Huntingdon, 2012

On the middle shelf of the corner hutch in the second floor Margaret E. Baker Room of the Richard Calhoun Baker Guest House on the campus of Juniata College in Huntingdon, Pennsylvania, there sit six books. Wedged between Edna St. Vincent Millay’s Make Bright the Arrows and Davis’ Disraeli, stands Hervey Allen’s novel Anthony Adverse. It opens with a quote by Sir Thomas Browne: “There is something in us that can be without us, and will be after us, though indeed it hath no history of what it was before us, and cannot tell how it entered into us.”

In the beginning was the hill,
And the hill was long and arduous,
A continual rise that never wavered
And grew steeper close to the crest.
The hill was Part One, First Act,
Testing Ground, Ground Zero.
Here was the place
Where harriers were hewn,
The defeated crestfallen.
The hill divided the men from the boys.
Hah!—we all were boys back then,
Young and strong and fast and free.
And now we all are men,
Come home to pay homage
To the hill that broke and choked
And shaped and molded and melded
And burned and turned us
Into what we have become:
Older men, seasoned men,
Wiser men, and yes, tender men.

At the top of Moore Street
Stands stately Founders Hall,
Formerly “The Building,” edifice original
Of Brethren Normal School,
Now surrounded by a score of brethren.
Together they form this bucolic
Ivy League college devoid of ivy:
Swigart, Oller, Brumbaugh, Ellis;
Good, von Liebig, Carnegie, Beeghly,
North, South, Sherwood, Cloister.

Together we gathered this too early spring,
Hooded brethren huddled beneath
Wide umbrellas to ward off the rain,
To witness the thinclads stride
Round the circular track that runs forever.
Parker shattered Bailey’s 3K record
Set a mere two years before.
Woods bested her own by 19 seconds.
Mandley took first in the hurdles,
McCoy the hundred.
While across the field next the grandstand
An ancient yellow willow watched and wept.

Once we were young,
Our faces shone as these faces shine,
Once we dreamt dreams,
Ran hard, set records, slept well.

We have come back to this place,
To this spacetime dimension,
To witness the prowess of young men,
To applaud the strength of their stride,
To marvel at the joy on their faces,
To mourn the passing of their youth.

We have come back to this place
To bear witness of the world beyond its walls,
Stories of success, stories of defeat,
Stories of imperfect journeys
That render life perfect in our minds.
We return to minister to mind-lost mothers,
We come back to mourn fallen fathers,
We come home to bury our dead
And take our place in line.

Spring came a month early this year.
Snowdrops and crocuses, already withered,
Gave way to forsythia and flowering crabapple.
Patches of pink petals adorned the sidewalks.
We arose early and set out for morning coffee,
Sauntering down side streets
Baptized with cherry blossoms.

In the beginning there was the hill,
And the hill, high and holy, still
Rises to rocky outcrops that overlook
The river that courses through eternal time.
At the base of the cliffs along the river
Runs a set of parallel steel tracks
Along which we once in our youth ran
Till our toenails blackened with blood.
Once more we pause at the crest of the hill
And listen for a sacred whistle, long and low.

2012 © Brian T. Maurer

"Crabapple Blossoms" by Brian T. Maurer

The Old Guitarist

“The Old Guitarist”

You, who have played out
Your song of songs
Over the course of a long life,
Now sit just so,
Caressing the feminine form
In your spent loins,
Short-term memory
Memory no more,
Recalling only
A litany of loves
Lost long ago.
Proteinaceous plaques
Pockmark synaptic pathways
Devoid of roadsigns.
Whole notes give way
To a slurred run of final rest.

2012 © Brian T. Maurer

"The Old Guitarist" by Pablo Picasso, 1903

Beware the Ides!

“Beware the Ides of March!”

Thus spake the soothsayer in Shakespeare’s Julius Caesar. Those words foretold the assassination of Caesar in the Roman Senate that very day. You can’t escape fate, it seems. In the Shakespearean folio, the play’s the thing; and here fate trumps human endeavor every time.

