The Art of Medicine — Something old, something new

It isn’t easy shifting gears at age 60. I always thought I would finish out my last few years in the pediatric practice I had helped to grow 20 years ago. But fate dealt me a different hand. more»

Interested readers can now access my latest Art of Medicine column — Something old, something new — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

Fox run

While out on an early morning saunter, I rounded a curve in the road to witness a furry bundle tumble four feet from the top of a retaining wall to the grassy turf below.

The ball unfolded, sat up and shook its head, as though momentarily stunned; then looked directly at me and froze.

There we stood stock still, eyeing each other for an eternal moment, before he turned and trotted off across the road and over the grassy expanse into the wood — a red fox, a juvenile most assuredly.

He was uniform in color, reddish grey, with neither a white tip on his tail nor black tipped ears.  The paws seemed oversized, like those of a puppy; and he ran with a lollop, like that of a young dog.

This is the third time I have sighted fox in this stretch of road. Most likely they return to their den from their nocturnal foraging along this run.

It’s heartening to see a young fox in the spring — a sign of health in the surrounding forest.

Sunrise concert, evening show

At dawn the eastern sky resembles a blackburnian warbler‘s throat: brilliant orange streaked with black.

At first light the mockingbirds rehearse their couplets, triplets and quatrains in preparation for their morning debut: practice makes perfect, though a more perfect rendition at dawn you would be hard-pressed to find. The catbirds chime in with a more subdued supporting role, dressed in their grey suits and black caps. High above in the tops of towering maples the warbling vireos announce the morning performance, while wood thrush offer their fluid trills in secluded spots backstage down by the river.

As I head back home from my morning saunter, I pause by the graveyard to listen to the lusty calls of a mockingbird perched on the tip-top branch of a towering spruce aglow in the rising sun. Over and over he sings, periodically spreading his wings, lifting momentarily into the air, displaying his signature white wing bars, then dropping back down onto the branch. Even he, it seems, has entered into the joy of his Lord.

The morning air stirs the leaves on our Japanese maple as slanted sunlight filters through the branches: a living stained-glass window in the outdoor chapel of the front yard. Scattered in the new grass near the base, forget-me-nots stand on tip toe, peering over the grassy blades to glimpse the rising sun.

This evening nighthawks display their aerial acrobatics above the river as a double rainbow appears in the eastern sky after the last of the late afternoon thunder showers. The folks across the street step out to take in this visual spectacle, chatting quietly among themselves; while another neighbor pauses at his grill to turn round for a reverent look.

Men still stop and stare at such infrequent unannounced transient natural phenomena, which seem to prick their spiritual senses, albeit for a few brief moments only.

On contemplating the death of a high school teacher

Mostly I remember the thermos and the pipe.

He kept both in the storage room behind the massive black slate counter that sat at the front of the chemistry classroom. A big man with reddish-brown hair that hinted a Scotch-Irish ancestry, he towered behind that counter when he taught, frequently using the overhead projector to illustrate chemical formulae — compositions of molecules and thermodynamic equations. During breaks or between classes, he would step into the storage room for a cup of warm coffee from the thermos or a draw on his briar pipe.

His father had been a chemist before him and worked for one of the industrial giants. He hinted that at one time his dad had made a number of discoveries in the company laboratories, discoveries which remained with the firm and for which he received little recognition — monetary or otherwise. This was a source of great consternation for him.

He had done a stint in the army early in life, as was the case with many young men of that era, and served in Korea. After discharge, he remained in the reserve, serving with a unit at Fort Indiantown Gap. The additional income came in handy for a family of six, and at some point in one of our conversations he confided in me that staying on in the military helped to keep him young.

He and his young wife bought a big old home near the center of Linglestown, which I visited on occasion when I was home on leave from the service. As I recall, the big white house had an expansive back yard with a small orchard of sorts. We spent an evening in conversation over a bottle of Chivas Regal which I had brought as a gift. The bottle didn’t last the night. I ended up sleeping over on the couch, none the worse for a time of extended discussion.

One evening while I was still in high school we attended some sort of educational dinner sponsored by industry. He drove us to the function in his old car, which he used to joke could run on kerosene. I don’t remember much of the evening, only the pleasure of the company of older and I assumed wiser men.

