This summer

Granddaughter,
For two years we have not seen your face.

The fireflies returned this June,
Flashing silent semaphores at eventide,
But this summer we have not seen your face.

In the bayou by the brook below the bridge
Frogs croak and splash in still green water
At the slightest approach,
But this summer we have not seen your face.

Swifts dance on drafts of early morning air
Over the blue and white-trimmed house,
While nighthawks dart above the river;
High in the trees the orioles sing their fluid arias—

But this summer
In the eaves of the ancient shed
Adjacent the churchyard
The swallows have not returned to nest.

7/1/2014

Catch me up in your story

Remarks at the recent wedding of a son and daughter-in-law.

The Irish have a saying: “A son is a son ’til he takes a wife; but a daughter’s a daughter all of your life.”

I don’t look upon this occasion as the loss of a son, but rather as the gain of a beautiful daughter.

A line from one of the songs we sang this morning caught my eye: “Catch me up in your story. Catch me up in your story.”

We are gathered here in this place on this day to celebrate Joshua and Kerra, the beginning of their new life together. Some of you have come from close by; others have come from far away. There are those from New England and those from Taiwan; those from Connecticut and those from Georgia; those from Hartford and those from Dallas. As individuals you hail from far and wide; but as a group you have assembled here, if only for a short while, to show your love and support for Joshua and Kerra.

Some of you I have met before; some of you I wouldn’t recognize if I passed you in the street. Some of you I know intimately well; others, hardly at all. Yet one thing I can say with confidence about each and every one of you: that you bring your unique life story to this place.

Each of us is part of an extended family of some sort, and each family has its own set of stories to tell. As for me, I could tell you some pretty good ones. I’m certain that you know some pretty good ones, too.

Stories are the glue that binds folks together in relationship. Some stories are funny, some are sad; some are uplifting, and others are tragic. Stories are the narratives that give structure to our lives. Without stories our existence would become a mere calendar of daily appointments and activities. It is through our stories that we come to know one another; it is through stories that we invite one another into our personal lives, to become a part of them.

Today I was thinking of a family photograph, one in which Josh and Ian are little boys, sitting on the porch of their grandparents’ house. Josh is sitting in Ian’s lap; Ian’s arms encircle his brother’s waist. Their hair sparkles in the sun, their eyes twinkle and there are big smiles on their faces.

What you don’t see in the photo are other sets of arms, the ones holding both of them, the arms of their mother and me, the arms of their Grandma and Grandpa — arms which encircle and hold, arms that shelter and protect, arms that offer comfort and security. Those are the arms which they depended upon for support when they were growing up.

And now for Josh and Kerra there will be new sets of arms, arms to have and to hold, arms to shelter and protect, arms to offer comfort and security. Two in relationship are better than one; for if they fall, the one will lift the other up.

Most of us will not remember what was said here this day, but all of us will recall this day, the day when Joshua and Kerra invited us, their dear friends and families, to gather together to celebrate this new beginning of their story. Through the vows they have taken they have invited each to be caught up in the story of the other; and we who have been caught up in their story will always be a part of it, and a part of them.

On contemplating the death of a high school teacher

Mostly I remember the thermos and the pipe.

He kept both in the storage room behind the massive black slate counter that sat at the front of the chemistry classroom. A big man with reddish-brown hair that hinted a Scotch-Irish ancestry, he towered behind that counter when he taught, frequently using the overhead projector to illustrate chemical formulae — compositions of molecules and thermodynamic equations. During breaks or between classes, he would step into the storage room for a cup of warm coffee from the thermos or a draw on his briar pipe.

His father had been a chemist before him and worked for one of the industrial giants. He hinted that at one time his dad had made a number of discoveries in the company laboratories, discoveries which remained with the firm and for which he received little recognition — monetary or otherwise. This was a source of great consternation for him.

He had done a stint in the army early in life, as was the case with many young men of that era, and served in Korea. After discharge, he remained in the reserve, serving with a unit at Fort Indiantown Gap. The additional income came in handy for a family of six, and at some point in one of our conversations he confided in me that staying on in the military helped to keep him young.

He and his young wife bought a big old home near the center of Linglestown, which I visited on occasion when I was home on leave from the service. As I recall, the big white house had an expansive back yard with a small orchard of sorts. We spent an evening in conversation over a bottle of Chivas Regal which I had brought as a gift. The bottle didn’t last the night. I ended up sleeping over on the couch, none the worse for a time of extended discussion.

