Surreal Reality: in our time

“Good pilgrim, you do wrong your hand too much,
Which mannerly devotion shows in this;
For saints have hands that pilgrims’ hands do touch,
And palm to palm is holy palmers’ kiss.” —Romeo and Juliet 1.5.102-05

“How are you doing in this time of surreal reality?” a colleague asks. In this time of the global coronaviral pandemic that two-word phrase nails it: surreal reality.

Hemingway lifted the title for his first collection of stories from the Book of Common Prayer: “Grant us peace in our time.” Instead of peace in our time, we’ve been granted surreal reality.

I just finished plowing my way through Atul Gawande’s latest New Yorker piece, “Amid the Coronavirus Crisis, A Regimen for Reentry.” He advocates using lessons learned in healthcare delivery as a template for reengaging on a societal level: hygiene measures, screening, distancing, and masks.

Those are precisely the measures we implemented at my workplace, a private pediatric practice in southern New England. Patients are screened with a series of questions over the phone and subsequent temperature measurements before being admitted to the office. Only one parent is permitted to accompany the child; both must wear masks. They are immediately escorted to a sanitized exam room for the well child visit. Providers practice good handwashing between patients before donning N-95 masks and gloves. For the first time since my house officer days, I habitually wear scrubs to work. Distancing is maintained within reason. (Even in a modified physical exam, it’s hard to keep a toddler at arm’s length.)

In primary pediatric care, this has become conventional surreal reality in our time.

It’s reminiscent of healthcare delivery, delivery room style.

Telehealth has also become standard care. We’ve had the technology to enable virtual visits for a long time. Lately, in our current surreal reality, telehealth has become an economic necessity for medical practice survival. Traditional screening tools have given way to the virtual screen: no touch, of course. Instead of a hands-on encounter, healthcare has become a conversation, albeit a virtual one.

Patients seem to be appreciative of our efforts. Most greet us with a smile; we make every effort to smile back. When asked, most say that they are holding up okay. Families are sheltering in place, parents are working from home, kids are engaged in online learning. Everyone is getting on everyone else’s nerves, but most everyone seems to be doing okay.

“We can’t complain,” a young mother tells me. “We’ve got a place to live, the kids can go outside, my husband can still work.”

“What does he do?” I ask.

“He delivers newspapers,” she says.

I ask if they’ve got enough money for food.

“We’re okay,” she says. “We can’t complain. Other folks got it a lot worse.”

The other week at the grocery store the woman standing in line behind my elderly parents told them she was paying their bill. “In honor of my grandson,” she said. “He passed away.”

Another man handed my mother a $20 gift card before he walked out the door of a local Subway shop. “For your sandwiches,” he said.

The last time my father went to the supermarket, there were only two loaves of bread left. He bought one and left the other on the shelf. “I figured somebody else might need it,” he told me.

Random acts of kindness have always been done; but lately, they seem to be more poignant.

After work I take my 3-year-old grandson out for a walk along the river. I point out the spring wildflowers, the warblers. We stop and talk to folks standing in the doorways of their houses along the street. The neighbor lady tells us to take some compost from the huge mound in her yard for our garden. Another neighbor invites us in to see the robin’s nest in the cherry tree in her back yard. She and her husband wear masks. My grandson and I practice physical distancing.

In our time of surreal reality, hugs and kisses are reserved for home.

The big tree and a jelly donut

“The men have come with their big machines to cut down the big tree on our street.  Should we go out to see them?”

My grandson claps his little hands together.  “Good!” he says.

I drape a scarf around my neck and slip my arms into my coat, then I hold his coat up for him.  “Push,” I say, and he pushes his little arms through the sleeves.  “Zip up!” I say, pulling the zipper up to his chin.  “Hold on to your hat, Harry!” I say, as I pull the woolen cap with the white letters over his head and tuck his ears underneath.

“Let’s go!” he says, racing to the door.  We step out onto the back stoop and make our way through the gate and down the driveway to the street.  Up ahead we can see the barricade and the orange sign announcing “Road Closed”.  The big trucks and the machines are parked bumper to bumper along the curb beyond.