Many contemporary patients consider themselves to fall in the same category. Somehow they’ve gotten it into their heads that there is little they can do to alter the course of their health. more»

Remembering Dr. Howard Spiro

I first encountered Dr. Howard Spiro at a medical humanities conference in Williamstown, Massachusetts, some 20 years ago. As a guest speaker, Dr. Spiro shared the podium with Dr. Robert Coles. The two made quite a pair: both distinguished practitioners of the art of medicine; one from Harvard, the other from Yale. Dr. Spiro wore a brown bow tie that day. I recall that detail exactly, because it was the kind of bow tie you had to tie yourself; and I remember suppressing an impulsive urge to discreetly snug it up for him. Curiously, I didn’t actually make his personal acquaintance until nearly a decade later.

One evening in December of 2002 my friend and colleague Dr. David Elpern and I traveled to New Haven to attend an evening lecture at the Yale Humanities in Medicine program. During the drive down, Dr. Elpern told me that Dr. Spiro had founded the lecture series back in 1983. Later that evening over dinner at Mory’s, we learned from Dr. Spiro that he had gotten up a fledgling online journal of similar import, the Yale Journal for Humanities in Medicine.

By that time a few of my early pieces had been published in JAMA and BMJ. Dr. Spiro was eager to hear all about them. I don’t recall whether he asked me to consider submitting something to YJHM at that time or not. At some point I did send him a piece, which he graciously accepted for publication.

Sometime later, after he offered to review my book Patients Are a Virtue, Dr. Spiro asked if I would consider doing a monthly column for the journal. “What would we call it?” I asked him. “Call it what you like,” he said. Shortly after that my “Notes from a Healer” began to appear in the electronic pages of YJHM.

And so began a collegial relationship that lasted up until the time of his death. (Dr. Spiro approved the submission for my March “Notes from a Healer” column days before entering the hospital for a cardiovascular event that would ultimately end his life.)

Every month for the past five years I would send Dr. Spiro a piece for the column, which he would critique, usually in a few brief lines, before okaying it for publication. These critiques were not those of a typical editor. Many times he would comment about something in his own life or how the piece I submitted moved him personally.

“Engineers are among the most difficult patients, for they are convinced there’s a detectable reason/cause for anything/everything.”

“Wise, indeed. One learns with age.”

“You are sounding more like O Henry with time.”

“Your usual beautiful turns. I confess I would have seen the opportunity/really the genius of America in their story, but suum cuique!”

Occasionally, he would point out a grammatical error; and red-faced, I would shoot off a corrected copy with my thanks appended. At some point, he would finally bestow his signature stamp of approval: “Imprimatur.”

Dr. Spiro rubbed shoulders with some of the medical greats of his era. Many times I only learned of these relationships through casual comments he would make on pieces I sent him. For example, in response to one of my submissions he wrote:

“I knew Leon Eisenberg—admired him—look at his CV. I cannot believe that he would want to be considered a mere psychopharmacologist.”

After researching Dr. Eisenberg’s biography, I wrote back, “I took your advice. You were obviously correct in pointing out that the man was much more than just that.” I included an article from Harvard’s FOCUS Online which I thought Dr. Spiro might enjoy . Dr. Eisenberg’s story about the schlemiel was priceless.

Sometimes Dr. Spiro and I exchanged correspondence on matters of medical practice as well. Once, I discovered an article that referenced a paper of his. I sent him the link with a few observations:

“Reading through this review, I couldn’t help but think that you would enjoy it. As it turned out, you were mentioned toward the end of the article.”

‘Stress,’ the American gastroenterologist Howard Spiro writes, ‘increases vulnerability’ to other ulcer-causing agents ‘like H. pylori’. Medical fascination with bacterial causation has, he says, resulted in culpable neglect of the roles of the mind, the emotions and the dietary and behavioural patterns of everyday life. (A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800-1950 by Ian Miller)

Dr. Spiro was obviously pleased: “Thanks, glad I am remembered! I worked on stress in the 1940’s, thanks to Selye’s idea of the ‘alarm reaction’ and published my first medical papers back then.”

In turn, I wrote back: “Perhaps my perspective is somewhat skewed, but it seems to me that precious few specialists seem to be able (or willing) to relate to such patients on a humane level these days, a demonstration of the lost art of medicine.”

Dr. Spiro’s assessment: “Boy, are you right! When I was young, we talked to patients. Lab data and images were scanty. Since 80% of patients get better with time and the right hand of fellowship, the clinician counted. But that will return after disenchantment spreads.” He had entitled this reply I-Thou.