When I told him I wanted to study biology, he retorted that I should press on for a career in medicine. “Why would you want to know about a bug crawling around on the ground, when you can study the complexities of the human body?” he argued. Now here I am in my 35th year of medical practice, contemplating retirement.

Later he would write a letter of recommendation for me to attend a small undergraduate school known for its forte in the sciences. “I had to tone it down a bit,” he said. “The first draft made you look too much like a saint.”

During one of our after-school conversations, he pointed out several good-looking girls in my class. He counseled me that a young man should not be too quick to commit to any one young lady in particular. Playing the field was a wiser approach. Indeed, that is how one amassed what in those days was known as a little black book.

We spoke about literary subjects. He told me about Hemingway’s success as a young man. “‘The Sun Also Rises’ was a good first novel, but it was ‘A Farewell to Arms’ that cemented Hemingway’s place in the American literary canon,” he said.

Secretly, he wished to become a writer. He shared several ideas for books of his own. Some were science-fiction based — one about a cleaning woman who fell into a nocturnal time warp and was whisked away to another world to become a primordial Eve. Another drew upon his boyhood experiences, events that occurred in a wooded lot in the neighborhood where he grew up.

“I never had a whole lot of direction in life,” he told me. “In the end I had to figure things out on my own.”

Perhaps that is the way it was for most of us.

2014©Brian T. Maurer

2014©Brian T. Maurer

When we know

Nothing jolts the mind more deeply than glimpsing the subject line of an unexpected e-mail as you simultaneously come to the sudden realization that someone you had at one time known and respected is now no longer counted among the living.

There are those who mentored us in our youth, perhaps a handful of special individuals — special for their presence, their wit, their innate intelligence and their caring — those who we envision visiting again to let them know how appreciative we are of the interest they took in us as students; to reminisce about former times and to discuss the current state of the world.  We jot their names on a mental list, and tell ourselves that one day, one day soon, when we can tear ourselves away for a couple of days from the rat race that has become our life, we will look them up and pay our respects.  And then the obituary notice arrives and suddenly we realize that the opportunity has passed and will not rap on our door again.

In addition to providing me with a solid grounding in chemistry, this particular mentor taught me a way of looking at the world.  In numerous discussions after school he gave me informal lessons on various ways through which we come to understand things in life — in short, how we know what we know.  The technical term is epistemology.  I recall being so taken with this concept that as editor of our high school newspaper, I devoted a large part of an interview with this teacher to that very subject. Much later in life those same seeds appeared in an essay I authored to launch an open access online journal for humane medicine and the medical humanities, Cell2Soul.

In addition to his scientific and philosophical bent, this teacher also shared a secret desire:  he wanted to become a writer of stories, in particular science fiction.  He outlined his idea for a novel during one of our chats, a novel he was in the midst of writing at the time. Whether it was ever published or subsequently abandoned, I don’t know.

Ironically, although I posted a piece about him on this blog sometime ago, I doubt that he ever saw it.

The best I can offer is an observation that that knowledge which is imparted to us by our mentors provides a way for us to carry them forward after they are gone. If we are diligent mentors ourselves, perhaps one day these torches will also be carried and in time passed along by those we have taken the time to instruct.

Vexed by a fox

Driving home this evening along a deserted stretch of divided highway, I saw what appeared to be a fox trot across the road with some sort of rodent dangling from its mouth. He disappeared over the grassy knoll on the opposite side. I pumped the brakes and pulled a U-turn, crossing over the median strip, then drove back up the other side of the road.

Soon I saw the fox standing in the thick grass, shaking the struggling body of the small rodent back and forth in his jaws. Finally, the animal went limp and he dropped it in the grass; then proceeded to pick it up again and crush the head in his jaws. Again he dropped it; again he picked it up, dropping it one last time.

Then the fox did a curious thing. Like a small puppy, he lay down on his side and propelled himself forward with his paws through the grass for several yards, at which point he reversed direction, propelling himself back, this time on his back, revealing his white throat and belly.

He stood up with his back to me. I could see the black points on his ears and his black forelegs and bushy grey tail. Once again he dropped into the grass to perform the same maneuver over and over several more times. After he had finished, he searched for the rodent, picked it up in his mouth, chewed the carcass a bit, dropped it in the grass, trotted off up the slight incline and disappeared behind the grassy bank.