I reach for my grandson’s hand and guide him across the street onto the grassy lot by the church.  We stand in the center of the expanse and look up the small rise to where the men are standing between the dump truck and the cherry picker.  A couple of them have sat down on the curb, hard hats in their laps, wiping their brows with their sleeves.  One tall man motions us closer.  “Does he want to see the trucks?” he asks.

“Trucks!” my grandson says, his eyes lighting up.

“He knows all their names,” I say, “dump truck, cherry picker, front loader, chipper.”

“Is your name Trouble?” one of the men asks, pointing with his chin to the letters on my grandson’s cap.

“Tell them: ‘Trouble’ is my middle name,” I say.

“Big truck!” my grandson says, pointing to the dump truck.

The men laugh.  “Come along, I’ll walk you two down past the vehicles to the end of the work zone,” the tall man says.

“Will you be taking down the other two trees as well?” I ask the man.

“No, we’ll do some heavy pruning on one and light pruning on the other.  They’ll have to come down eventually, but for right now they appear to be healthy — not like the one we took down yesterday.  A good portion of it had split off during that big wind storm we had last month.”

“Yes, we saw it lying in the street.  I tried to count the rings in the stump, but it’s so scarred and uneven.  How old do you figure it was?”

“Hard to say.  These trees were probably planted around the same time that the church was built — 1881 or thereabouts, somewhere around 140 years, give or take.  Maples usually last a century and a half, so that’s about right.”

“I guess everything has its allotted time,” I say.  “Just like us.”

The man looks off and nods his head.  “That’s right,” he says.  We walk past the barrier on the far end.  “I’m afraid you won’t be able to come back this way,” he says.  “We’ll be working again soon.”

“No problem. We can find our way back to the house around the block,” I say.

The man holds up his hand, smiles, and retraces his steps to the vehicles.  My grandson and I turn left at the corner and walk the short distance to the back of the church to see another dump truck parked in the lot.  I lift him up to see the inside of the bed.  Afterward, we walk back down to the corner to cross over to the sidewalk on the opposite side.

“Hey, Trouble!” a man’s voice booms from the work zone.  It’s the tall man again.  He approaches us with a shallow white box.  He holds it out and lifts the lid.  Two powdered jelly donuts sit nestled inside.  “Go ahead,” he says, “take one.”

My grandson looks up at the man, then he looks at me.  “It’s okay,” I say.  He reaches out his tiny hand and grabs one of the donuts.  “What do you say?” I ask him.

“Thank you,” he says.

The man smiles.  “The other one’s for you,” he says.

“Boy, oh boy,” I say, “this is our lucky day!”

The man nods his head and turns to go.  We look both ways for cars, then cross the street.  My grandson takes a small bite of his donut.  “How is it?” I ask.

“Good!” he says.

We walk down the street, eating our donuts.  “Look!” I say.  Parked in the lot outside the fire station sits a big yellow front loader.  “Come, let’s go see.”

Once more we cross the street.  The wheels on the front loader are big, about twice as high as my grandson.

“Big yellow machine!” he says, beaming as he stands in front of the big bucket, his small arm raised, half-eaten jelly donut in hand.

How does the moo cow go?

Now nearly fifteen months of age, my grandson adds new words to his vocabulary daily; his linguistic ability continues to blossom, each day filled with new surprising utterances.  Like most toddlers he has learned the names of several body parts.  When asked, he can point to his head, his hair, his eye, his ear, his nose, his tongue.  He also responds when questioned on animal sounds.  “How does the puppy dog go?” we ask. “Woof woof,” he says.  “How does the kitty cat go?”  “Meow,” he intones.  Although he has yet to learn how the moo cow goes, he readily imitates the mourning dove’s call:  “Ooh Ooh, Ooh; Ooh-ooh.”

Just his morning a colleague sent me the link to a NYT article — Cleaning Toilets, Following Rules: A Migrant Child’s Days in Detention — that profiles a number of “illegal” immigrant children separated from their parents at the U.S.-Mexican border and whisked off to any one of a number of detention centers around the country.  Some youngsters have not seen their mothers in over forty days.

Life in these centers is highly regulated according to set routines.  Children undergo strict regimentation; even the very young are expected to perform daily work tasks.  Hugging or touching other children is forbidden.  In some instances children have awoken to find a friend gone, his whereabouts unknown.  One little girl has taken to writing her mother frequent letters, which she keeps until the day when they might be reunited; she is not allowed to mail them; and even if she could, she does not know her mother’s address.

