetooth technology.

The earth moved

“When I was young the earth moved so that you could feel it all shift in space and were afraid it would go out from under you.”  Hemingway, For Whom the Bell Tolls

Like countless other folks in New England, I found myself momentarily caught up in a rather bizarre course of events earlier this afternoon.

Shortly before 2:00 PM, while seated at my desk scanning the salient points of a medical article online, I noticed the pull chain of my desk lamp start to jiggle back and forth like a small pendulum.  At the same time the leaves in the potted plant by my laptop began to tremble.  I tagged a similar disturbance of the leafy shoots of the peace lily in the pot by the credenza.  A mild wave of nausea passed through my stomach, reminiscent of the feeling I used to get when the cutter I was attached to in the Coast Guard would get underway.

The tremor lasted all of ten seconds.  I sat completely still, waiting, anticipating the worst.  When nothing else occurred, I stood up and walked down the hallway to the front office.  All of my coworkers had a look of consternation on their faces.

“Did you feel it?” I asked.

They nodded.

“Maybe we should move everyone outside for now.”

I didn’t have to make the suggestion twice.  Medical assistants and receptionists began escorting mothers and children out the front entrance into the parking lot.

I retraced my steps through the back office and exited via the side door.  Groups of people were huddled in front of each entrance all along the strip mall.

“Did you feel it, too?”  Everyone seemed to need reassurance that they had in fact experienced what they thought they had felt.

We observed the lamp posts towering above the parking lot and looked to the trees beyond.  Nothing moved — not a branch, not a leaf.  We waited, holding our collective breaths.

“What was it?” someone asked.

“Earthquake — it had to have been a mild earthquake.”

We waited an additional ten minutes, then filtered back into the building.  Quickly, I did an online search and found that there had indeed been a quake just outside of Richmond,Virginia, that registered 5.8 on the Richter scale.

Twenty minutes later an article on the Times website described the quake.  They had evacuated the Capitol building and the White House in D.C.  At least three pinnacles on the central tower of the National Cathedral had broken off.  Within minutes no less than 133 comments were posted.  The quake had been felt as far away as Vermont and North Carolina.

I listened to the report on NPR on my way home from work.  Most folks in the region had never experienced the eerie feeling that a tremor of the earth brings before.

One woman interviewed said that when she felt the earth move, she wasn’t disappointed.  “I’ve been married a long time,” she explained.  “I haven’t felt the earth move for years.  At my age, I’ll gladly take any movement I can get.”

Decisions, Decisions

These days the subject of medical error has become a hot topic. Morbidity and mortality secondary to medical error is staggering.  Groopman has delineated some of the foibles in medical decision makingGawande has proposed a standard check list to curb the number of surgical errors.  Leading experts opine that widespread implementation of the electronic medical record might serve to drastically reduce the number of errors made by practicing clinicians.

Now New York Times science columnist John Tierney delves into the subject of decision making by examining not how decisions are made, but rather the state of mind of the decision maker.  Citing recent extensive psychological research, Tierney proposes that the attentiveness and care that we muster when making a decision seems to be directly dependent upon the supply of glucose to our brains.

In the Times article (which is adapted from a book Tierney authored with Roy F. Baumeister, Willpower: Rediscovering the Greatest Human Strength), Tierney expounds on the concept of decision fatigue, the idea that the more decisions we are forced to make during the course of the day, the more likely we are to opt for the path of least resistance.  Either we act impulsively or refuse to commit to making a choice.

Obviously, in medical practice either tack has the very real potential of resulting in suboptimal care for the patient.

“‘Good decision making is not a trait of the person, in the sense that it’s always there,’ Baumeister says. ‘It’s a state that fluctuates.’ His studies show that people with the best self-control are the ones who structure their lives so as to conserve willpower.”

“The restored willpower improved people’s self-control as well as the quality of their decisions: they resisted irrational bias when making choices…they were more likely to choose the better long-term strategy instead of going for a quick payoff.”

Nearly all practicing clinicians do not enjoy the luxury of structured 4-hour workdays.  We are thrown into the daily fray, forced to evaluate those patients that find their way to us in whatever area of clinical medicine we work.

So what can we do to avoid decision fatigue?

As it turns out, “glucose is a vital part of willpower….Your brain does not stop working when glucose is low. It stops doing some things and starts doing others. It responds more strongly to immediate rewards and pays less attention to long-term prospects.”

If these data are to be believed, in order to keep our minds sharp one simple solution might be a mid-afternoon snack consisting of a load of glucose: perhaps a sugary soft drink coupled with a cookie.

A plea for poetry in medical practice

I was pleased as punch to peruse New York Times executive editor Bill Keller’s delightful essay on the relevance of poetry, I Yield My Time to the Gentleman From Stratford-Upon-Avon. Here Keller expounds on the relative weight that a seemingly small, insignificant seminar carried in his course of summer study at the Wharton School of Business.

In my book we would do well to advocate for the inclusion of poetry in the medical curriculum—for largely the same reasons.  more»

A Garden of Verses

We stopped by the white outbuilding on our way home from walking the dog.
Seemingly overnight, the garden had mushroomed.
We stood marveling at the rows of green plants:
Next to the line of marigolds
A jungle of bushy tomato plants rose three feet high;
Cabbage and kale, eggplant and peppers,
Bushy basil and bouquets of parsley,
Anise, cucumbers, pumpkin squash;
All laid out in parallel rows rooted in the rich brown earth.
I stooped to study the plants heavily laden with seed pods.
What an assemblage of fruit, what a harvest of meticulous care!

I stood, contemplating the collective goodness borne by this soil
Sowed and tended by the local parish priest,
Who was led away in handcuffs just two days before,
Accused of sexual improprieties with an adolescent boy.

Last year a neighbor, not given to going to mass,
Hearing him speak at the funeral of the wife of a friend,
Swore he was a holy man.
I remember passing by in the evening stillness
As he watered the flower beds outside his home.
His eyes met mine; we exchanged a cordial greeting.

Could it be, I wondered; could it be true?

Jesus said: “By their fruits you shall know them.”

Here I stand, deeply pained; confused, unknowing,
Blessed by the summer abundance strewn at my feet.


“The Parish Garden” ©2011 Brian T. Maurer

Humane Medicine — In pediatrics, everything starts small

In pediatrics, things start small, then grow and develop. Like all things in pediatrics, the lesion that appeared on this child’s calf had started small as well. more»

Interested readers can now access my latest Humane Medicine column — Growth and development: In pediatrics, everything starts small — recently published in the Journal of the American Academy of Physician Assistants.

“Notes from a Healer” — Small Potatoes

When it comes to the relative weight of medical diagnoses, perspective is everything. more»

My latest installment of Notes from a HealerSmall Potatoes — 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.

Cardinal Flowers at Beaver Brook

This morning under cirrus skies
We headed north to Beaver Brook;
We dropped below the giant pines
And searched the wooded nook.

We padded down the forest path
Beneath those towering stately trees;
Unbroken silence met our ears—
The stillness of a frieze.

Then suddenly, there in the wood,
Appearing through a break of brush,
The regiment in scarlet stood
Enshrouded by the hush.

The mossy bank had formed the frame
Of redcoats mustered in the stream,
While darting damsels, undistressed,
Displayed their turquoise sheen.

A still-life frozen in the glen,
A masterwork now on display
For any curious passerby
Who traipsed this August day.


“Cardinal Flowers”©Brian T. Maurer