“Notes from a Healer” — Flu Shot

It was just a short visit for a flu shot. Short and sweet, filled with impromptu reflections on the human condition—something of value that we aren’t taught in our years of training, these seemingly insignificant snippets of conversation that ultimately serve to cultivate caring relationships in medical practice.  more»

My latest installment of Notes from a HealerFlu Shot — 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.

You never know

According to the newspaper obit, this soldier’s one true ambition was to become a writer.

He took four years of Latin in high school to become a better writer, and he had had a number of pieces published in the school’s literary magazine.

He planned to attend college and major in English. He thought he might be able to teach on the side until he could get himself established in print.

Somehow after high school graduation he ended up enlisting in the Army National Guard. He held the rank of private when he died.

His high school friends described him as quiet and polite. He was known for thinking outside of the box, and always had a ready smile.

According to his medical record, with the exception of a minor forearm fracture incurred in boyhood, he was only seen in the office for annual physical examinations; and those became less frequent as he got older.

There was never a hint of depression, never any inclination toward self-destructive behavior. When the news broke, that was why no one could believe that the cause of death was a self-inflicted gunshot wound.

Vita incerta, mors certissima — an ironic epitaph for a young gifted writer with promising talent.

You just never know about such things, I muse, as I gently close the medical record on my desk.

The road home

Sunday sermons disappear,
Receding in the rear-view mirror;
A roadside pond comes into sight—
Earthly eye, celestial seer.

At the fork I ease to right,
Following the morning light
Underneath the piney stands—
Broken branches, dusted white.

Here the narrow road expands,
Tools between tobacco lands;
Tidy houses, neatly nursed,
Lead me to the poets’ strands.

Tennyson, the first traversed,
Stately silent, couplets terse;
Buttles next, serenely steeped;
Next, Walt Whitman’s leaves of verse.

Shelley’s is the final street,
Making poets block complete,
Nestled round Three Corner Lake,
Rimmed with cottages, replete.

Would that I could boast a stake
In Poets’ Corner real estate;
My lot is but to let it lie—
Homeward bound, the road and I.

Copyright 2012 © Brian T. Maurer

Showing my (digital) age

“The quality of silence is organically linked to the quality of language. You and I are sitting here, in this house surrounded by a garden, where there is no other noise other than the sound of our conversation. Here I can work. Here I can dream and try to think. Silence has become a huge luxury. People are living in a constant din….What will become of serious and difficult reading? Is it possible to read Plato while wearing a Walkman?” —George Steiner

My first patient of the morning—a 15-month-old boy—is sitting on his father’s lap when I enter the exam room. His father has a cell phone glued to his ear. He continues his digital chat while I attempt to engage the toddler by making faces. Finally, he ends the call with a short “Gotta go now, doctor’s here,” snapping the flip phone shut.

My next patient—a 2-year-old girl—clings to her mother’s pant leg, tears in her eyes. “Don’t worry, honey; no shot today, I promise,” the mother says. To me she continues: “She’s been sticking her fingers in her ears. I think she might have an infection.”

“Let’s have a look,” I say, directing the mother to restrain the child in her lap. As I attempt to peer into the little girl’s ear with an otoscope, the mother produces a smart phone and swipes the screen with her thumb, skimming messages in her e-mail account.

Midway through the interview with my third patient—a 16-year-old adolescent with shoulder pain—his mother’s cell phone sounds off. “Sorry,” she says, as she turns toward the corner of the room to take the call.

Sometime ago our office staff posted colorful signs in prominent places: “Please turn off all cell phones in this office.” After this morning’s fiasco, I’m beginning to think that the majority of parents suffer from literacy regression.

The Irish have a saying: Every man a king in his own home. Here in America, every patient (or in pediatric practice, at least the parent) exercises totalitarian rule. Rude is not a word in their vocabulary. They think nothing of inconveniencing me; God forbid I should inconvenience them.

I see my own primary care physician once a year for my annual physical exam. He used to sit and talk to me. Now he sits behind a flat screen monitor and records my answers to his questions with the click of a mouse. All of my salient medical data is duly digitalized, readily available for immediate electronic access. This, I’m told, is progress.