I waited to see what might happen. After a minute or two the fox reappeared, returned to the carcass as if to reassure himself that it was still there, then turned and left.

I signaled and pulled out into the right lane, then drove ahead down to the intersection. As I pulled into the left lane to make another U-turn and head home, I caught one more glimpse of the fox as he continued to trot along the grassy bank up the road.

This seemed a bit strange to me. I wondered why he chose not to devour his prey and eventually leave it behind. And why the seeming rapturous play in the grass immediately after the kill?

Of the surface of things

In my room, the world is beyond my understanding;
But when I walk I see that it consists of three or four hills and a cloud.

—Wallace Stevens, “Of the Surface of Things”

May 2, 2014

Dear Henry,

I was up at first light and slipped out the back door for my early morning saunter. I recall that you took most of your walks in the afternoon, reserving mornings for jotting down musings in your journal; but my current job mandates me to work afternoons and evenings, and so I elect to take my strolls at dawn.

Today the morning air was cool and moist. There must have been a gentle overnight rain, as the streets were still wet, glistening in the last glow of the dimming streetlights.

“Methinks that the moment my legs began to move, my thoughts began to flow.” Do you remember penning those words, Henry? I’ll wager you do.

I must confess that as I started out I found my thoughts gravitating to my workplace. I recalled your observation of self-concern: “I am alarmed when it happens that I have walked a mile into the woods bodily, without getting there in spirit…. The thought of some work will run in my head and I am not where my body is — I am out of my senses. In my walks I would fain return to my senses.” It wasn’t until I had ascended the long sloped hill that the gravelly squawk of a silhouetted starling pulled me into the present moment. When his comrade-in-arms answered opposite, I left them to their dawn discourse and commenced my descent.

As I rounded the curve, I noticed the clouds streaked along the eastern ridge — back-lit inkblots tinged with fire along their southern borders: harbingers of the dawn.

At the bottom I cut across the main street and made my way along the indistinct path, traversing ancient gnarled pine roots to the parking lot behind the white church. The piles of snow had long since receded, leaving behind sandy deposits scattered beneath the overhanging branches of the hemlocks — a dry beach of sorts, no longer subject to the tidy rivulets of melting spring snows.

Along the far lane I was chagrined to find that the stretch of rhododendron had browned out; only a few sparse green leaves held on to the promise of new life. I wondered if they might flourish this year. As I plodded down the hill lost in thought, I rounded the corner and was greeted with a breathtaking display of color.

Wispy forsythia shoots stood in full bloom at the edge of the wall. A shower of white petals from a young magnolia lay scattered across the walkway. Weeping cherries hung their pink boughs in despair — for what reason I could not fathom. I paused before them to offer a word of encouragement in silent soliloquy: “On a pleasant spring morning all your sins are forgiven!” — your words, Henry; your words.

Pine warblers chattered from lofty bristled branches overhead. Titmice chanted their mournful “Pe-ter, Pe-ter” calls, while blue jays scolded from violet-pink flowered dogwoods.

Then suddenly there it was, the one trill that never ceases to bring me up short: moist fluid bars sounding clearly from the deep wood by the river — the notes of the first wood thrush of spring. I stopped for a moment and entered eternity, remembering your words:

“This is the only bird whose note affects me like music. It lifts and exhilarates me. It is inspiring. It changes all hours to an eternal morning.”

“Whenever a man hears it he is young, and Nature is in her spring; wherever he hears it, it is a new world and a free country, and the gates of heaven are not shut against him.”

At the end of the cul-de-sac I lifted my eyes to the sky, now gashed vermilion above the eastern ridge. Turning back, you could see the yellow tops of puffy cumulus clouds glowing in the rising sun.

It’s hard to believe that you’ve been gone 152 years this month, Henry. I’m glad that you left the gift of your words for us to ponder.

In another century or so perhaps some seeker will saunter a similar route and revel in such a glorious morning as this, while we both rest beneath the moist moss at the base of a towering pine in springtime.

"Yellow on Blue" 2013©Brian T. Maurer

“Yellow on Blue” 2013©Brian T. Maurer