A good bit of life is learning how to deal with contingencies; the same could be said for medical practice.
My latest installment of Notes from a Healer — The Best Laid Plans — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine. Interested readers can access a list of editorial board members and regular contributors here.
She brings her 12-year-old son to the office for his sixth grade physical examination. I have not seen the boy in three years. She blames it on the health insurance—“they only cover a physical every other year now”—even though I suspect otherwise. No matter: here he sits before me, quietly waiting. >>more
My latest Notes from a Healer column — Flashback — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine. Interested readers can access a list of editorial board members and regular contributors here.
When I was a resident pursuing an elective rotation in pediatric cardiology, I met my mentor one spring afternoon at a local hospital. He escorted me down a long hallway to a bank of elevators, where we descended to the basement and traversed the tiled floor to the heavy metal door of the morgue.
My latest installment of Notes from a Healer — The Heart of the Matter — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine. Interested readers can access a list of editorial board members and regular contributors here.
I walked the avenue till my legs felt like stone
I heard the voices of friends vanished and gone
At night I could hear the blood in my veins
Black and whispering as the rain
On the streets of Philadelphia.
—Bruce Springsteen
This past weekend I did something I hadn’t done in thirty years: I took the train to Philadelphia.
The occasion for my excursion was an editorial board meeting for a national medical journal. Such meetings are held twice a year. Six months ago I flew out to San Diego for the previous one. This time round I took the train.
Friday morning I boarded a two-car commuter rail just north of Hartford, rode it to New Haven, and connected with the northeast regional to Philadelphia. In thirty years I had forgotten that trains in the northeast corridor pass through rough stretches of country—past litter strewn ravines, boarded up brick buildings, scrap yards filled with piles of junked cars, graveyards populated by the dead.
Those of us on the train—the living—sit by the windows and watch graffiti covered walls stream by or read the morning paper, listen to an iPod shuffle or text message a friend. Occasionally we rise to our feet and stagger down the central aisle to the john before picking up a coffee or a bottle of water in the café car and return to our seats.
I arrived at 30th Street station in Philadelphia that afternoon and walked thirteen blocks to the Westin Hotel on 17th Street and checked in. The remainder of the afternoon I spent exploring the city on foot. I sauntered down Chestnut Street to Independence Hall, glimpsed the Liberty Bell through the massive window, paused at the memorial in Washington Square and picked up Walnut Street on the return leg. Near Jefferson Hospital I cut up to Chestnut again and stopped at a medical bookstore to browse the titles.
My first medical mentor had attended Jefferson Medical College in the 1960s. Shortly after I got to know him in the late 1970s, he developed Hodgkin’s lymphoma.
I in turn took my medical studies at Hahnemann at Vine and Broad Streets, where I cemented a life-long friendship with another student who now practices family medicine in Arizona. At the time we both roomed on north 15th Street, although he and his wife later took another apartment ten blocks south near Spruce. My wife and I sublet from them when they were out of town for a month that second summer.
I exited the bookstore with my hands thrust deep into the pockets of my trench coat. It had started to rain; the wind was whipping up in cold wet gusts. I passed by two musicians huddled in a stone archway playing a Michael Jackson tune on their saxophones. I’ll be there, one horn soothed reassuringly, while shortly afterward its companion echoed the same soulful sentiment. I tightened the collar of my trench coat against the wind and pulled the brim of my cap down tight.
That evening I met up with my fellow editorial board members for dinner at Upstares & Sotto Varalli on South Broad. The remainder of the weekend flew by: an all day meeting in the Director’s Room at the hotel on Saturday, dinner at the Raw sushi bar on Sansom Street, a late evening demitasse of melted chocolate at the Naked Chocolate Café on Walnut.
Back in my room on the 14th floor of the hotel I stood at the window and looked down on the gleaming streets of the city. I thought about the man I had seen slumped over a makeshift cardboard sign on which was scrawled one word: “Hungry.” A tangled mass of black hair emanated from the back of his stocking cap, his coat was marred with grease stains, his ankles showed white between the tattered cuffs of his trousers and the tops of his dirty sneakers. When I dropped a few coins into the plastic bowl in his lap, he barely stirred. In thirty years the streets of Philadelphia haven’t changed much.
The cabbie I hired Sunday morning chatted in Arabic on his cell phone all the way down JFK Boulevard to 30th Street station. I tipped him a dollar and stepped out onto the wet pavement in the early morning darkness.
