The blue moon

“Blue Moon Rising” 2012 © Arthur Drescher

I arose early, pulled on my pants and shirt and dashed out the back door down the street to the hill that overlooks the valley to catch a glimpse of the orange moon before it set.

Folk lore has it that the second full moon in the same month is called a blue moon, but the Maine Farmers’ Almanac defines it differently. The third full moon in any given quarter where there are four full moons is referred to as the blue moon.

In the economy of the ancients the tropical year began with the winter solstice or “Yule.” From this point of reference the remainder of the year was defined by the vernal equinox, the summer solstice and the autumnal equinox.

In any given quarter there are usually three full moons. On those rare occasions when there are four, the third full moon is called the blue moon.

According to the calendar, there will be one blue moon in 2012 (tonight) and one in 2013 (in August, the same month).

Either this evening or perhaps early tomorrow morning I hope to witness this year’s blue moon as it rises and sets opposite the sun.

An aerial dance at eventide

My daughter and I were sitting out on the front porch with the dog at our feet when out of the corner of my eye I glimpsed them — silhouettes soaring overhead against the backdrop of fading blue sky, their bent wings trembling in the clear air of eventide.

Nighthawks!” I whispered, pointing out the darting forms.

“Look at all of them,” my daughter said.  “There must be ten or twelve at least.”

“More than that,” I mused. “Maybe twenty.”

We left the comfort of the chairs and descended to the front walk.  The sky was full of them, flitting back and forth, their white wing bars flashing in the evening sunlight.

“What are they doing?”

“Feeding, I imagine.”

“I didn’t know insects flew that high.”

We watched their aerial acrobatics for fifteen minutes before they soared off, still pursuing their invisible prey.

“I’ve never seen so many at one time before.”

“I have — in springtime, above the river before it drops into the gorge. They’re probably preparing for the fall migration. Soon the hummingbirds and hawks will follow.”

Early signs of autumn amidst the close fading days of summer.

After work

It was not a particularly stressful Saturday morning to work in the office. Only three prescheduled physical examinations and a handful of sick children came in by morning’s end.

One child, a 1-month-old, my first patient of the morning, had colic. His mother reported that he wanted to feed constantly; whenever she didn’t give him a bottle he fretted, sucking on his fingers and hands. I had evaluated him one week ago for similar complaints. Since then the child gained 1-1/4 pounds, nearly three times the expected weekly weight gain. Obviously, she was overfeeding him. I suspected that part of the reason might have been because her first child was born prematurely and had a difficult time gaining weight.

Mothers nurture through feeding; a thriving baby exemplifies good maternal care, but sometimes too much of a good thing is not best.

As the morning wound down I ruminated behind my desk and reviewed the remainder of outstanding laboratory reports, signed off on a stack of physical examination forms and phoned in prescription renewals. The medical assistants finished with the filing and departed, locking the front door behind them.

I snugged the bow tie at the base of my throat, picked up my blue blazer and stepped out the side door. It was a short drive to the funeral home. By the time I arrived the lot was nearly filled with vehicles.

Inside people milled about, speaking in low tones, touching one another briefly on the arm or shoulder, exchanging whispered words. Some paused before the large displays of photographs mounted on easels in the hallway.

I stepped into the parlor, signed the guest book and found the end of the receiving line. There were stands of flowers everywhere, roses mostly — pink and red and white — done up in intricate arrangements identified by cards signed by family, friends and well-wishers.

A small silver urn stood in the center of the table; a golden crucifix rested against it. On either side lay two stacks of books — three on the left, two on the right. I noted the author of the two on the right — medical titles reflecting her area of expertise.

Most physicians don’t leave any written creative works behind; she had left two — these two texts, in addition to her two teenaged sons, who stood in the receiving line on either side of their father. Each of the three wore a pink tie. Pink, the color of the ribbon supporting breast cancer research; pink, the color of the delicate rose in full bloom; pink, the color of fading rose petals at the close of day.

My words were inadequate — “I’m sorry for your loss” — followed by handshakes and brief smiles.

“How are things at the office?” the father asked.

“Busy,” I said. “Back to school physical exams, you know. It’s the same every fall.”