One evening while I was still in high school we attended some sort of educational dinner sponsored by industry. He drove us to the function in his old car, which he used to joke could run on kerosene. I don’t remember much of the evening, only the pleasure of the company of older and I assumed wiser men.

When I told him I wanted to study biology, he retorted that I should press on for a career in medicine. “Why would you want to know about a bug crawling around on the ground, when you can study the complexities of the human body?” he argued. Now here I am in my 35th year of medical practice, contemplating retirement.

Later he would write a letter of recommendation for me to attend a small undergraduate school known for its forte in the sciences. “I had to tone it down a bit,” he said. “The first draft made you look too much like a saint.”

During one of our after-school conversations, he pointed out several good-looking girls in my class. He counseled me that a young man should not be too quick to commit to any one young lady in particular. Playing the field was a wiser approach. Indeed, that is how one amassed what in those days was known as a little black book.

We spoke about literary subjects. He told me about Hemingway’s success as a young man. “‘The Sun Also Rises’ was a good first novel, but it was ‘A Farewell to Arms’ that cemented Hemingway’s place in the American literary canon,” he said.

Secretly, he wished to become a writer. He shared several ideas for books of his own. Some were science-fiction based — one about a cleaning woman who fell into a nocturnal time warp and was whisked away to another world to become a primordial Eve. Another drew upon his boyhood experiences, events that occurred in a wooded lot in the neighborhood where he grew up.

“I never had a whole lot of direction in life,” he told me. “In the end I had to figure things out on my own.”

Perhaps that is the way it was for most of us.

2014©Brian T. Maurer

2014©Brian T. Maurer

Sacraments

Among other things, when my wife returned from Europe she brought along an ancient aluminum percolator, the kind you heat over a burner on the stove top. The unit makes one cup of coffee or, if you are having company over and prefer, two demitasses. Etched into the side of the urn is the word “Bialetti” — the name of the Italian maker — and the trademark, Dama.

Although coffee in our house is traditionally made in a 12-cup coffee maker by the first person up in the morning, since her return my wife has developed a preference for the small European unit. Even if there is hot coffee available when she descends the stairs to the kitchen, my wife will invariably make her own personal cup in the Bialetti Dama.

It’s not that my wife is particular about her coffee, or that she’s the type who needs to exert her individuality; but merely that the Bialetti urn was given to her by her mother, who is now 82 years old and aging rapidly like the rest of us. My mother-in-law had used the Dama most of her adult life to brew her coffee, and now my wife is following in her mother’s footsteps.

Although she hasn’t said so, I’m certain that when my wife pours her cup of morning coffee from the Bialetti urn, as she watches the dark caramel colored liquid swirl into the thin rimmed cup, she almost surely thinks of her mother as she had performed the same rite of passage every morning, day in day out, for decades.

In giving the urn as a gift, my mother-in-law offered her daughter a widow’s mite; for she has been a poor woman her entire life — poor, that is, in a material sense.

As I disassembled the Dama and washed the individual components at the sink this morning, I reflected that the Bialetti urn was in reality a sacrament of sorts — the outward and visible sign of my suegra‘s inward and spiritual grace.

“Bialetti Dama” 2012©Brian T. Maurer

“Notes from a Healer” — Those We Carry With Us

Some of us need more time to grow up than others. Some of us never seem to make that transition. more»

My latest installment of Notes from a Healer — Those We Carry With Us — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

After work

It was not a particularly stressful Saturday morning to work in the office. Only three prescheduled physical examinations and a handful of sick children came in by morning’s end.

One child, a 1-month-old, my first patient of the morning, had colic. His mother reported that he wanted to feed constantly; whenever she didn’t give him a bottle he fretted, sucking on his fingers and hands. I had evaluated him one week ago for similar complaints. Since then the child gained 1-1/4 pounds, nearly three times the expected weekly weight gain. Obviously, she was overfeeding him. I suspected that part of the reason might have been because her first child was born prematurely and had a difficult time gaining weight.

Mothers nurture through feeding; a thriving baby exemplifies good maternal care, but sometimes too much of a good thing is not best.

As the morning wound down I ruminated behind my desk and reviewed the remainder of outstanding laboratory reports, signed off on a stack of physical examination forms and phoned in prescription renewals. The medical assistants finished with the filing and departed, locking the front door behind them.

I snugged the bow tie at the base of my throat, picked up my blue blazer and stepped out the side door. It was a short drive to the funeral home. By the time I arrived the lot was nearly filled with vehicles.