As we gathered at Gate 3 to make our descent to the waiting train, I noticed a young couple standing off to the side, holding hands with their foreheads touching. There are always young couples standing on station platforms, it seems; huddled together, oblivious to the rest of humanity.
Shortly after pulling out of the station we passed over the Schuylkill River. I caught a glimpse of the macadam path that runs along the bank by the boat houses. Another good friend and I attempted the Philadelphia marathon there when we were undergraduate students. I logged 18 miles before I cramped up from dehydration and dropped out of the race. Some things in life you never complete.
My mentor finally succumbed to his lymphoma this past year. I still correspond regularly with my doctor friend in Arizona. Once a year we get together for an afternoon saunter through another Pennsylvania town and catch up on our lives—far from the streets of Philadelphia.
As I back into the parking space at the edge of the wood and step outside my car, the melodic trills of a veery sound clear and sharp, descending the scale like a xylophone in the early morning air. Punctuated by a pause, the song repeats in flawless fashion. The number of notes I can not count, but the pattern is unmistakable. I stop to listen and find myself transported back in time to another summer day years ago when my friend and I spent an afternoon exploring a stretch of the Connecticut River.
We put in near Gillette Castle and paddled our kayaks north against the current to Chapman Pond. As we entered the expanse of quiet water, we passed a sentinel cormorant perched on a rock, its wings held aloft like a semaphore signaling our arrival. High overhead along the far ridge a pair of red tail hawks sailed on the updrafts. We slipped across the pond, and a gaggle of mute swans descended over our heads, wingbeats whistling through the still afternoon air.
We circled the lake before stopping to eat our snack of fresh blueberries and granola bars. I glimpsed a number of goldfinches in the treetops before we returned to the river. The waves lapped against the kayaks in the current as we drifted downstream past the rocky cliffs where eagles nest in the late winter.
Here we entered the quiet waters of Whalebone Creek and followed the meandering stream back through canals bordered on both sides by tall marsh grass to a beaver dam. It was there, at the edge of a wood, that I heard the clear sharp notes of a veery in the late afternoon shadows.
In her recent piece The Trouble With Twitter, University of Oregon adjunct instructor of journalism Melissa Hart laments: “I worry that microblogging cheats my students out of their trump card: a mindful attention to the subject in front of them, so that they can capture its sights and sounds, its smells and tactile qualities, to share with readers. How can Twittering stories from laptops and phones possibly replace the attentive journalist who tucks a digital recorder artfully under a notepad, pencil behind one ear, and gives full attention to the subject at hand?”
Sound bites — those 140-character tweets — don’t begin to do any story justice, unless they happen to have their origin in the warbled notes of a mystical woodland singer.
As I drove along the highway en route to the gym for my morning workout, I thought about the last e-mail message I had read before retiring the previous night: a former runner and high school classmate, “The Shark,” now dead at 55 from injuries sustained in a freak motorcycle accident over the July 4th holiday weekend. A vehicle pulled out in front of him as he tooled down a local highway. The driver didn’t see the oncoming bike—until it was too late.
Shortly after I crossed the bridge heading north, I noticed a slight movement in the shadows beneath the trees. My eyes picked out the silhouette of a young white-tail deer, head erect, oversized ears panning the landscape to monitor the morning sounds. I eased my foot off the accelerator and coasted by the doe, close enough to see her nose twitch. I imagined that she was waiting to cross the road on her way down to a morning watering at the river.
Minutes later I pulled into the parking lot at the gym and stepped out into the cool morning air. Off to the east the sky lay littered with purple clouds edged in red; the sun was just breaking over the mountains. A wood thrush piped an eerie call from the woods as I crossed the macadam to the front entrance of the facility that housed the pool in which I would spend the next two hours.
I took up swimming as an exercise regimen sixteen years ago when I turned forty, after my knees had given out from two decades of distance running. A workout in the pool, much easier on the joints, allows me to keep my cardiovascular system in reasonably good condition without punishing my hips and knees.
When I was a miler back in high school, “The Shark” was a sprinter. Short, compact and powerfully built, he logged a number of records in the shorter distances and relays. While I worried about keeping my grades up and brooded over lost loves, “The Shark” grinned through those turbulent adolescent years seemingly without a care in the world. The writer of his obituary captured his disposition in a few short lines: “always pursing the light side of life…full of laughter and love…he uniquely left his mark on everyone he met.”