The article also notes that children receive instruction in conversational English, as well as in American civics.  Perhaps they are also taught the democratic process, where legislation is enacted by representatives bought by special interest groups and subsequently signed into law by the President to ensure fairness and justice for all, regardless of race, creed or color.  As a boy I was taught that the marble statue of Justice bore a blindfold for a reason.

As I read through this article, I found myself wondering if these children might also be taught the words enshrined on a bronze plaque in the pedestal of the Statue of Liberty:

Give us your tired, your poor, your huddled masses, yearning to breathe free.

At one point the authors of the article note that the interior of one of the larger detention facilities has been subdivided to accommodate the juvenile residents.  Partitions fall short of the common ceiling overhead, so that sound readily travels from one section of the building to another.  Every so often a child will spontaneously emit a loud mooing sound, picked up and repeated by others throughout the building, the end effect being something analogous to a cacophonous echo, like that of a herd of cattle, penned in and lowing mournfully to one another.

It has been said that the moral conscience of a nation might be measured by the way in which it treats its most vulnerable citizens:  the aged, the infirm, its children.  As one who has made it his life’s work to care for the health and well-being of children, I have come to consider all children to be part of the family of man and citizens of the world order.

My grandson has yet to learn how the moo cow goes, but we’re working on it.  Meantime, when I ask him, he readily recites the lonesome echo of the mourning dove on cue.

The worst day of your life

“I suppose you’re going to tell me that this will be the worst day of my life?”

Coming from the mouth of a 10-year-old girl whose mother had just succumbed to an opiate overdose, the child’s words carried unspoken impact.

The priest who was telling me this story said he wasn’t sure how to respond.

This was back in the day when one of his duties was to serve as chaplain for the city fire department. The firemen would call him in on those sorts of impossible cases where no one had any idea what to do; cases like this one: a 10-year-old girl unexpectedly orphaned on the spot with no apparent next-of-kin.

By the time he arrived at the sparse apartment, other tenants in the public housing complex had started to filter in, each attempting in his or her own inept way to offer condolences and comfort.

“It was like something out of a Tennessee Williams play,” the priest said. “Everyone was concerned. No one knew what to do.”

“What did you say to her?” I asked.

Momentarily, the priest’s eyes regarded an infinite point in the distance; then he collected himself.

“I thought of all the bad things that this little girl would be facing in the coming hours, days, and weeks ahead. I thought of all the not-so-good things she might be facing for the remainder of her formative years, maybe even for the rest of her adult life.”

He lapsed into silence. Then the words came again. “Suddenly, I remembered that I had just lost my own mother. I knew how it felt. It felt like the worst day of my life. That gave me the courage to tell her: yes, this would be the worst day of her life; but there was always hope that somehow things would work out for the better.”

The hint of a tear glistened in the corner of his eye.

“Those are the ones that you always remember,” I said.

“Yes,” he said. “They are.”

Sometimes in our struggle to care for others, we must first learn how to care for ourselves, how to lay down our own burdens. In facing our own suffering and accepting our own wounds, we learn how to help others heal.

Long day’s journey of the Saturday

At the beginning of this Easter weekend, I will leave my readers the thoughts of George Steiner from the concluding chapter of his book, Real Presences:

“There is one particular day in Western history about which neither historical record nor myth nor Scripture make report. It is a Saturday. And it has become the longest of days. We know of the Good Friday which Christianity holds to have been that of the Cross. But the non-Christian, the atheist, knows of it as well. This is to say that he knows of the injustice, of the interminable suffering, of the waste, of the brute enigma of ending, which so largely make up not only the historical dimension of the human condition, but the everyday fabric of our personal lives. We know, ineluctably, of the pain, of the failure of love, of the solitude which are our history and private fate. We know also about Sunday. To the Christian, the day signifies an intimation, both assured and precarious, both evident and beyond comprehension, of resurrection, of a justice and a love that have conquered death. If we are non-Christians or non-believers, we know of that Sunday in precisely analogous terms. We conceive of it as the day of liberation from inhumanity and servitude. We look to resolutions, be they therapeutic or political, be they social or messianic. The lineaments of that Sunday carry the name of hope (there is no word less deconstructible).

