A marriage of humanity and medicine

Medical practice lay a-bed,
With fever to the core;
Sickness festered in her head,
While death passed by the door.

A string of suitors, all untrue,
Had left her bed of pain,
Parties of the third did woo—
Though not for love, but gain.

Big Pharma promised wonder drugs,
To ease the maiden’s plight,
True colors shown: this band of thugs,
Had raped her in the night.

So there she lay upon the cot,
Delirious, forsaken;
If she once had, she now had not—
Her very soul was shaken.

An ancient door eased open;
Humanity crept in
With tender thoughts unspoken
For dying medicine.

He slipped a hand in her hand,
Caressed the feverish brow;
He lingered by the night-stand,
Then turned the lantern low.

Humanity kept vigil
Close by throughout the night;
The heartbeat, once so feeble,
Had strengthened by first light.

When medicine awoke,
She stared into a face
That whispered words of comfort
And emanated grace.

So medicine was married,
Humanity, the groom;
Their grateful patients tarried
At tables in the room.

Now this is but a fable,
It never came to be—
Though fictions often lead to facts,
And blind men sometimes see.

2012 © Brian T. Maurer

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Winter advisory

"Winter Window" 2012 © Brian T. Maurer

Since acquiring an iPad, I’ve gotten used to checking the Weather Channel app every night before retiring. Most times the predictions are humdrum, but every once in a while I’m brought up short by an unanticipated forecast.

Last night the app carried a winter weather advisory. A major storm would strike our area shortly before noon today. The advisory called for 3 – 5 inches of snow over the course of the afternoon and night, ending in sleet and freezing rain.

I got up early this morning to run several errands before the storm. I topped off the tank in my car and brought back additional gasoline in a 2-gallon container for the snow blower, should the need arise. I pulled the snow shovels out of the garage and cleared extraneous debris from the driveway. Last night my wife had made a big pot of chicken soup for dinner. I turned on the burner and let it simmer. After working outside in the cold, there’s nothing like coming in to a bowl of steaming soup .

I gave myself a pat on the back, pleased that I had been able to prepare for the weather in advance. But even the best laid plans can’t anticipate everything.

Mid-morning I stared at a reply that popped up shortly after I e-mailed the editor at one of the medical journals I write for. Entitled “Away,” the automated message informed me that the editor would be indisposed for an undetermined period of time. Several personal contacts were listed, among them his spouse and granddaughter—not the sort of contacts that you would typically find in an automated e-mail.

Immediately, I shot off a couple of messages to some friends, asking whether they’d heard anything recently about the state of this editor’s health. I’m probably jumping to conclusions, I muttered under my breath as I pounded the keyboard; but I couldn’t help it—my clinical nose was twitching. I feared something was up.

The snow started to fall shortly before noon. Within an hour the yard was blanketed white. Snow lay on the bare branches of the maples in back of the house and accumulated on the cars parked in the street. Outside the window of my office it continued to come down steadily. This was certainly no ordinary snow, I mused, recalling the advisory. Such a rate of descent portended more than a mere dusting.

Another message popped into my Inbox. This one was from the editorial assistant. She confirmed my fears: the editor was indeed in the hospital. She didn’t know the particulars. She imagined that he wanted to keep things quiet—no fanfare, no fuss. She admitted that she was worried too. She would let me know as soon as she heard anything more. Meanwhile, outside the snow continued to fall.

Soup—piping hot, chocked full of fine noodles with bits of celery, carrots and corn. I lifted a spoonful from the edge of the shallow bowl to my lips and blew softly to cool it off. The dog perched at my side, eyeing the spoon and begging for cracker crumbs.

Years ago a friend and I had visited the editor at his townhouse. For lunch he had warmed up some homemade soup on the stove.

How different the hospital must have looked through his eyes from the bed. This esteemed professor emeritus who had attended so many patients over the course of his lengthy career was now at the mercy of his own attending physicians, a patient himself.

A thick layer of heavy wet snow accumulated on the driveway. I downed a cup of fresh brewed coffee, pulled on my cap and coat and stepped outside into the winter whiteness. I grabbed the shovel on the back porch and started pushing the snow off the driveway, herring-boning my way down the long expanse of macadam to the street. As I worked the snow continued to descend. The wet snow stuck to my woolen cap and my coat; soon I was blanketed with the wet whiteness.

“Do you tip your barber?” the editor had written after reading the manuscript of my piece Haircut. “I still do, though people tell me it’s no longer done.”

“When I read your latest, I was reminded of the stout cigars I used to love when I was stationed overseas.”

“Crafted with your characteristic twist, served up with a touch of grace—imprimatur!

Imprimatur!—that was his stamp of approval: Let it be printed! I learned a bit of Latin phraseology through our casual correspondence. He was a wonderful mentor, even when he wasn’t aware that he was teaching.

By the time I reached the street the upper driveway was once again covered in snow. I shouldered my shovel and trudged back to the top. For the second time that morning I threw myself into my work.