(Of course, the traditional prostate exam remains digital as well. And in that position, face to face communication is likewise impossible.)

The other week at Sunday services I noticed a teenager standing beside her mother, one arm raised in worship, the other by her side, cupping an iPhone, on which she stroked the small screen with her thumb, surfing digital data on the web.

I mull these scenarios over in my mind as I drive home down the interstate. An SUV merges into traffic from the entrance ramp, nearly cutting me off. I hit the brake pedal with my foot, flip the signal stem down, check my side view mirror and scoot into the left lane. The SUV holds a steady speed. As I pass by I shoot a glance at the driver. He’s busily chatting away on a cell phone, oblivious to how close he had just come to a collision.

These are the sorts of attention deficit disorders than no amount of stimulant medication will fix. This is our modern-day pandemic, ADDD: attention deficit digital disorder, a clinical entity as real as any DSM-V diagnosis, for which no treatment exists.

A woodland walk

“Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth.”

—Robert Frost, The Road Not Taken

I stood at the edge of the wood near the bottom of the rise, leaning against my walking stick. Directly ahead the trail continued to ascend the rocky slope along the ridge, while below, off to the left, branches and debris from last October’s winter storm blocked the leaf-strewn path.  After a moment’s reflection I took up the walking stick in hand and tramped down through the leaves.

At the bottom I found the blue blaze marks and proceeded west along the path parallel to the ridge trail. Many of the fallen limbs had been cut up and kicked off to the side. In a few spots new trail had been blazed around extensive clusters of debris. Eventually, I stepped out of the woods onto the dirt road at the power line cut.

Here I had another decision to make: continue on into the woods or follow the dirt road to the crest. Moments later I stepped into the woods again and continued along the path.

At the bottom of the hollow I found the remnant of a trail that crossed the stream and led directly up the rise. Many times I had followed this straight stretch of trail, striding up the natural stone steps. It soon became apparent that the former trail was impassable: a jungle of fallen trunks and contorted branches blocked the way.

I turned right and followed an improvised path across the slope to where it doubled back through the forest. Back and forth I followed the switchbacks, crisscrossing the old straight trail.

Near the top of the rise, off to the right, a vernal pool lay frozen in the forest. I paused at its edge and stared down into the black ice. Patches of blue sky silhouetted the wispy tops of stark trees in this cracked icy mirror.

It was a short ascent to the ridge. I stood on the rocky outcropping and looked out over the expansive valley at my feet, shading my eyes from the intense afternoon sun. A cold wind cut my cheek.

Shortly, I turned and disappeared back into the forest.

Every life shares the burden of meaning

In her New York Times essay “The Book of Books” Marilynne Robinson argues that the Bible is “the model for more art and thought than those who live within its influence will ever know.” Even one of the most ardent atheists of our time, the late Christopher Hitchens, acknowledged the profound literary influence of this book, particularly the King James version. In Robinson’s words, “these references demonstrate a well of special meaning to be drawn upon…an obscure death can become a martyrdom; a gesture of forgiveness an act of grace.”

Mahmoud appears in the office with four of his five children. Lutfi, his 6-year-old son, complained of an earache at school this afternoon. The nurse called Mahmoud to come and collect his son, and so Mahmoud is here to have his son’s ear looked at.

I first met Mahmoud eight years ago, when he brought his first-born child, a daughter, to the office. At that time a recent immigrant from Palestine, Mahmoud drove a taxi cab for a living. He scrimped and managed to amass enough money to bring his wife to the states. They lived in a rough section of town where the rents were cheap.

Mahmoud never missed a well-child appointment. He always appeared on time. He never questioned the need to have the children immunized and always complied with medical recommendations. The children were rarely sick. If they did fall ill, Mahmoud nursed them through their sickness at home.

When the children got their shots, Mahmoud would always hug them and quietly recite simple prayers or verses from the Koran while I plunged the hypodermic needle into their flesh.