“But ours is the long day’s journey of the Saturday. Between suffering, aloneness, unutterable waste on the one hand and the dream of liberation, of rebirth on the other. In the face of the torture of a child, of the death of love which is Friday, even the greatest art and poetry are almost helpless. In the Utopia of the Sunday, the aesthetic will, presumably, no longer have logic or necessity. The apprehensions and figurations in the play of metaphysical imagining, in the poem and the music, which tell of pain and of hope, of the flesh which is said to taste of ash and of the spirit which is said to have the savour of fire, are always Sabbatarian. They have risen out of an immensity of waiting which is that of man. Without them, how could we be patient?”

Dinner break

“I’m heading down to the cafeteria for dinner,” I said.

The charge nurse looked up from the central desk. “Go ahead. We’re good for now.”

I padded down the hallway to the end of the ward, touched the square steel plate on the wall, walked through the open doors and caught the elevator to the ground floor.

The serving line was still open. I picked up a tray, made my selections, paid the cashier and sat down at one of the empty tables along the far wall. There were plenty of vacant seats to choose from.

Methodically, I began to eat. It had been a long afternoon, looking in on the patients on the ward, talking with concerned parents, answering pages from the ED, reviewing labs and x-rays in radiology on the third floor. I was glad for my dinner break, glad for a few moments of down time, glad for the chance to put something in my stomach.

“Mind if I join you?” I looked up at the bald-headed bearded face and motioned for him to sit down. He slid his tray onto the table and pulled out the chair. “You on for the duration?” he asked, reaching for his napkin.

“Until tomorrow morning,” I said. “Twenty-four hour shift.”

“Sometimes Sundays are quiet,” he said.

“You never know,” I smiled.

“You never do,” he said.

We ate in silence. Then he said, “You’re covering pediatrics?” I nodded. “I thought I saw you earlier in the ED.”

“I’ve been around the block a few times since the morning.”

“Haven’t we all,” he said. I noticed the name embroidered in red over the breast pocket on his white coat. “Had a gunshot wound come in mid afternoon,” he said. “Self inflicted.”

I pushed the mashed potatoes around on the plate with my fork. “Did he make it?”

“If you want to call it that,” he said. He held his fork suspended by his side and raised the index finger of his left hand to the side of his head. “Amateurs,” he said. “They don’t know anatomy.”

I lifted a forkful of food to my mouth and chewed slowly.

“The bullet entered the cranium at a shallow angle,” he said. “Spun around the inside of his head like a marble on a roulette wheel. Homogenized his grey matter like whipped jelly. Left the brainstem intact. Not much to do for that.”

I swallowed the potatoes and waited.

“I expect he’s gone by now,” the bald-headed bearded man said. “At least, I hope so.”

Suddenly, the quiet was broken: my pager went off. I pushed the button to silence the noise, read the extension and rose from the table. “Gotta go,” I said.

He raised a silent hand, as though he were offering a blessing. “Hope the rest of your night is quiet,” he said.

For some inexplicable reason, it was.

An accent of local color

I was bending down to bag a pile of dog dirt when Dennis lifted his hand in greeting as he drove by in his big white truck with the backhoe logo on the side panel.

Further along, I noticed the white truck parked by the curb near the old post office. As Daisy and I crossed the village green, Dennis came out of the package store with a number of lotto tickets in his hand.

“I saw you pickin’ up your dog’s shit,” Dennis said. “That’s good to see. So many folks don’t bother. There’s piles of dog shit along the sidewalks all over town. There used to be piles of dog shit in the cemetery, too. Father Flower put a stop to that. You remember Father Flower? ‘Dennis,’ he’d say, ‘you see any people in the cemetery with their dogs, tell ’em to pick up their dogs’ shit and vamoose.’ People ought to know better.”

“Yes, indeed,” I said.

“I take care of the cemetery,” Dennis continued. “I cut the grass in summer, blow the leaves in fall, plow the driveways in winter. I put up a memorial wreath down there this afternoon — donated it with my own money.”

“That was good of you,” I said.