He nodded. “Thanks for stopping by.”

I left by the side door and stepped out into the heat of the early afternoon sun.

As practicing clinicians we are granted the high privilege of glimpsing the struggles of families entrusted to our care. For brief periods were share in their triumphs, their joys and ultimately, their grief.

But many times it’s the grief that seems to linger the longest.

2012 © Brian T. Maurer

What do you see?

“Poonam” by Alex Masi © 2009

This photograph of a 7-year-old girl was taken by Alex Masi near her family’s home in Bhopal, India.

Take some time to study it. What do you see?

I see the face of joyful innocence raised to gentle falling rain, hunkered down before a backdrop of filth and poverty.

For me, this one photo captures the condition of the human race.

Study the photo. What do you see?

Humane Medicine — Focusing in on an obscure diagnosis

In my youth I had visions of becoming an ophthalmologist. Nothing, I thought, could rival the anatomy and physiology of the human eye for sheer beauty and function. more»

Interested readers can now access my latest Humane Medicine column —Kitchen medicine: Focusing in on an obscure diagnosis— recently published in the Journal of the American Academy of Physician Assistants.

An assessment of digital diagnoses

When it comes to charting in the medical record, nobody writes SOAP notes anymore. In fact, faced with the EHR format, very few clinicians take the time to type a short narrative. Instead, the available boxes are checked, the Next buttons are hit, the ICD codes are entered, and voila! — the health record is virtually complete!

The only thing missing is a precise description of the condition of the suffering patient. more»

“Notes from a Healer” — The Beat Goes On

Tachycardia, episodic chest pain with shortness of breath and post-op knee pain — a tall order of problems to be sorted out in a 10-minute time slot. more»

My latest installment of Notes from a Healer — The Beat Goes On — 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.

Readjusting to medical practice in America

I write these words in a bit of a mental fog. Lying in my own bed in the early morning stillness, I unable to say with any degree of certainty whether our recent 16-day medical mission to Africa was a conjurer’s dream, or if this American life with its mundane worries and cares might actually be the illusion.

Yesterday, belatedly I flipped the page of the calendar that hangs on my bedroom closet door. The month of August bears a reproduction of Gauguin’s “Dog Before Straw-Covered Huts, 1892.” Although Gauguin painted in Tahiti, this scene could well be African; the colors certainly are. In any case the Gauguin print offers a magical window to the events of the past two weeks.

I am still on Nigerian time, five hours ahead of schedule. I become sleepy at 4 o’clock in the afternoon. Last night I forced myself to stay awake until 9:00 PM, then slept soundly until 2:30 AM. Shortly, I drifted back to sleep until 4:00 AM, when agitated, I arose, unable to endure the confines of the bed any longer.

Yesterday at the office I saw 18 patients, a mere pittance compared to the usual daily roster of 75 to 90 in Obudu and Ogoja. Yesterday my American patients came to me with their slates of worries and anxieties, for which I silently forgave each one of them on the spot, because they had no understanding, really no concept of what it means to face suffering truly every day without hope.

The one exception was the father whose young son failed his routine vision screening in the right eye. Instead of the usual red reflex, a grayish white pupil greeted my light. Over the course of the past two years this man’s wife had been diagnosed with breast cancer and his daughter developed insulin-dependent diabetes. I referred the boy to an ophthalmologist for further evaluation. This family has suffered much, and there will be more suffering to come; but at the very least there will be treatment available and the means to access it.

As yet I have not left Nigeria in my mind. I am still haunted by the faces of the suffering children I saw, children for whom I could do little from a medical standpoint. As a clinician practicing in the African bush, I could not cure dislocated hips, disfiguring keloid scars, congenital hernias the size of eggplants, hemolytic anemias, and scarred corneas. Moreover, my Nigerian patients didn’t have the resources to travel 5 hours to the nearest university hospital, let alone bear the cost of care. (In Nigeria, medical care must be paid for out-of-pocket prior to treatment.)

Although I have left Nigeria, Nigeria has not left me. She is like a child crying in the night, waiting to be comforted; rooting for a mother’s breast nowhere to be found.