During one office visit Mahmoud pointed out an extensive rash on one of the boys. Linear papules covered the child’s arms and legs. The lesions had the textbook appearance of bedbug bites. “We all have them,” Mahmoud admitted. “My children scratch in the night. The apartment is infested with them.”

“Have you notified the landlord?” I asked him.

Mahmoud shrugged his shoulders. “I have. He sent someone to spray, but they keep coming back.”

“Maybe you need to look for another place to live.”

“Believe me, I know; but everything is so expensive. Even now I pay good money for this apartment, and it is a pit.”

“Have you looked into Section 8?” I asked, referring to the state subsidized housing program for families.

“My name has been on the list for years. And yet, I have known some people further down on the list who have hired an attorney to represent them. They pay money and somehow they get a good apartment.” He shook his head. “There is something wrong with the system.”

This was not the first time I had heard this.

“If you play fair, you never get ahead—but,” he said, “I play fair. It is the right thing to do.”

I thought about the great mass of humanity. We struggle to survive. We clamor over each other in an attempt to ascend the mountain. Those who game the system might reach the summit long before those who don’t, but perhaps they are the lesser for it.

“So, what will you do?” I asked him.

“I will do what I have to do.  By God’s grace I will do what I can.”

The first shall be last, the last first.

“Moments of the highest import pass among people who are so marginal that conventional history would not have noticed them,” Robinson writes. “Ordinary lives are invested with a kind of significance that justifies, or requires, its endless iterations of the commonplace…however minor these might seem in the world’s eyes.”

Something there is that loves a wall

After a morning’s work of seeing patients in the office and several hours editing a manuscript previously accepted for publication, I decided I needed to take a break.

I reached for my heavy winter jacket and stocking cap and stepped outside into the cold. It was a short walk down the street to the old house that my daughter and son-in-law recently purchased.

I could hear muffled buzzing as I approached the front walk. It became appreciably louder when I opened the door to the kitchen and stepped inside.

Remnants of past snacks covered the table. Cleaned paint brushes lay in the dish drainer on the old cast iron sink. A cache of paint cans, scrapers and stirring sticks hovered in the corner by the refrigerator.

I pushed the door to the dining room open and stuck my head in to admire the freshly finished oak floors and maroon walls trimmed in white. Lace curtains hung at the windows. Newly painted cast iron radiators guarded the far corners.

I retraced my steps to the bottom of the stairs and ascended the chocolate-brown steps to the second floor landing. The door to the master bedroom stood open a crack. The buzzing sound rose to a deafening crescendo as I eased it open.

The room was fogged with grey dust. I could make out the forms of two young women—my grown up daughters—on step stools, masks in place over their noses and mouths, as they passed handheld sanders back and forth across freshly spackled walls. A thick coat of dust covered the floor.

Neither one heard me enter over the roar of the sanders. I stood still for a minute or two before my youngest daughter saw me. She turned off her sander and stepped down from the stool.

“Hey, Dad. What’s up?”

My married daughter turned off her sander and raised her mask. “We didn’t hear you come in.”

“I guess not. Those sanders make quite a racket. Looks like things are coming along.” I rubbed my hand over the smooth surface of the wall. “Have you decided what to do with the ceiling yet?”

“We bought some textured wallpaper for it. It should look nice when it’s done.”

“You’ll have to seal and size it beforehand. I can give you a hand when you’re ready.”

“Did you see the bathroom? It’s gutted. The plumber was here yesterday to replace the pipes.”

I walked across the dusty floor and stuck my head into the bathroom. You could see knob-and-tube wiring running between the bare studs above the bathtub. Strips of old lathe were visible where part of the plaster had been broken away during the demolition.

“It’s a shame you didn’t give Norm Abram a call before you started. He and his crew could have made a segment for ‘This Old House’.”

“You can see the new drainage pipes in the pantry downstairs.”

“I did. It looks like he did a good job. Well, I’ll let you get back to work. Let me know when you want to start in on the ceiling.”

“We will. Thanks, Dad.”

I turned to go, then stopped at the doorway. “You guys are doing a good job. Redoing an old house is a lot of work, but it makes you appreciate what you’ve got. You invest more than just your money and your time. You put some of your soul in it, too.”