I swam my allotted yardage, showered up and headed back home for breakfast. The early morning clouds had broken up, leaving a faultless blue dome overhead. I got in line at the yield sign and headed south with the thread of morning commuters.
As I came up over a slight rise, I caught sight of flashing red and blue lights by the side of the road up ahead. A patrol car was parked behind an old pickup truck that had an extension ladder strapped to the roof. A man in a plaid work shirt kneeled by the front of the vehicle, inspecting the twisted front bumper. A uniformed policeman stood next to him, writing on a small tablet in his hand.
I glanced to the right, and there on the shoulder by the curb lay the doe, stretched out on her side with one foreleg bent, cinnamon coat gleaming in the bright sunlight, the white belly already swollen, a trickle of bright red blood oozing from the left nostril.
She had bolted at the last minute, I imagined. Most likely the driver of the pickup hadn’t seen her—until it was too late.
I walked through the front door of the pub and slid into a seat across from the bar. A few regulars had gathered in front of one of the big screen TVs. Bob Costas was interviewing Calvin Borel, the jockey slated to ride Rachel Alexandra in this year’s Preakness. If she wins, Rachel Alexandra would be the first filly to do so in 85 years.
I sat for a while in the darkness in one of the small booths by the brick wall. It had not been a pleasant morning at work. Shortly after I arrived at the office I was informed of the accidental death of a mother who brought her daughters to our practice. The girls are 10 and 14 years old. Only last month I had seen the older daughter in the office with her mother. I wondered how the father would manage things now that his wife was gone.
The waitress brought me a menu. She apologized for not coming by sooner. “I didn’t see you come in,” she said. “What’s yours?”
“Ten Penny,” I said.
She brought me the draft. “You know what you want?” she asked.
“Bring me the deluxe burger for here, and one to go.”
“How would you like them?”
“Medium rare for here, well done to go.”
She collected the menu and disappeared into the kitchen. A few more patrons drifted in and took their seats at the bar. One of the men was reading the racing news. On the TV the horses were being paraded across the turf. A female commentator said that she liked Rachel Alexandra because “she ran like a girl.”
By the time the waitress brought me the burger, it had started to rain in Baltimore. Bob Costas continued his commentary while standing under a purple umbrella. The horses, now mounted with their jockeys, were being led from the paddocks. It was nice to see their muscles working beneath their chestnut brown flanks as they walked. Big Drama bucked his rider in the starting gate and had to be led out momentarily to calm down. The bell finally sounded at 6:19 PM.
I took a long pull at my beer and settled in to watch the race. Rachel Alexandra broke immediately from the outside post to take the lead. Mine That Bird, this year’s Kentucky Derby winner, was running last going into the first turn. Absolute silence reined through the entire pub as the eyes of every patron fastened on the big screen.
Although Mine That Bird had advanced steadily into the final stretch, Rachel Alexandra finished first by a length. “She’s the greatest horse I’ve ever been on in my life,” Borel said of the filly afterwards.
The waitress brought the check and the burger to go. I waited for the receipt, popped my cap on my head and walked out. A light rain was falling. I felt warm and happy in the street.
For two minutes I had been totally absorbed in the intricacies of the Preakness Stakes. For two minutes I hadn’t thought about the mother who had died that morning, the victim of an automobile accident. For two minutes I hadn’t thought about the driver of the vehicle that killed her—her 70-year-old mother.
I didn’t know how this grandmother would fare. I didn’t know how she would be able to face her granddaughters or her son-in-law again. I only knew that at some point the girls’ names would appear on my schedule. I imagined it would be an extended office visit.
I wondered what I would say to them. “Rachel Alexandra won the Preakness the day your mother died.” That would be inappropriate, of course. Yet in my mind that is how the events of this day would be linked forever.
In the icy grip of early morning winter cold and darkness, it’s pure joy to meet an old friend in a warm well-lighted place and chat over a hearty English breakfast of eggs, fried potatoes, biscuits and hot coffee. Even the very thought of such times makes me wax nostalgic.…
The latest installment of Notes from a Healer — Waxing Nostalgic — is now online, newly published in the Yale Journal for Humanities in Medicine.
The Yale Journal for Humanities in Medicine is an online clearinghouse for manuscripts dealing with the humanities and medicine.
My granddaughter and her mother recently moved to Florida—fifteen hundred miles away from New England. For the past year they lived across the street from us. This year my granddaughter had the opportunity to attend the same elementary school that her father went to when he was a boy.