On a professional level, Dr. Spiro was supportive of my clinical practice as a physician assistant. He strongly advocated for the advancement of “mid-level practitioners” as he called us, feeling that we were the answer to the primary care clinician shortage problem. “The expertise you demonstrate in the way you care for your patients is evident in your writing,” he wrote. “I argue with my colleagues, many of whom feel that medical practice should be regarded as the exclusive domain of the physician.”

“As you may know—or more likely may not—for the last 20 years I have been pushing the idea that physician assistants or nurse-practitioners should be doing pediatrics and general internal medicine. Very few in the internal medicine business agree.”

“Your enthusiasm, amity, empathy for your patients—and your prolific writing skills—continues to reassure me that physician extenders—if I can call you that—should constitute our general docs and pediatricians. It’s a canard that they will not recognize serious problems! I keep wondering why you do not talk about that—or maybe you do, indirectly, or in other places.”

This past fall Dr. Spiro wrote that he would be traveling to Arizona to give a medical humanities presentation at one of the medical schools there. “I would like to use you as an example of a clinician who not only practices humane medicine, but writes about it well. Send me a copy of your CV. I imagine you to be somewhere around 45, give or take.”

I sent him my résumé with the caveat that he was off on my age by more than a decade. “Hah! You write with the vigor of someone in his early thirties,” he quipped.

Toward the end it was evident that Dr. Spiro was becoming a bit forgetful. When the name of George Bascom resurfaced in one of our e-mail exchanges, he wrote: “Tell me again how you knew him.”

“It was you who knew him personally,” I wrote back. “I only knew him through his poetry. In any event, he was a fine mensch who continues to influence clinicians from beyond the grave.”

“If you didn’t know him personally, a word like mensch—which I take to be a personal assessment—might be out of place,” he replied. The response stung.

I took a deep breath and typed out a reply. “According to the dictionary, a mensch is someone to admire and emulate, someone of noble character. It’s meant as a compliment to highlight the rarity and value of that individual’s qualities.”

I suppose those words might just as well have been written to describe Dr. Spiro himself.

Howard M. Spiro, M.D. (Photo credit: Peter Casolino Photography, New Haven, CT)

A marriage of humanity and medicine

Medical practice lay a-bed,
With fever to the core;
Sickness festered in her head,
While death passed by the door.

A string of suitors, all untrue,
Had left her bed of pain,
Parties of the third did woo—
Though not for love, but gain.

Big Pharma promised wonder drugs,
To ease the maiden’s plight,
True colors shown: this band of thugs,
Had raped her in the night.

So there she lay upon the cot,
Delirious, forsaken;
If she once had, she now had not—
Her very soul was shaken.

An ancient door eased open;
Humanity crept in
With tender thoughts unspoken
For dying medicine.

He slipped a hand in her hand,
Caressed the feverish brow;
He lingered by the night-stand,
Then turned the lantern low.

Humanity kept vigil
Close by throughout the night;
The heartbeat, once so feeble,
Had strengthened by first light.

When medicine awoke,
She stared into a face
That whispered words of comfort
And emanated grace.

So medicine was married,
Humanity, the groom;
Their grateful patients tarried
At tables in the room.

Now this is but a fable,
It never came to be—
Though fictions often lead to facts,
And blind men sometimes see.

2012 © Brian T. Maurer

A good walk spoiled — almost

Walt Landgraf used to boast that he never went for a walk in the woods and came back disappointed.

I’ve always put a lot of stock in his remark—up until today. Were it not for the fact that I continued to press forward along a woodland trail, I might have returned distraught indeed.

I started out early. The morning air was crisp, but the weatherman was calling for sunny skies with highs in the 60s. I grabbed my binoculars and camera and set out for the Metacomet Trailhead.

"Metacomet Trailhead" 2012 © Brian T. Maurer

A wren called from a sparse lilac bush. I heard the familiar “Pe-ter, Pe-ter” notes of the titmice and focused my binoculars on several chickadees flitting about in the upper branches of a stand of hemlocks.

"Metacomet Trail" 2012 © Brian T. MaurerFrom the small plateau just below the remnants of the Bartlett Tower I panned the lower Farmington shimmering silver in the morning sun. I turned and entered the forest, following the blue blaze marks along the narrow rocky ridge trail.

