Communal grief

“Use’ ta be the fambly was fust. It ain’t so now. It’s anybody.” —Ma Joad in “The Grapes of Wrath”

I pull up to where the town cop stands in the wide expanse of macadam, roll down my window and look up into his face. He’s sucking on something; it might be a plum pit. Whatever it is, he spits it out into a loosely clenched hand. “Just to let you know,” he says, matter-of-factly, “it’ll be at least a two-and-a-half-hour wait. The line runs all the way around the back, and that doesn’t include the folks on the inside.”

I nod my head, drive to the back of the parking lot and pull into an empty space. I leave the windows down a crack, lock the car and walk across the way to the end of the line. The folks at the back acknowledge me with nods of their heads. Shortly, I hear footsteps behind me.

“Dr Brian, we meet again — for the second time in 24 hours.”

I turn and face the father whom I had seen the previous evening at the after-hours care center. He had brought his little girl in after discovering that she had eaten a combination of cough drops and cold tablets. Thankfully, the ingredients were largely inert.

“How’s your daughter?” I ask.

“Oh fine, ornery as ever,” he smiles. Then he says: “Wish we were meeting under happier circumstances today.”

I drop my eyes and shake my head. “I just found out from a former co-worker at the old practice. I missed the obit in the paper.”

“I figured it would be jam-packed,” the father says. “They said that when the doors opened four hours ago, there were already fifty people here.” He glances at his watch. “Seven-thirty now. Looks like it’ll be at least another two hours before we get inside.”

We inch forward as other people step in line behind us.

“It’s bad enough when an elderly person passes away. He was only seventeen years old.”

“Did you know the family?”

“We all grew up together in the same part of town. I went to school with his uncle. I guess everybody’s a wreck.”

“Rightly so. I can’t imagine….”

“I’m regional director for a hospice program,” he says. “We deal with a lot of veterans. It’s tough when one of them goes. We had one fellow who was terminal, no family, all his buddies were gone. It was sad. We asked him if there was anything he really wanted to do. He said he wanted to ride down Main Street in the town where he grew up. We contacted the local VFW. Over two hundred vets showed up to line the street when they drove him through — quite a moment.”

We stand together in silence. The line inches along. People exit the building. One woman hails the father I have been talking with. I recognize her voice. She looks different from when I last saw her, but the voice is unmistakably the same. Twenty-five years ago we worked together in the same office. I had taken care of her children at that time. She crosses the parking lot and disappears behind the rows of vehicles.

The line moves forward. Finally, we reach the entrance. A man in a business suit opens the door and ushers us into the closeness of the foyer. The line of humanity snakes in and out of rooms adjacent to the hallway.

I study the faces as we inch along: familiar faces, all in line; brief smiles, acknowledgements, nods of the head — former patients, former families with whom I had at one time sat in small examination rooms over the past four decades.

But today I am not their healer; today I am not their doctor. Today I have come as a fellow mourner to pay my respects to the family of man and share in the communal grief.

Cookies

“We need to have you upload your electronic signature into the EMR,” the office manager tells me. “I’ve got the file stored on my desktop. You can log in, and I’ll walk you through the process.”

I slide into the chair at her desk and log in to my account. “Click on the gear icon at the top of the screen to access the drop-down menu,” the office manager says. A few clicks later the upload is complete.

“Good, another task accomplished,” she says. “Would you like a cookie? I baked them myself: oatmeal-raisin-chocolate chip.”

“Thanks,” I say, reaching an ample specimen from the zip-lock bag on her desk. I push back in the chair and savor the first melt-in-your-mouth bite.

“How are they?”

“Wonderful! Just the thing for a mid-morning pick-me-up.”

“We don’t do a lot of treats in the office — everyone seems to be watching their weight — but it is nice to have a sugar boost every once in a while.”

Thoughtfully, I savor another bite. “You could consider addressing both of those issues by adding a cookie icon to the EMR drop-down menu,” I muse. “Anytime a staff member feels the need for a snack, they could log on, access the menu, click on the cookie icon and voilà! — an instant calorie-free pick-me-up.”

The office manager studies my face with a mixture of awe and disbelief. She opens her mouth, as if to utter a comment; then quietly closes it.

“The only thing is,” I add, happily munching the final few crumbs of my treat, “you would have to be sure to change the browser settings to accept cookies.”

Morning portrait

A cold front had moved in overnight; overhead, wispy cirrus clouds dotted the sky.

The surface of the river lay finely polished at first light. Already the waxwings were flitting about, performing their aerial acrobatics high above the water. Directly opposite, near the entrance to the cove, a great blue heron rose up with a series of sharp squawks.

As I emerged from the trees and stepped out onto the sandy point, a gaggle of Canada geese waddled into the water. Out in the middle of the river a large heavy bird was already bleating a warning.

One by one the geese paddled toward him as he led the gaggle upstream, sounding off with a good deal of regularity. His honks were echoed by another goose close behind. The two took turns, the second playing off the lead, until at one point the honks overlapped and merged into one.

Steadily, the others followed along behind. I counted eleven in all.

I turned and retraced my steps through the woods, skirting the duckweed-choked pond nestled beneath the trees. Nothing stirred the coarse green surface as I sauntered by.

Later, as I ascended the road toward home, a frenzied honking rose from the river behind me, filling the air. I turned and shielded my eyes.

Overhead in single file the Canada geese flew, eleven in formation, silhouetted against the rising sun.

A glimpse of grace

The morning sun had just broken through the treetops when I saw her standing motionless at the edge of the wood just outside the chain link fence that bordered the ball field. A fine mist was rising from the grassy expanse; and as the mist lifted, suddenly, there she was, standing stock still, ears erect, regarding my frozen form.

Involuntarily, my hand came up to brush a mosquito off my cheek; one of her ears simultaneously twitched. My hand came down; her ear returned to assume its vigilant post.

She turned her head momentarily to scan the forest; I shifted my stance. She dipped her nose as if to scent the grass, then brought her head up. She lifted a slender foreleg and planted a black hoof daintily back down in the grass. Slowly she walked along the edge of the wood, hesitantly high-stepping, as though she were a show horse, striding before a panel of top-hatted judges. Her coat gleamed golden brown in the sunlight against the backdrop of lemon green.

At length she reached the road that stretched before me, stopped, dipped her nose, then raised her head, turning to look at me once more. Shortly, she stepped out onto the tarmac, walked across the expanse and in one smooth leap, vaulted over the high brush into the forest.

Quietly, I edged along the road, peering into the wood. Suddenly she appeared, framed by the forest foliage, looking directly at me. Once again I froze. With a short snort the doe leapt up and disappeared through the trees.

Tightrope

Like a small performance on the high wire, there’s an art to tightrope walking in clinical practice. more»

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

Philippe Petit on the wire