The move was difficult for all of us, particularly for my wife, who cared for our granddaughter since she was a baby. Knowing that there are no guarantees in life didn’t make this particular transition any easier, but we have learned to accept the hand that we’ve been dealt.
My granddaughter loves to play Memory. You may recall that this game consists of pairs of identical cards shuffled and randomly placed face down in rows and columns. Players take turns selecting two cards at a time. You keep the matches and whoever collects the most matched pairs wins the game. My granddaughter would pout if an opponent scored a matched pair, and brighten each time she picked a match. Invariably, in spite of our best efforts, she would usually win. “You’re one sharp cookie,” I would tell her, counting up my meager score.
The last time she wanted to play Memory, we couldn’t find the game. Later, I asked my wife where she had put it. She couldn’t remember. I guess her memory isn’t what it used to be either.
The other day a lonely card from the Memory game surfaced. It depicted Princess Jasmine, the character from the Disney movie Aladdin, posing in her turquoise bloomers and tank top with a small blue butterfly perched on the tip of her index finger.
I recalled the myriad species of butterflies we had seen on our spring trek to the butterfly conservatory in Deerfield, Massachusetts. The blue ones were my granddaughter’s favorite.
I studied this memento of former carefree play intently, then hid it away in a safe place, somewhere I knew I wouldn’t forget. Memories are what we cherish to fill the void that a child leaves behind.
Last week I watched my granddaughter lounging on the swing in our back yard. It was a bright morning, but still cool in the shade under the maples. Her little dog—a malti-poo—sat by her side, eyeing her buttered toast. Periodically she would tear off a small piece of crust and hold it out for the puppy, who gladly accepted the tiny offering. Renoir could have done this portrait justice on canvas, had he been alive to see it.
Today we are up early, long before the sun, sitting on the front porch steps, waiting. It is still night, and the air is cool and damp. The yellow porch light burns like a beacon in the darkness. Overhead, beneath the sliver of a waning crescent moon, a bat leafs its way through the night air. All else is still.
My wife cradles a small urn in her hands, delicately decorated with tiny flowers and birds. The inside she has lined with leaves of lemon verbena, her favorite herb. “I put our telephone numbers inside on little pieces of paper,” she tells me.
Morning light appears on the horizon. Mist blankets the distant hills. The call of a lone mourning dove breaks through the stillness at first light.
Across the street a door opens. A man emerges with bundles in his arms. He carries them to the rental truck and stows them in the back. I lift a hand in greeting.
A woman comes out with a small dog. “She needs to go out before the long drive,” the woman tells me. “It’s thirteen hundred miles to Florida. We’re hoping to make Richmond by this evening.”
Suddenly, the little girl is out, dancing across the street to our front porch, where she sits on my wife’s lap and fingers the small urn in her hands. “Open it,” my wife says. “Smell.”
“Oooh, lemon!”
“It’s a music box,” my wife says. The little girl pushes the button on the bottom and listens to the notes of the childhood song.
Once more my wife and the little girl descend from the porch and make the rounds through the gardens. The frog is sitting by the fish pond in the back yard. The day lilies are blooming; the irises have faded. The yellow primroses are just opening up.
Now that the clothing and linens and dishes and utensils are packed, now that the beds have been taken apart and stowed in the rental truck along with the sofa and kitchen table and chairs; now that the appliances have been unplugged and wheeled out strapped to the hand-truck and securely fastened by ropes passed through the steel rings embedded in the interior wall; now that the metal paneled door is pulled down and locked with the heavy safety latch and the apartment door is shut for the last time—now the time has come to say goodbye.
Goodbyes have always been awkward for my granddaughter, this little girl who barely tips the scales at 46 pounds. In her eight years she has moved nine times (this will be the tenth), she has had to say goodbye to two fathers (failed relationships of her mother), and now she is put in the position of having to say goodbye to us, her grandparents, for what will undoubtedly be the last time for a long time. She has learned to keep the goodbyes short.
When the final moment comes, the men shake hands, the women hug each other. The little girl climbs into the back seat of the car where her mother and the dog are waiting, and waves through the window.
Goodbye—just another moment in time. Goodbye, from the Old English “God be with ye.” Not aufwiedersehen, until we see each other again; not au revoir or arrevidercci, but vaya con Dios—the Spanish is closest—go with God.
Brian T Maurer's Weblog 