Inside people milled about, speaking in low tones, touching one another briefly on the arm or shoulder, exchanging whispered words. Some paused before the large displays of photographs mounted on easels in the hallway.

I stepped into the parlor, signed the guest book and found the end of the receiving line. There were stands of flowers everywhere, roses mostly — pink and red and white — done up in intricate arrangements identified by cards signed by family, friends and well-wishers.

A small silver urn stood in the center of the table; a golden crucifix rested against it. On either side lay two stacks of books — three on the left, two on the right. I noted the author of the two on the right — medical titles reflecting her area of expertise.

Most physicians don’t leave any written creative works behind; she had left two — these two texts, in addition to her two teenaged sons, who stood in the receiving line on either side of their father. Each of the three wore a pink tie. Pink, the color of the ribbon supporting breast cancer research; pink, the color of the delicate rose in full bloom; pink, the color of fading rose petals at the close of day.

My words were inadequate — “I’m sorry for your loss” — followed by handshakes and brief smiles.

“How are things at the office?” the father asked.

“Busy,” I said. “Back to school physical exams, you know. It’s the same every fall.”

He nodded. “Thanks for stopping by.”

I left by the side door and stepped out into the heat of the early afternoon sun.

As practicing clinicians we are granted the high privilege of glimpsing the struggles of families entrusted to our care. For brief periods were share in their triumphs, their joys and ultimately, their grief.

But many times it’s the grief that seems to linger the longest.

2012 © Brian T. Maurer

“Notes from a Healer” — Think Pink

Some hurts never leave us. Willingly, we choke down our daily pill; and the bitterness lingers. more»

My latest installment of Notes from a HealerThink Pink — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

“Notes from a Healer” — A lot can happen in a year

A lot can happen in a year, and sometimes those changes last a lifetime. more»

My latest installment of Notes from a HealerA Lot Can Happen in a Year — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

Remembering Dr. Howard Spiro

I first encountered Dr. Howard Spiro at a medical humanities conference in Williamstown, Massachusetts, some 20 years ago. As a guest speaker, Dr. Spiro shared the podium with Dr. Robert Coles. The two made quite a pair: both distinguished practitioners of the art of medicine; one from Harvard, the other from Yale. Dr. Spiro wore a brown bow tie that day. I recall that detail exactly, because it was the kind of bow tie you had to tie yourself; and I remember suppressing an impulsive urge to discreetly snug it up for him. Curiously, I didn’t actually make his personal acquaintance until nearly a decade later.

One evening in December of 2002 my friend and colleague Dr. David Elpern and I traveled to New Haven to attend an evening lecture at the Yale Humanities in Medicine program. During the drive down, Dr. Elpern told me that Dr. Spiro had founded the lecture series back in 1983. Later that evening over dinner at Mory’s, we learned from Dr. Spiro that he had gotten up a fledgling online journal of similar import, the Yale Journal for Humanities in Medicine.

By that time a few of my early pieces had been published in JAMA and BMJ. Dr. Spiro was eager to hear all about them. I don’t recall whether he asked me to consider submitting something to YJHM at that time or not. At some point I did send him a piece, which he graciously accepted for publication.

Sometime later, after he offered to review my book Patients Are a Virtue, Dr. Spiro asked if I would consider doing a monthly column for the journal. “What would we call it?” I asked him. “Call it what you like,” he said. Shortly after that my “Notes from a Healer” began to appear in the electronic pages of YJHM.

And so began a collegial relationship that lasted up until the time of his death. (Dr. Spiro approved the submission for my March “Notes from a Healer” column days before entering the hospital for a cardiovascular event that would ultimately end his life.)

Every month for the past five years I would send Dr. Spiro a piece for the column, which he would critique, usually in a few brief lines, before okaying it for publication. These critiques were not those of a typical editor. Many times he would comment about something in his own life or how the piece I submitted moved him personally.

“Engineers are among the most difficult patients, for they are convinced there’s a detectable reason/cause for anything/everything.”

“Wise, indeed. One learns with age.”

“You are sounding more like O Henry with time.”

“Your usual beautiful turns. I confess I would have seen the opportunity/really the genius of America in their story, but suum cuique!”

Occasionally, he would point out a grammatical error; and red-faced, I would shoot off a corrected copy with my thanks appended. At some point, he would finally bestow his signature stamp of approval: “Imprimatur.”