I remember when they were little girls, sharing a bedroom in our old house. As they grew up, at some point each one of them decided to personalize the walls that I had worked so hard to restore. Some of the remnants of their redecorating were still visible. Now here they were, the two of them, working to beautify the walls of another old house.

Robert Frost’s “Mending Wall” notwithstanding, something there is that loves a wall after all—particularly old plaster ones.

“Notes from a Healer” — The Pyramids of Giza

Over 30 years of medical practice I have come to know quite a few immigrants who confided that they felt cast adrift, unable to settle the question of where they truly belonged. In effect, they felt as though they had become sojourners without a permanent country. Wherever they happened to be at the time, they carried the acute awareness of an emotional tug from their other home halfway round the globe. more»

My latest installment of Notes from a HealerThe Pyramids of Giza — 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.

A new year

The phone rang; my wife picked it up. I could hear her voice from the other room.

She appeared in the doorway, holding the receiver against her shoulder. “They want to know if we want to joint them for dinner at the pub. Are you up for it?”

I had been sitting on the sofa in the dark, mesmerized by our Christmas tree all lit up in the corner.

“If you want to go, we’ll go,” I said.

“We’ll swing by the apartment on our way down,” my wife said into the phone. Slowly, I rose from the sofa and reached for my coat and cap.

A thick fog blanketed the wet streets as we walked beneath the streetlights. I pulled up the collar of my coat and jammed my fingers into my gloves. The cold dampness cut through my trousers as we walked down the street beneath the yellow cones of light in silence.

We knocked at the door of the first floor flat. My son-in-law let us in. He and his father had been working in the new old house most of the day, tearing plasterboard off the walls in the upstairs bathroom. His mother had finished sanding the walls in the master bedroom, getting them ready for the first coat of primer. Both of his parents had worked all day without eating. They looked spent.

They pulled on their coats and we stepped back outside into the fog. It was a short walk to the pub at the end of the street.

The dining room was vacant; a few regular patrons lounged at the bar; a sentinel Christmas tree stood silently in the corner.

We shed our coats and slid into a booth. A waitress appeared to take our order. “Where are all your customers?” I asked. “It’s New Year’s Eve.”

She shrugged her shoulders and smiled. “Somewhere else, I guess. We’re thinking of closing early.”

“Is the kitchen still open?”

“Of course.”

We ordered a round of drinks and studied the menus.

Later, my daughter and son-in-law arrived with my son and his girlfriend. They sat down at the table next to our booth.

“This place is dead,” my son said.

“It’s quiet and warm and clean,” I said. “What more do you want?”

“A party,” he said. “You going to watch the ball drop on TV?”

“I’m going to drop long before that — into bed,” I said.

“Ian posted a letter he wrote me when he was away at college.” He handed me his smartphone. I scrolled down to read the text written 15 years before. Work on your grades, his older brother had written. You don’t have to get A’s to get into college, but you have to graduate from high school. Otherwise you’ll be pumping gas at the Getty station or bagging groceries when you’re 30.

I laughed. He was 31 now with an undergraduate degree, working for the government, going back to school in the spring.

“When we tore out the wallboard, there was knob-and-tube wiring underneath,” my son-in-law’s father said. “You’ve got to be careful when you do demolition in these old houses. No telling what you might run into. I cracked my head on a beam in the basement.” He dropped his chin to show us the red crease on his scalp.

I thought about the work I had done on our home shortly after we purchased it 26 years ago: stripping paper, priming walls and ceilings, replacing the subflooring in the bathroom, repairing a leak in the roof.

“I told them to concentrate on one room at a time. That way they can see some accomplishment. It gives you a little incentive to move ahead. Somehow, it doesn’t seem so overwhelming.”

We finished up and stopped by the table to say good-bye to the kids, who were now starting out on their own, just like we did three decades ago.

Outside the fog lay in the street. But overhead the stars were out. A clear crescent moon hung in the sky.

The next morning dawned faultless blue above the village. Outside the back window, high up in one of the maples, a woodpecker pummeled the bark of a broken limb, a remnant of last October’s storm.