As I sit at my desk, pecking out a rough draft on my computer, the small dog paws repeatedly at my thigh. I offer some temporary solace, reaching down to scratch her ears and neck. She drops down on all fours, only to rear up again shortly after my hand returns to the keyboard. Finally, I let out a short sigh and decide to pack it in: nothing short of a walk will do, it seems, even though we’ve just come back from a morning stroll around the block less than an hour ago.

I zip the collar of my fleece up to my chin, reach for my coat, don my hiking boots, pull on my wool cap and gloves, snap the leash on the dog’s collar; and we head out the back door at a brisk pace down the deserted street in the winter cold.

We turn right at the end of the block and continue down the long grey ribbon of sidewalk to the center of town. Today the school yard is barren, devoid of children. A solitary car sits in the parking lot outside the barber shop. No one, it seems, wants a haircut on this last day of the year.

We round the corner onto Main Street and wait for traffic to thin out on the highway. Despite the crosswalk, no vehicle slows or stops for us to cross. The dog shivers and lifts her nose in the cold air. Finally, the last northbound car disappears over the crest of the hill, and we scoot across the tarmac to the other side.

I let the dog off leash at the old mill and trudge along the loop of frozen gravel road to the bank of the river. Patches of white water bubble and churn in the current. Overhead, billowy clouds press against the backdrop of pure blue sky.

I snap the leash on the dog’s collar as we approach the mill. Linked together once again, we descend the short slope to the concrete retaining wall, built to withstand the torrents that continuously lash against it.

At the top of the rise we follow the great curve of road to the cul-de-sac, then hop the guard rail and pick our way through the remnants of last summer’s brush to the concrete bulwark where the old bridge once stood.

We peer over the edge into the gorge. Just below our feet white water boils against the old bridge abutments, leaping into the air as it scrubs them clean in its turbulent descent. Mesmerized I stand, unable to tear my eyes from the torrent.

We retrace our steps back to the mill, cross the deserted highway and pick up the road to where it intersects the blue-blazed trailhead. From here we follow the leaf-strewn path through the forest back down into town.

A lone dog barks and pads back and forth behind the invisible electronic fence in a front yard, his cinnamon tail erect, curled into a full arc above his back. Tragedy has come to this house over the course of the past year; the couple that had lived there has dwindled to one.

We cross the street and huff up the hill toward the house. The air is cold on my cheek. Despite the gloves my finger tips have turned numb.

We step through the back door into a warm kitchen. I pull off my cap and gloves and rub my palms together. I unzip my coat and throw it over the back of a wooden chair.

A cup of hot coffee restores feeling to my fingertips, but the turbulence of the white water in the river still churns in my soul.

Christmas presence

Christmas was meant for children; so the old song goes. It comes round every year about this time—the song, I mean—and Christmas too, of course.

When I was a child, the anticipation of Christmas waxed more and more intense as December days waned. Hours of daylight grew shorter and shorter; and the anticipation of Christmas morning became so great, it almost hurt.

Then suddenly it came, that special morning like no other in the year. Presents, picture perfect, magically appeared, nestled beneath the tree. Happily, we tore into the wrappings, then “ooh-ed” and “aah-ed” with delight as we unveiled our treasures. The exercise didn’t take long; in a moment it was all over, the anticipation evaporated. Gift-wrapped presents had morphed into things that we touched, held, played with and hugged. Now, as a grownup, I recognize that these presents were given as gestures of love.

For a week over the Thanksgiving holiday this year we hosted my niece and her husband and their little girl from Spain. My wife began making preparations weeks in advance. The house was cleaned; collections of items were donated to the Veterans and the Salvation Army; the larder was stocked, brimming with food; sleeping arrangements were made; my daughter volunteered to drive to Newark to pick our visitors up at the airport. Anticipation coursed through the household, nearly palpable. You see, my niece had announced that she was pregnant with their second child, due sometime next spring.

At 3 years of age, my grandniece chatted frequently about the coming baby. In the Spanish culture children are revered. Many times I would overhear her parents refer to my grandniece with terms of endearment: “Princesa,” “Amor,” “Vida.” My niece spoke candidly about the pregnancy. “Que milagro, el desarrollo de un niño!” she said. What a miracle, this knitting together of a child in the dark recesses of the womb!

The Spanish refer to parturition—the act of giving birth—as “dar la luz,” literally, “to give the light.” The reference makes sense: at birth the infant passes from the utter darkness of the womb out into the intense light of day.

All mothers know the pain associated with childbirth. It is acknowledged to be some of the most severe pain that a human being can suffer. (Kidney stones are close, I’m told. I’ve never had a baby, but I’ve had several kidney stones, so I feel as though I can relate.) The scriptures refer to the pain of childbirth as travail. It costs quite a bit to move an infant from utter darkness to blinding light; but in the end the suffering is forgotten, replaced by joy—the joy of witnessing the presence of precious new life.

I must confess that sometime ago I lost the delight of receiving presents at Christmas time. It’s not that I don’t appreciate the gesture behind the act of giving; it’s just that, well, at my age I really have no desire for more material possessions.

Now, as Christmas approaches, I reflect on the anticipation of presence instead—you might say the present of presence: the presence of a newborn child, clothed in flesh, which is come into the world that we humans might pass from utter darkness into the realm of exquisite light and experience joy in the morning.

Finding a voice

This morning I awoke with thoughts of Ariel on my mind. That’s Ariel, the red-headed little mermaid, of course. more»

Interested readers can now peruse my latest Musings blog — Finding a voice — at the Journal of the American Academy of Physician Assistants (JAAPA) website.

JAAPA is the official publication of the American Academy of Physician Assistants.

"Finding a voice"

“Finding a voice”

Mindful practice: Drive-through medicine

Although I recognize the need for sentiments — in both the patient and myself — many times I no longer have the luxury of time necessary to provide them. more»

Interested readers can now access my latest Mindful Practice piece — Drive-through medicine: The McDonaldization of modern medical practice — 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.

Commentary on “What a doctor is good for”

When Dr. David Loxterkamp’s BMJ article “What a doctor is good for” drew caustic comments from a couple of British physicians, as a practicing Physician Assistant I felt the need to respond.

Interested readers can access my commentary here.

The Art of Medicine: Hidden Agendas

In the clinical setting there are always hidden agendas. It takes an astute clinician to identify them. Many times students operate on a different wavelength entirely. Readers of the same novel will often come away with different takes on the narrative. Medical practice is no exception. more»

Interested readers can now access my latest Art of Medicine column — Hidden agendas — 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.