Dr. Spiro rubbed shoulders with some of the medical greats of his era. Many times I only learned of these relationships through casual comments he would make on pieces I sent him. For example, in response to one of my submissions he wrote:

“I knew Leon Eisenberg—admired him—look at his CV. I cannot believe that he would want to be considered a mere psychopharmacologist.”

After researching Dr. Eisenberg’s biography, I wrote back, “I took your advice. You were obviously correct in pointing out that the man was much more than just that.” I included an article from Harvard’s FOCUS Online which I thought Dr. Spiro might enjoy . Dr. Eisenberg’s story about the schlemiel was priceless.

Sometimes Dr. Spiro and I exchanged correspondence on matters of medical practice as well. Once, I discovered an article that referenced a paper of his. I sent him the link with a few observations:

“Reading through this review, I couldn’t help but think that you would enjoy it. As it turned out, you were mentioned toward the end of the article.”

‘Stress,’ the American gastroenterologist Howard Spiro writes, ‘increases vulnerability’ to other ulcer-causing agents ‘like H. pylori’. Medical fascination with bacterial causation has, he says, resulted in culpable neglect of the roles of the mind, the emotions and the dietary and behavioural patterns of everyday life. (A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800-1950 by Ian Miller)

Dr. Spiro was obviously pleased: “Thanks, glad I am remembered! I worked on stress in the 1940’s, thanks to Selye’s idea of the ‘alarm reaction’ and published my first medical papers back then.”

In turn, I wrote back: “Perhaps my perspective is somewhat skewed, but it seems to me that precious few specialists seem to be able (or willing) to relate to such patients on a humane level these days, a demonstration of the lost art of medicine.”

Dr. Spiro’s assessment: “Boy, are you right! When I was young, we talked to patients. Lab data and images were scanty. Since 80% of patients get better with time and the right hand of fellowship, the clinician counted. But that will return after disenchantment spreads.” He had entitled this reply I-Thou.

On a professional level, Dr. Spiro was supportive of my clinical practice as a physician assistant. He strongly advocated for the advancement of “mid-level practitioners” as he called us, feeling that we were the answer to the primary care clinician shortage problem. “The expertise you demonstrate in the way you care for your patients is evident in your writing,” he wrote. “I argue with my colleagues, many of whom feel that medical practice should be regarded as the exclusive domain of the physician.”

“As you may know—or more likely may not—for the last 20 years I have been pushing the idea that physician assistants or nurse-practitioners should be doing pediatrics and general internal medicine. Very few in the internal medicine business agree.”

“Your enthusiasm, amity, empathy for your patients—and your prolific writing skills—continues to reassure me that physician extenders—if I can call you that—should constitute our general docs and pediatricians. It’s a canard that they will not recognize serious problems! I keep wondering why you do not talk about that—or maybe you do, indirectly, or in other places.”

This past fall Dr. Spiro wrote that he would be traveling to Arizona to give a medical humanities presentation at one of the medical schools there. “I would like to use you as an example of a clinician who not only practices humane medicine, but writes about it well. Send me a copy of your CV. I imagine you to be somewhere around 45, give or take.”

I sent him my résumé with the caveat that he was off on my age by more than a decade. “Hah! You write with the vigor of someone in his early thirties,” he quipped.

Toward the end it was evident that Dr. Spiro was becoming a bit forgetful. When the name of George Bascom resurfaced in one of our e-mail exchanges, he wrote: “Tell me again how you knew him.”

“It was you who knew him personally,” I wrote back. “I only knew him through his poetry. In any event, he was a fine mensch who continues to influence clinicians from beyond the grave.”

“If you didn’t know him personally, a word like mensch—which I take to be a personal assessment—might be out of place,” he replied. The response stung.

I took a deep breath and typed out a reply. “According to the dictionary, a mensch is someone to admire and emulate, someone of noble character. It’s meant as a compliment to highlight the rarity and value of that individual’s qualities.”

I suppose those words might just as well have been written to describe Dr. Spiro himself.

Howard M. Spiro, M.D. (Photo credit: Peter Casolino Photography, New Haven, CT)

“Notes from a Healer” — Flu Shot

It was just a short visit for a flu shot. Short and sweet, filled with impromptu reflections on the human condition—something of value that we aren’t taught in our years of training, these seemingly insignificant snippets of conversation that ultimately serve to cultivate caring relationships in medical practice.  more»

My latest installment of Notes from a HealerFlu Shot — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.