CHAT rooms revisited

My editor alerted me to a recent article in Pediatrics“Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)” — and asked if I might provide a bit of commentary. I obliged with a few revised thoughts on developmental surveillance and screening in the pediatric patient. more»

For those readers who aren’t familiar with the tool, the M-CHAT is a screening instrument designed to identify toddlers at risk for ASD — that’s Autistic Spectrum Disorder, not Atrial Septal Defect, which is a different problem entirely, diagnosed using the grey matter between the ear pieces of a stethoscope in lieu of a parental questionnaire.

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“Reir hasta el llanto” — Laugh until you cry

It’s been a bit of a rough stretch these past few days after the announcement of Robin Williams’ death by suicide. Like many of my colleagues and friends, I’ve been struggling to maintain myself in the wake of overwhelming sadness.

How could someone so upbeat, so sharp, so funny, have taken his own life?

Robin Williams was the comedian for my generation. His extemporaneous rapid-fire deliveries cracked us up. (I still recall that incomparable line his character uttered when caught behind enemy lines in “Good Morning, Vietnam” — “This isn’t going to look good on a résumé!”) During his hilarious free associations Williams pulled us out of ourselves and made us temporarily forget our troubles. Yet he himself died as a result of overwhelming depression.

A good many comedians harbor hidden sadness; many struggle to maintain themselves in the face of personal despair. I think of Red Skelton and Carroll O’Connor: both suffered the death of a son during their professional careers.

Freud reportedly observed that wherever he went, a poet had been there first.

All of this brought to mind a poem by Juan de Dios Peza, Reir Llorando.

The opening lines allude to Garrick, an English comedian —

el más gracioso de la tierra y el más feliz

— who acknowledged public applause with a hearty laugh of his own. Even the most distraught noblemen would double over, cackling and guffawing during Garrick’s performances.

The poem then goes on to relate the tale of a man suffering from chronic melancholia who consults a famous doctor known for his clinical expertise, hoping for a cure for his depression. The doctor takes a careful medical history, ascertains that his patient is indeed overwhelmingly depressed, and begins to offer suggestions for treatment. But everything he advises his patient to do, the man has already tried, to no avail. Finally, the doctor prescribes an evening out to a performance of Garrick, the world-famous comedian, who will undoubtedly lift his spirits.

“It won’t work,” the man explains. “You see, I am Garrick.”

The proverbial funny man is impotent to lift his own spirits.

Nada me causa encanto ni atractivo;
no me importan mi nombre ni mi suerte;
en un eterno spleen muriendo vivo,
y es mi única pasión la de la muerte.

“Nothing enchants or attracts me;
Neither name nor luck are important;
In an eternal melancholia I live dying,
My only passion is the thought of death.”

The poet goes on to lament those who are downcast in this life:

¡Cúantos hay que, cansados de la vida,
enfermos de pesar, muertos de tedio,
hacen reir como el autor suicida
sin encontrar para su mal remedio!

“How many are there, tired of this life,
Sick of its weight, dying of tedium,
Who goad themselves to laugh like the suicide
Finding no relief for their despair.”

Here are Dios Peza’s last three stanzas with my translation:

¡Ay ! ¡ Cuántas veces al reír se llora!..
¡Nadie en lo alegre de la risa fíe,
porque en los seres que el dolor devora
el alma llora cuando el rostro rie!

“Ay! How often one cries in laughter!…
No one trusts in the happy smile,
Because in those whom pain devours
The soul cries out when the face laughs!”

Si se muere la fe, si huye la calma,
si sólo abrojos nuestras plantas pisa
lanza a la faz la tempestad del alma
un relámpago triste: la sonrisa.

“If faith should die and calmness should flee,
If the soles of our feet tread only on thistles,
Then cast on your face the tempest of the soul
a sad lightning bolt: the smile.”

El carnaval del mundo engaña tanto;
que las vidas son breves mascaradas;
aquí aprendemos a reír con llanto
y también a llorar con carcajadas.

“The carnival of this world well tricks us;
Our lives are masked in brief;
Here we learn to laugh with weeping
and in our laughter hide our grief.”

Freud was right: Dios Peza’s quatrains describe Robin Williams’ soulful life to a tee.

How poignantly they speak to me in this time of collective grief!

Author to address Quinnipiac PA program class of 2014

Brian T. Maurer has been invited to address the graduating class of the Quinnipiac Physician Assistant program at nine o’clock in the morning on Monday, August 4, 2014.

He will speak to the new graduates on “Something of Value: The Art of Medicine.” Maurer’s presentation will include insights from his 35 years of practice in pediatric medicine, crafted in his book, Patients Are a Virtue.

“We learn the practice of medicine through the complex process of integrating knowledge and skills with wisdom and insight in our interaction with the patient. Although the medical record forms a composite history of the patient’s illness; for the clinician, it may be the illness narrative that ultimately imparts some degree of healing to both practitioner and patient alike.”

“You have learned the science of medicine; you have delved into its business. Now it is time to recall the art of its practice, for it is only in the practice of the art of medicine that you will sustain yourselves from day-to-day over the span of your professional careers.”