When I reached the first power line cut my stomach tightened. There before me lay a newly constructed gravel road, wide enough to accommodate a large utility truck.

"Metacomet Trail: Utility Road" 2012 © Brian T. Maurer

At first I thought I was dreaming; perhaps I had taken a wrong turn. But no, there was only one path—the one I was on—and that path led most assuredly onto the road.

Gone was the rocky outcropping on which I had stood countless times over the past three decades to survey the distant Barndoor Hills, gone was the lookout point with the blue blaze mark; gone the familiar ancient oaks and underbrush, spring nesting grounds for hermit thrush.

I hesitated, looked back over my shoulder, then stepped out onto the crushed grey stone, hoping that it might vaporize beneath my feet. It didn’t, of course.

I followed the road along the ridge to where it veered sharply in its descent down the eastern slope of the ravine. At this point I was able to pick up the original trail again. I had traversed a distance of perhaps 600 yards. I stopped to look back at this swath of centuries old Indian trail, now obliterated by earth-moving machines and buried in gravel.

"Metacomet Trail: Gravel Road" 2012 © Brian T. Maurer

A young man passed me on the trail ahead. I hailed him to ask about the road. “It’s been there for the past several months,” he said. “The power company put it through after last fall’s storm.”

“I thought it was public land,” I said.

He shrugged his shoulders. “The power company can do whatever it wants,” he said, and walked off.

I continued down the trail, seething under my breath. The scarred woods had momentarily lost their magical charm.

I stopped to study a placard mounted on a tree. It carried a map of the area. I traced the stretch of Metacomet Trail along which I had come, chagrined to find that it lay just outside the border of the town land trust.

I fought back the lump in my throat and pressed ahead. At the second lookout point I paused to survey the valley before entering the woods again. I decided that I would go as far as the flat rock before heading back.

Shortly, I was greeted with a cacophony that grew louder and louder. As I approached the vernal pond nestled in the hollow behind the flat rock, the crescendo became deafening.

"Vernal Pool" 2012 © Brian T. Maurer

I crept closer, inching my way to the shoreline. Scores of little dark knobs bobbed on the surface of the pond. Periodically, concentric circles of ripples expanded from the knobs. As I peered closer I noticed a frog floating near a fallen branch close to shore. From time to time it stretched its hind legs and kicked languorously two or three times.

"Spring Peeper" 2012 © Brian T. Maurer

I brought my binoculars up to survey the water. Each knob turned out to be a young frog, newly formed from its prior existence as a tadpole. Hundreds of them bobbed on the surface.

Awestruck, I stood and listened to the peepers—for how long I cannot say. Like Thoreau seated before the door of his cabin on a summer morning, in those moments I grew like corn in the night.

The bark of a dog broke my reverie. I turned to see a golden flash along the trail. A jogger followed, and both promptly disappeared over the next rise.

I climbed up the steep cut to the flat rock and looked out over the valley. I trained my binoculars on the swamp just east of the town. The water shimmered through the dead trees in silver patches in the late morning sun.

I turned and retraced my steps back through the forest to the lookout point. From there I took an alternative route back to the village.

My good walk had come quite close to being spoiled, but in the end an unexpected orchestral performance of spring peepers redeemed it.

Final Night

For Howard Spiro M.D., on the eve of his passing

In the darkness of the night,
Blindly, I arise and stumble,
Half asleep, with shoes I fumble,
Pause before the soft blue light
To parse the message in the night.

In the darkness of the night
Groping for my coat, I swag,
Search the corner for my bag,
Pull the door behind me tight,
Step outside into the night.

In the darkness of this night
A waning gibbous moon appears,
As it has through finite years;
It hangs upon the cheek of night,
The Bard’s rich jewel, this silver light.

In the darkness of this night
It questions me with faceless stare
To ask if I might tarry there
To speak a word into the night,
Into the dark, before first light.

In the darkness of the night
The orb embraced by silver shroud
Now slips behind a veil of cloud
Serenely, as it fades from sight
In the silence of the night.

3/12/2012 © Brian T. Maurer

Thin Places

Together we parse the woodland trail
Past stands of ancient evergreens
Through patches of ice-melt mud,
Bearing right at the fork.
A quickened pace across the creek,
Then up the sandy rise
To Spring Pond.

