Far from the madding crowd

We had thought to give it a go this past Sunday afternoon, but the wind was up and temperatures had dropped to a point where it would have been uncomfortable out on the open water.

My friend checked the weather forecast on his smartphone. “Let’s shoot for Wednesday,” he said. “It’s supposed to be clear, considerably less windy, with highs in the mid-forties.”

“Sounds good,” I said.

True to predictions, we awoke to clear skies this morning; the air a bit nippy. By midafternoon the temperature had climbed to 44 degrees.

The phone rang. “Are you still game?” my friend asked.

“I’m on,” I said.

We pulled away from the curb in front of his house at 3:30 PM with his old blue Old Town canoe strapped to the roof rack and headed for Curtis Park.

“I can’t believe the river is so low,” I said. “It must be down at least four feet.”

“They haven’t been able to release any water from the dams because of the drought this summer.”

A brisk breeze was blowing against the current.

“Let’s head upstream,” my friend said. “We’ll have a tail wind, and hopefully the current will help us a bit coming back.”

We pushed off from the bank and swung the bow into the current. Clusters of leaves floated in arcs on the water. You could see the river bottom matted with yellows and browns that had lately hung suspended from branches above the banks on either side.

Up ahead a big hawk dropped off a high bleached branch and flew off through the far trees.

We dug our paddles deeper and pulled with rhythmic stokes against the current with the wind at our backs.

“It’s not too bad once you get your arms moving,” my friend said.

I was glad I had thought to don my long underwear and layer extra clothing against the cold.

A lone grey blue heron lifted off the branch of a tree half submerged up along the far bank.

“Lots of fallen wood in this section,” my friend said. “Great for bass and trout.”

We paddled for a good hour before checking the time.

“I guess we should turn now if we want to get back before dark.”

I feathered my paddle momentarily, then swung it in a wide arc to bring the bow around.


Downstream below the bend a black Labrador waded near the bank, lapping up great gulps of water. We heard a whistle sound, and the dog bounded up the bank. Shortly, the pom-pom of two shotgun blasts deafened our ears.

“They’re out hunting pheasant in the fields,” my friend said. “Small game season opened the other week.”

Another large hawk soared overhead and disappeared into the trees.

A sudden sound of nails rattling in a bag shot across the water. I scoured the sparse foliage for a small dark blue bird with a white collar and sighted him as he dropped off his perch and flew downstream.

We chased the kingfisher all the way back to the boat launch, pleased to endure his ceaseless cackles and scoldings.

A good autumn afternoon: two hours on the open water, far from the madding crowd.



“My fiftieth year had come and gone,
I sat, a solitary man,
In a crowded London shop,
An open book and empty cup
On the marble table-top.
While on the shop and street I gazed
My body of a sudden blazed;
And twenty minutes more or less
It seemed, so great my happiness,
That I was blessed and could bless.”

—W. B. Yeats, Vacillation, Part IV

We cared for each other once — I thought, as I surveyed my former classmates seated at rows of tables — way back when we were young, so long ago that perhaps it might have been only yesterday.

Why do we come, I wondered; why do we periodically gather together in our later years? To boast of our accomplishments? To brag about our children? Some might; but personally, I experienced little of that.

Mostly, I think we gather to touch a common base that once we were a part of, a community of sorts, a home. Our gatherings become periodic homecomings, where we eat and drink, sit and reminisce, tell our stories, and listen.

The stories themselves can become quite intimate. Suddenly, in the moment, we are prone to share beyond what we might have felt we comfortably could. “I didn’t graduate with our class,” one woman told me. “I got pregnant, dropped out, had my baby, then went back to complete my GED. I got a good job with the state, and then after 40 years, I retired. Life is good.”

“In high school I was painfully shy,” a man at the top of his profession told me. I had always considered him to be quietly reserved.

“You will always hold a piece of my heart,” another woman whispered, as she hugged me at the end of the evening before we left.

In each interaction I felt blessed, blessed that some folks I hadn’t seen in perhaps 45 years felt comfortable enough to share such intimate details of their lives with me. I trust that I may have blessed some of them just by listening attentively to their stories.

When we said our final farewells and walked out the door, overhead a full moon blazed in the clear night sky. As I looked up at that ancient glowing orb, I considered that those who came had chosen to make themselves vulnerable once again, to offer up the remnants of their broken lives to one another, perhaps in the hope of finding forgiveness and a certain undefined redemption.

In our gathering together, I felt overwhelmingly certain that some of us had indeed.

The GMENAC report and the PA profession

The GMENAC was convened in 1976 to forecast the supply and demand for physicians nationwide in 1990 and 2000. Despite the use of sophisticated analytic models, predicted trends ultimately missed the mark in breadth and scope. more»

Read more about the GMENAC report and its influence on the Physician Assistant profession in my latest entry on the Musings blog of the JAAPA editorial board here.

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

A bird’s eye view

I arise early this crisp autumn morning, determined to make a day of it.

Out the door before sunrise, I stride down Winthrop Street, cross Main and cut through the empty lot behind the pub. Sauntering over the bridge, I face an endless string of southbound traffic; but the din melts away the moment I step into the woods.

I discover a shortcut to the old blue-blazed path and follow it deeper and deeper into the wood. It crosses what had been a narrow brook, now dried up in the long summer drought. I begin the diagonal climb up the ridge below spruce and hemlock, gingerly picking my way along over stretches of broken basalt rock. It isn’t long before I reach the top.

At the summit I step off the trail onto the rocky ledge high above the gorge. At my feet runs the river; directly opposite, nestled among the maples and oaks, lies the hamlet, now partially illuminated in the morning sun.


Off to the west a blanket of grey mist floods the far valley. Directly across from where I stand, the Barndoor Hills rise up from the valley floor. Roof-lines of houses and the spires of two churches wax sharp in the morning light as the sun cuts through the stands of trees behind me.

I bring my binoculars up to pan the landscape, then let them fall gently against my chest. I drop my gaze to the river below to study the current. It meanders by the old mill, then slowly picks up speed, forming ribs of white water as it cascades down past the old bridge abutments into the gorge.

Suddenly, a shadow flashes across my eyes. I glimpse an airborne form floating over the river below. A big black bird pumps its broad wings, then soars through the air, its white head and alabaster tail blazing in the sunlight.

Momentarily mesmerized, I scramble to reach the binoculars at my chest. I ease the eagle into focus and follow the final few wing beats before it disappears around the distant bend.


The Art of Medicine: A distant close encounter

I glance at the encounter form and step into the examination room. A young boy sits on the examination table. A man, presumably his father, stands off to the side by the back window, chatting on his smartphone. more»

Interested readers can now access my latest Art of Medicine column — A distant close encounter — recently published in the Journal of the American Academy of Physician Assistants.

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