Afterwards, I pulled the car into the driveway off the street. My wife let our little white terrier out and handed me the leash. We took a short walk around the block. Several times the dog stopped to shake the snow from her rough coat. She bounded through the snow like a miniature sheep, tugging at her leash.

Back home I brushed the snow from my cap and coat in the mud room. I dried the dog with an old towel, kicked off my boots and stepped into the warm kitchen. The soup still simmered on the back burner of the stove.

I hurried upstairs to check my e-mail. A new message from the editorial assistant informed me that the editor had suffered a stroke during cardiac catheterization. No one knew anything more at that point. I dashed off a quick reply, thanking her for the timely update.

Outside the snow continues to descend. The bare maple branches bend precariously under the weight of the wet snow. It will only be a matter of time until one of the weaker ones snaps.

Poetry in medicine: Chapter and verse

In a previously published Musings blog entry, A plea for poetry in medical practice, I wrote:

Poetry (as well as good literature) is capable of stimulating the development of empathy in the reader—in this case, the clinician—and serves to enable him or her to approach the patient with an element of understanding and compassion. Such an approach undergirds the delivery of quality medical care.

In that piece I advocated for the inclusion of poetry in the medical curriculum to cultivate empathy on the part of clinicians toward their patients:

“It isn’t that clinicians are totally thoughtless people,” I opined. “In many instances they just never learned to appreciate what it might be like to stand in the patient’s shoes.”

On the heels of these words how heartened I was to peruse Dr. Pauline Chen’s recent New York Times column The Doctor as Poet, for here Dr. Chen expresses the same sentiment. more»

Author to speak at 6th annual Cell2Soul retreat

Author Brian T. Maurer is slated to speak at the 6th annual Cell2Soul retreat to be held at Sheep Hill conference center, Williamstown, Massachusetts, the weekend of October 1 – 2, 2011.

Maurer will deliver a short talk entitled “Donning the Yoke” on Sunday morning, October 2nd.

Additional topics at this year’s gathering include the medical humanities, surviving survivorship, absolute self-care, dignifying dementia, navigating madness, the odyssey of coyote medicine, and sacred undertakings.

Readers interested in additional information can access it here.

A plea for poetry in medical practice

I was pleased as punch to peruse New York Times executive editor Bill Keller’s delightful essay on the relevance of poetry, I Yield My Time to the Gentleman From Stratford-Upon-Avon. Here Keller expounds on the relative weight that a seemingly small, insignificant seminar carried in his course of summer study at the Wharton School of Business.

In my book we would do well to advocate for the inclusion of poetry in the medical curriculum—for largely the same reasons.  more»

The Naïve Narrative

In his recent column In Defense of Naïve Reading, Professor Robert Pippin speaks to the state of literary criticism as it is taught on university campuses. His contention is that, although the current trend is to scrutinize the literary arts through the lens of the natural scientific research model — with the ultimate end of developing a “science of meaning” — creative works themselves were never crafted to serve research. Rather, their authors penned them as works of art, works meant to speak to us at the deepest level of our being.

In Pippin’s words: “Literature and the arts have a dimension unique in the academy, not shared by the objects studied, or ‘researched’ by our scientific brethren. They invite or invoke, at a kind of ‘first level,’ an aesthetic experience that is by its nature resistant to restatement in more formalized, theoretical or generalizing language.”

Pippin goes on to say: “Likewise ─ and this is a much more controversial thesis ─ such works also can directly deliver a kind of practical knowledge and self-understanding not available from a third person or more general formulation of such knowledge.”

I was reminded of these words during small group discussion at our recent Cell2Soul gathering on Nantucket. One of the presenters, a young physician, published author and director of a narrative medicine course, put forth his observations on illness. Illness, he maintained, separates us from our bodies. Illness diminishes us physically and morally. Illness alters the way we perceive the world and our place in it. Illness threatens us at the core of our being.

This young physician examined illness in various spheres of influence: illness and the self, illness in the doctor-patient relationship, illness and the family unit, illness and the community. He is working to formulate a theory of illness and its impact on the individual, the family, the community and society, in part to provide a framework for and justification of the study of narrative medicine in the medical school curriculum.

I applaud his efforts. In academic settings it is always necessary to justify what students need to learn to become competent in their chosen careers. A well-developed theory lends credence to academic study — and ultimately, acceptance of the particular discipline. In Pippin’s words: “We certainly need a theory about how artistic works mean anything at all, why or in what sense, reading a novel, say, is different than reading a detailed case history.”

When I engaged him in further discussion, the young physician maintained that the illness narrative could not stand alone by itself. It is too soft a subject to garner academic recognition.

Personally, I believe that narrative, like art, whether in written, cinematic, poetic or visual format, is sufficient to speak by itself. Although narrative understandably deals with the particular, it encompasses the universal, and so becomes relevant on a profound level.

Simple vignettes, simple narratives, in the hands of a skilled teacher, can be used to impart universal truths — scientific or moral — which every clinician needs to learn.