A fallen pine rests on its side,
An empty cabin slumps.
Geese bleat over still water.

Blue blazed trees lead us to
An open yellow meadow,
The etched path arcs through
Last summer’s grassy remnants.

A sudden shrill drumming
Sounds in the forest.
Silence ensues;
We wait and listen.
Drumming cracks the air again,
Echoes through our amphitheater,
This hallowed forest glen.

Copyright 2012 © Brian T. Maurer

"Spring Pond" 2012 © Brian T. Maurer

Thrown stones

“I attended the funeral of a pediatrician in New Jersey last weekend. The place was packed. This fellow was revered in the community. His patients just loved him. And here’s the thing: he was such a humble guy.”

We pulled on our coats in the locker room and gathered our belongings, preparing to head out after the morning workout in the pool. One of my swimming buddies has a link to New Jersey: his wife’s family is from there. The pediatrician of whom he spoke was a cousin of his father-in-law.

“Google him if you get a chance,” my friend said, as we walked down the hallway past the front desk. “Be sure to read the condolences in the guest book—the comments are amazing. There must be at least 120 of them.”

“What town did he practice in?” I asked, as we exited the building.

My friend told me the name of the small town.

“Is that anywhere near Paterson?” I asked.

“It is.”

“I wonder if he knew the pediatrician William Carlos Williams. Williams practiced in Paterson and wrote Life along the Passaic River. He was also a poet.”

“A poet-pediatrician,” my friend smiled.

“You might have heard of Robert Coles,” I went on, “the child psychiatrist who teaches literature at Harvard. As an undergraduate, Coles did a paper on Williams. His advisor suggested that he send it to Williams. Coles did, and he received a reply from Williams, who wrote that the thesis wasn’t bad for a Harvard man.”

We walked to our cars and stowed our bags.

“Williams invited Coles to visit him. They struck a chord. Coles eventually ended up practicing psychiatry at Keesler Air Force Base in Biloxi, Mississippi. That was back in the ’60s, during the school integration crisis. In New Orleans he witnessed the mob of people jeering at Ruby Bridges, the little black girl who had to be escorted to her school every morning by federal marshals.

“Coles got to meet Ruby and her family professionally. He couldn’t believe the kid’s ego strength. He kept waiting for her to break. How much abuse could a 6-year-old girl take? Finally, at one of their sessions, he told Ruby that her teacher had noticed her lips moving as she walked to school. He asked her what she was saying.

“She told him that she was praying. ‘Praying for your safety?’ Coles asked. ‘No,’ she said, ‘I was praying that God would forgive those angry people, because they really don’t know what they’re doing.’

“Later, Coles complied an anthology of Williams’ writings called The Doctor Stories.  He also published a posthumous tribute to Williams, House Calls.”

My friend smiled. “Good story. It’s all connected.”

I shut the door of my car. “Ripple effect—like stones cast in a pond.”

When I got home, I did an online search for Robert Rento. In a few clicks I had accessed his obituary. Here are several salient excerpts.

For over 40 years he evaluated students at Passaic County Technical Institute where he was known for making a connection with each and every child. “This was not so much a job to him as it was a calling,” recalled one nurse.

At her father’s core, daughter Susan Cottle said, was “a God-given ability to get on an elemental level with another human, often with humor or kindness as the connective tissue.”

“And he was an excellent communicator. When he walked out of that treatment room after seeing a kid, those parents knew exactly what was going on.”

Dr. Rento took advantage of his semi-retirement to reach far beyond his Clifton roots, traveling to Nepal, China, and Brazil with volunteer, non-profit medical teams to provide aid to children. These trips touched him deeply and re-invigorated his desire to continue his life’s work as a physician. In 2009 he received the Humanitarian Award from the Knights of Columbus for this work.

Dr. Rento will be remembered for his strength of character, for “getting the job done,” for his love of story-telling, his boundless energy, and perhaps mostly for the kind, competent manner in which he cared for those in need and all those he loved.

Some will bear witness through their words, others through their actions; still others—precious few—through the lives they lead.

Like stones cast into a pond, they resonate through the murky depths, generating those ripples which spread wider and wider until they are  finally embraced by the great arc of the far shore.