Contemporary literacy in literature

This 14-year-old girl has come to the office with her mother. She noticed a blister on the bottom of her foot shortly after running through the mall in sandals two days ago. Her mother is concerned because the blister has black dots in it. She thinks it might be infected.

I examine her foot under magnification. There, at the base of the right second toe, I see the lesion: a common plantar wart.

“It looks like a plantar wart,” I tell the mother. “Are you sure it’s only been there for a few days?”

“I didn’t notice it before,” the girl says. “I guess it could have been there longer.”

“What do we do to get rid of it?” the mother asks.

“There’s any number of ways to treat plantar warts,” I explain. “You might consider a patch kit. You apply a small patch to the wart every night before bed. The acid in the patch will leech down into the wart overnight. It takes a week or so, but eventually the acid kills the wart—problem solved.”

“Where do we get that?”

“You can buy it over the counter at the pharmacy.”

“Should we come back to see you after treatment?”

“Only if you’re not making headway. In that case, we’ll have to talk about tossing dead cats into the cemetery at midnight,” I smile.

The girl looks at me with wide eyes. “What kind of treatment is that?” she whispers.

“An old-fashioned one. It’s described in The Adventures of Tom Sawyer. You can read up on it if you like.”

I’m greeted with a blank look on her face.

“You’ve heard of The Adventures of Tom Sawyer, no? Do you know who wrote it?”

Again, that blank look. After a moment’s thought, she offers a guess: “Tom Sawyer?”

“No, it’s not an autobiography. Surely you’ve heard of—well, let me ask you. Have you heard of The Adventures of Huckleberry Finn?”

She nods her head. “Sure, everybody knows Huckleberry Finn.”

“Good. Do you know who wrote The Adventures of Huckleberry Finn?”

She pulls back, thinks a moment, then says, “Tom Sawyer?”

Her mother covers her face with her hands.

“No, Tom Sawyer didn’t write Huckleberry Finn. Did you ever hear of Mark Twain?”

“Kind of,” she says. “What did he do?”

“He was an American humorist—he wrote a number of funny stories and books.”

She perks up at this news. “Cool,” she says. “So, what did he write?”

The mother’s chin is now buried in her chest.

“Mark Twain wrote The Adventures of Tom Sawyer and The Adventures of Huckleberry Finn.”

“Oh, now I get it. He was the guy who wrote the story about the dead cat in the cemetery!”

“One and the same,” I say. “If you get the chance, sometime you really ought to go to Hartford to see his house.”

“I didn’t know he lived in Hartford,” the mother says.

“Does he usually let people visit?” the girl says.

“Well,” I smile, “I don’t think he’d mind.”

The girl slips into her sandals and pulls her cellphone out of the pocket of her jeans. Soon she’s all thumbs, texting a message at lightning speed.

As I watch her walk down the hallway behind her mother, the thought occurs to me that she might be searching for Mark Twain’s FaceBook page.

Twain is credited with formulating the definition of the literary classic—a book that everyone wants to have read but nobody wants to read. He might just roll over in his grave were he to learn that 100 years after his death, some members of the youngest generation don’t even recognize the title of a classic, let alone the author or the storyline itself.

Huckleberry Finn as illustrated by True Williams for the first edition of “The Adventures of Tom Sawyer”

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“Notes from a Healer” — A lot can happen in a year

A lot can happen in a year, and sometimes those changes last a lifetime. more»

My latest installment of Notes from a HealerA Lot Can Happen in a Year — 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.

JAAPA’s 25th anniversary poetry contest winners announced

“Why poetry?” you might ask. Why indeed? Of the many venues available to validate the human condition, poetry is perhaps the most poignant. In a poem, we see the pathos of both practitioner and patient laid bare, crystallized before our eyes, whispered under the ebb and flow of our collective breath. Poetry presents the human heart with its joys and sufferings, trials and travails. But what, you might ask, does that have to do with the practice of medicine? more»

Interested readers may access the winning poems in JAAPA’s 25th anniversary poetry competition here. JAAPA is the official journal of the American Academy of Physician Assistants.

Walt Whitman, 1887

The bend in the great river

One generation passeth away, and another generation cometh, but the earth abideth forever. The sun also riseth, and the sun goeth down, and hasteth to its place where it rose. The wind goeth toward the south, and turneth about unto the north; it whirleth about continually, and the wind returneth again according to its circuits. All the rivers run into the sea; yet the sea is not full. Unto the place from whence the rivers come, thither they return again. Ecclesiastes 1:5-7

“He’s had fever for two days. He’s been so fussy, he won’t let me put him down.”

This mother looks exasperated, exhausted as well. And she’s not a new mother. This 7-month-old infant was her caboose. Up until today, she’s only brought him in for well-child care.

“Has he been eating?”

“Not well. I could only get him to take 4 ounces all day.”

“Vomiting?”

“No, no vomiting—just extreme fussiness.”

“How high has his fever been?”

“102 to 103.”

I study the infant in her arms while we talk. At this point he seems comfortable. He even smiles at me, always a good sign in my book of clinical diagnoses.

“Any one else at home sick?” I ask, reaching for my stethoscope.

“No, not at home. But we did take him to see my husband’s grandfather in the nursing home a week ago. He was bedridden with pneumonia.”

I nod and listen to the baby’s back and chest. Nothing but normal breath sounds greet my ears, another good sign.

“Let’s lay him down,” I say, standing at the head of the exam table with otoscope and tongue blade in hand. The mother pins her infant son’s arms at his sides while I peer into his ears and throat. The tympanic membranes appear pearly grey, but the throat is red and swollen with a small amount of exudate on the tonsils.

“He’s got a sore throat,” I announce. “Let me swab it and run a quick test.”

“I knew he had a sore throat from the way he was acting,” the mother muses. “He cried every time he tried to swallow.”

Even without running the test, I know that this infant has contracted a virus. It’s exceedingly rare to see strep throat in such a young child. But I need confirmatory evidence to prove it.

By the time I return with the news that the results show no strep, the baby has calmed down. Even his fever has dropped — another good sign. I tell this seasoned mother that in all likelihood her little boy will turn the corner in 24 hours. “Give him some acetaminophen, hang in there and call me tomorrow morning to let me know how he’s faring.”

“By the way,” I say, “what did his great-grandfather think of him?”

“He was pleased to see him. Could the baby have picked up pneumonia from him?”

I pause to ponder her question. “Do they know what sort of pneumonia he had?”

Tears fill the mother’s eyes. “Terminal,” she says. “He wanted to see his great-grandson before he died.”

Pneumonia, the dying man’s friend. It settles into the lungs of the exhausted aged bedridden patient and whisks him away in the night.

“When did he pass away?”

“Ten days ago.”

“I doubt that the baby contracted pneumonia from him,” I say. “The incubation period is too long, and there are no signs of a lung infection on exam.”

The mother seems reassured. She will follow my instructions and call me in morning.

One generation makes its entrance while a former one fades away. Standing at the bend in the great river, I look upstream and marvel at how the new white water cascades down over the smooth rocks as downstream the current meanders around the far oxbow and silently slips from sight.

“Pine Creek” 2011 © Brian T. Maurer