“Paul Duclos used to drive down every day to check on the flag, make sure it wasn’t tethered on the pole. If it was torn, he’d replace it with a new one. Never asked anyone for a dime neither. Now he’s gone, I figure someone ought to tend to it.”

“When did he pass away?”

“Couple of years ago,” Dennis said. He looked off into the distance. You could tell that his salt and pepper beard hadn’t been trimmed in months. “I saw him mowin’ his lawn late one Sunday afternoon. He looked white as a sheet. ‘What’re doing mowin’ the grass on a Sunday?’ I asked him. He said he figured he ought to cut it one last time. Next day I heard he died.”

Daisy jumped up and put her paws on Dennis’s work pants. “Upsidaisy,” Dennis said. He ran a rough hand along the dog’s head.

“My brother had a dog once,” he continued. “Nice Shepherd, got him when he was a puppy, big floppy paws,” he chuckled. “At the time my brother was livin’ in a farmhouse up in Suffield.”

“One day he come home and saw a thread through the high grass in the field behind the house. The thread led through the field over to the neighbor’s place. The neighbor’s lawn mower was sittin’ in my brother’s back yard. The dog was sittin’ beside the lawn mower.”

“Sometime after that, this dog took to trottin’ across the road to the farmhouse on the other side. He’d come home with a rake in his mouth. Next thing you know, he’d show up with a shovel. Eventually, the dog stole nearly every implement that neighbor owned.”

“That dog was so smart, he’d fetch a shovel from the back of a pickup truck on command.”

Dennis climbed up into the cab of the big white truck. He laid the lotto tickets on the seat beside him and coaxed a cigarette from the pack with his teeth. He hit the ignition, lifted his hand in farewell and pulled away from the curb.

Daisy and I watched the old white truck rattle down the street and disappear around the corner.

“Well, Daisy,” I said, “despite it being December, it’s nice to see that there’s still a bit of local color in the neighborhood.”

Down on my knees

Down on my knees
Sanding and wiping
The hard wooden porch deck
Preparing to lay a coat
Of stain
On this clear morning
After rain
A bleating of geese
Breaks through.
I pause, sit back on my haunches,
Careen my neck
To glimpse the V-formation
As they sweep overhead.
Had they heard my prayer,
If indeed I were praying?
No matter.
Grace is grace,
Wherever found.

2017©Brian T. Maurer

Returning to a place

“I’ve read that because of the drought and unseasonably warm temperatures, the fall foliage could be muted this year,” my friend said on a recent day hike.

That certainly seemed to be the case during our annual visit to Ricketts Glen State Park just days before. Although many of the leaves of the deciduous trees remained green, the foliage on most of the maples had turned a rusty brown; absent were the vibrant scarlets and vermillions we remembered from other autumns.

The lake was low as well, likely from the summer drought. The falls along Kitchen Creek, usually spectacular rushing cataracts, had turned to mere trickles over the shale rock formations. A few water striders darted about on the surfaces of shallow pools. Only the sky overhead remained a faultless blue.

I heard a couple of duck calls at eventide, but we saw none on the lake. Once, while sitting by the late afternoon campfire, I caught sight of the white triangular tail of a hawk as it disappeared through the trees. Only the chipmunks were out in force, chasing one another about the campsite. One made a hesitant approach to beg some crumbs, then scurried across the porch of our cabin to hide among the rocks.

Chickadees piped in the early mornings, and twice we noticed flocks of blackbirds rooting among the branches and leaves in the forest thickets.

Overnight the stars shone brightly, much more so than here at home.  We tagged Orion and his dogs, Taurus, the Seven Sisters, Castor and Pollux, Ursa Major and Minor, Cepheus and Cassiopeia. We rcalled the recent photos of Saturn’s rings and moons sent back across the solar system by Cassini before it plunged into the planet.

This morning I read that the fall foliage is supposed to be spectacular. Perhaps this year we had ventured into the wilds too early, I thought.

But no matter the color of her smock, nature still heals.

Sunrise, Lake Jean, 2017 © Thomas A. Doty

Dog days

“We need a dog,” my wife said.

“Not a good time for another dog,” I replied.

