The Art of Medicine: Our daughters, ourselves

There she sits, fully clothed, on the examination table. She’s tall and lithe with long straight hair, high cheekbones, and slender fingers. I introduce myself, smile, and offer her my hand. It’s all she can do to flash a fleeting smile back. more»

Interested readers can now access my latest Art of Medicine column — Our daughters, ourselves — 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.

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The Art of Medicine: The source of your strength

She appears in the hallway outside the laboratory, spray bottle in hand. Dressed in hospital scrubs, she’s just arrived for the evening shift, while I’m zipping up my coat to go home. more»

Interested readers can now access my latest Art of Medicine column — The source of your strength — 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.

Le rouge et le noir

I had just gotten back from my morning walk down by the river, had just finished talking with my neighbor across the street whose dog had come down with kennel cough, just finished telling my wife that what we heard outside the kitchen window last night was most likely the neighbor’s dog’s throaty cough and not the retching of our cat who’s been missing for five days, just finished petting our dog who seems to be particularly in need of attention since the cat’s disappearance, just retired to the upstairs bedroom to stow my binoculars on the bookshelf — I had just done all that, when suddenly my wife stood before me fighting back tears.

“I found Milo,” she sobbed. “Out on the old sofa in the garage. She looks like she’s just fallen asleep.”

It had been five days since we last saw our black cat. She had all but vanished from hearth and home. And now there she was, cold and stiff, lying on the old sofa, unquestionably dead.

Six months ago she started shedding hair from her hindquarters. Gradually, it grew back in; but the new hair was mostly grey. I suppose we should have expected that, given that the cat was 20 years old.

She also started to walk with some difficulty in her rear legs. She ate less and less of her dried food. My wife started feeding her cut up chicken breast by hand. The weight loss became more obvious with the passage of time.

Last week the cat stopped drinking milk and then water. I caught her retching in the family room, but nothing came up. The litter box remained dry.

The last day I saw her, she emitted several cries, the likes of which I had never heard before. I let her out on the back porch, where she sat, waiting for my wife to come home. She allowed my wife to pet her before she slinked underneath the car. No amount of coaxing could induce her to come out. The following morning she was gone.

We searched the yard, we searched the garage, we searched her favorite haunts. We made inquiries to the neighbors. No one had seen or heard anything.

I must say that this cat gave me a run for the money over the years. If someone didn’t immediately acquiesce to her demands, she would systematically knock my wife’s antique teacups off the bureau onto the floor with her paw. She would meow loudly in the middle of the night to be let in, and then meow just as loudly to be let out. I swore I couldn’t wait until she was gone. And now she truly was.

My wife fished some plastic bags from the kitchen drawer to use as makeshift gloves. I followed her out to the garage.

In the end we eased a plastic snow shovel under the carcass to lift it off the sofa. My wife carried it out to one of the flower beds in the back yard under the shade of our neighbor’s maple tree and gently laid the remains into a freshly dug hole. I snapped off a few stalks of red flowers and laid them on top of the black fur. Le rouge et le noirI thought.

My wife filled in the hole with fresh black earth, and I dropped a flagstone on top. We disposed of the plastic bags in the trash, scrubbed up at the kitchen sink and shared the last paper towel in the roll to dry the drops from our hands.

Somehow closure is easier when you’ve got a body.

But now that she is gone, I find myself grieving for this animal that chose to fade away into the night without uttering even so much as a final audible complaint.

Ten years after

When we left the house as the party broke up last evening, I looked up at the night sky.  “Look!” I said to two of my companions, pointing up at the yellow cracks in the dark grey clouds backlit by the light of the moon.

“Apocalypse now,” one of my friends murmured.

I laughed, shrugged off his words and said good night as I slid into the seat behind the wheel of my car.

Halfway home, the full moon appeared, shining brightly in the midst of the panoramic inkblot of clouds silhouetted against a cream-colored sky.

Early this morning I awoke to peruse the NYT home page and found the words of the headline burning into the retinas at the back of my eyes:  Witness to Apocalypse: A Collective Diary — accounts of “the fall of the trade center told moment by moment and person by person drawn from the more than 600 interviews collected in the September 11, 2001 Oral History Project” — somber reading at best.

We humans mark anniversaries of birth, marriage, and death.  The first two are celebrations of joy, the latter a remembrance of loss punctuated by grief.  As anyone who has ever lost a loved one will tell you, those feelings of grief and loss tend to resurface acutely on the anniversary of the death.

Every generation has memorialized those tragic events that have served to define it in history.  The sunken ships of Pearl Harbor, the eternal flame at JFK’s grave, the black wall bearing the names of our dead in the Vietnam War; and today, ten years after 9/11, the dedication of  the World Trade Center memorial.

Certainly, the string of events on that clear blue morning of September 11, 2001, defined the first decade of the new millennium for Americans.  At the outset it ushered in a brief era of compassionate service.  It changed the way many of us would come to view the world.  It created a national paranoia, which still resides in our collective western psyche.  To a certain degree it eroded our civil liberties, spurred two unwinnable wars, and drained hundreds of billions of dollars from the U.S. treasury.

I do not wish to minimize the mourning of those who lost loved ones in the tragic events that unfolded ten years ago today.  An anniversary is a suitable time to pause and reflect on irreplaceable loss.

But perhaps with the dedication of this memorial at Ground Zero, we as a nation can choose to let the tragedy of 9/11 take its place in the queue of similar tragic historical events, and begin to move on.

Expressing the Inexpressible

In his review of The Autobiography of Mark Twain, American humorist Garrison Keillor charges that Samuel Clemens’s belated musings are “a powerful argument for writers’ burning their papers.”

While Keillor is somewhat less than kind to Sam Clemens for baiting the public for a century with the promise of his last hurrah, he recognizes some gems in this massive volume (the first of three).

“What a wee little part of a person’s life are his acts and his words!” Twain writes.  “His real life is led in his head, and is known to none but himself…. The mass of him is hidden — it and its volcanic fires that toss and boil, and never rest, night nor day. These are his life, and they are not written, and cannot be written. . . . Biographies are but the clothes and buttons of the man — the biography of the man himself cannot be written.”

Keillor concludes his review with these words: “The death of the beloved daughter far beyond her father’s love and care is a disaster from which there is no recovery. Boyishness cannot prevail, nor irreverence. The story can’t be written. The man buttons up his clothes and resigns himself to the inexpressible.”

I distinctly recall my high school physics teacher brooding over how to define a problem.  “If you can’t express it in a mathematical statement,” he said, “it simply can’t be understood.”

Some things border on the inexpressible.  While it is difficult to come to grips with grief, making the attempt sometimes pays off.  Our muddled emotions stir about inside our heads.  We define them by turning them into words, fleshing them out, even if in their final form they fall short.

A friend from the other side of the globe writes that she is wrestling with two recent tragedies, one national, one personal.  “Why do these things happen?” she asks.  “I cry deep in my heart.”

Six words that express the inexpressible.

Humane Medicine — A Grief Observed

Turning back the clock is something most of us have wished to do at one time or another. We experience the loss of a loved one, or the parent of a patient under our care takes a turn for the worse. If only we could turn back the clock, we think, everything would be just fine.

Interested readers can now access my latest Humane Medicine column, A Grief Observed, recently published in the Journal of the American Academy of Physician Assistants.