The memories of our deceased Jack Russell rough cut still loomed fresh in my mind. The Friday I came home after work, finding the dog pacing endless circles in the kitchen; the call to the veterinarian; the referral to the after-hours emergency veterinary service; the drive down, my wife holding the dog wrapped in a blanket in her arms. The vet watched the dog pace, suggested a shot of steroids, observation for 24 hours. We returned the next day to have the dog put down. She had paced the kitchen floor for 18 hours straight.

“No time for another dog,” I reiterated.

Two months later, after the Christmas holidays, my grown children bought a new puppy for my wife’s birthday: a dachshund-Yorkshire terrier mix. My wife took the 6-pound baby in her arms and christened her Daisy. And so we got a dog.

“We need a gate,” my wife said.

It was spring; the winter snows had melted. The snowdrops had blossomed; the crocuses were up. Daisy had explored the back yard along the paths my wife had shoveled through the deep snows. Now that the snows were gone and the paths with them, Daisy had taken to bolting down the driveway across the street and into the neighbor’s yard.

I pulled up the garage door and surveyed the scene: a collection of paraphernalia assembled over 40 years of marriage. My eyes considered the remnants of a former trellised archway, a length of 3-inch square pressure-treated lumber, a pair of hinges screwed to one of the studs by the sagging door, a roll of wire mesh, some aluminum trim. Gradually, an idea began to take shape in my mind. I gathered my tools from the basement and set myself to the task.

I measured the expanse between the edge of the house and the scalloped fence that ran along the northern border of our property, calculated the length and swing of the gate, cut the posts from scrap lumber and set them in the ground on either side of the driveway, secured the wire mesh with staples, trimmed the two trellises and mounted them with the old hinges on the posts.

Daisy watched while I worked, sniffing the boards, the wire, the wood shavings in turn. After I was done, I stood back with hands on hips to survey the completed work. Daisy regarded the structure, looked up at me, sniffed along the length of the gate, then promptly jumped over the top and bolted down the driveway into the neighbor’s yard across the street.

“You need to make it higher,” my wife said.

I salvaged the wood from a structure designed to support the growth of garden peas to add another tier atop the existing gate. The top of the gate was now even with the support posts. I stood back to survey my work. Daisy sat in the upper driveway, regarding the addition. Slowly, she approached, sniffed along the base of the structure, attempted to push her head beneath the lower tier, retracted, then promptly leaped over the gate and bounded down the driveway across the street into the neighbor’s yard.

“It’s not high enough,” my wife said.

“How high can a dachshund jump?” I asked.

“Higher than your gate,” she said.

I stood back and regarded the top tier. The wood had a series of holes bored into it to accommodate the strings that served as support lines for growing peas. I retreated to the back yard and lingered at my wife’s flower garden. The beds had been edged with series of black wrought iron pieces that formed a low fence. I pulled one section up, walked to the gate, and pushed the tines down through the existing holes in the top board. Miraculously, it fit. It also added an additional 8 inches in height to the gate.

“You’re not going to use my flower bed fence?” my wife said.

“Just an experiment,” I said. “To see if the dog can negotiate it.”

Daisy regarded the addition to the structure. Gingerly, she approached it, stood up on her hind quarters and placed her paws on the top wooden tier. She turned to look at me, then dropped back down, pacing along the gate. Finally, she sat and looked up. I stroked her floppy ears. She bounded off into the back yard and returned with a tennis ball.

Daisy sat by the gate and dropped the ball from her mouth. We both watched it roll under the gate down the long expanse of driveway into the street. It struck the far curb and came to rest.

“I guess that’ll do it,” I said, bending down to collect my tools. I carried them into the basement, stowed them in the workbench drawers and ascended the stairs. I washed up at the kitchen sink, poured myself a glass of cold water from the refrigerator and retreated to one of the rocking chairs on the front porch.

Life was good. I closed my eyes and let my mind wander. Shortly, I heard Daisy’s bark.

There she was, bounding about in the front yard, sniffing along the fence. Sharply, I called her name. She raised her head, froze momentarily, then dashed down through the bed of day lilies into the neighbor’s yard across the street.

My wife appeared at the screen door.

“She must’ve gotten out through the fence on the other side of the house,” she said. “You’ll have to make another gate.”