“Notes from a Healer” — Attachments

The little girl’s chest sounds like a deranged sonata of squeaks and whistles. She’s breathing fast — somewhere between 40 and 50 times a minute — with see-sawing motions of her belly and chest. more»

My latest installment of Notes from a HealerAttachments — 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 New Era

As it was New Year’s Eve, my new employer told me I could close the after-hours care center early. “You probably won’t have much business,” he said. “People will be getting ready to celebrate, and I hear we might get some snow.”

I informed my medical assistant of the plan. “We’ll see how the evening unfolds,” I told him. “If it’s dead, we’ll pack it in. I suppose you have plans to celebrate?”

“I never make plans,” my medical assistant said. In some respects, he is a wise fellow. more»

My latest installment of Notes from a HealerA New Era — 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” — Three Important Things

From where I sit behind my desk I can hear him coming down the hall. His voice pierces the quiet calm of the office. Layered throughout I hear two additional voices: that of a woman, presumably the boy’s mother, and that of the medical assistant, soft and low. I have been forewarned about this boy. more»

My latest installment of Notes from a HealerThree Important Things — 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 Suitable Diagnosis

I found my new patient seated in the chair, dressed in a blue and white johnny top. She had a round face and a ready smile. Thick black curly hair covered her head. I noticed that the hair growth extended down the sides of her cheeks to the angles of the jaw. more»

My latest installment of Notes from a HealerA Suitable Diagnosis — 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” — Body Electric at 17

Of one thing I’m certain: the world will never be this boy’s oyster. When you suffer from chronic debilitating disease that deforms your young body as it struggles to develop and mature, you can bet that the world won’t be your oyster anytime soon. more»

My latest installment of Notes from a HealerThe Body Electric at 17 — 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” — The i’s Have It

The schedule says he’s here for suture removal. The sutures were placed nearly two weeks ago at a local hospital emergency room. The diagnosis listed on the ER form is “gun shot wound,” a rather uncommon occurrence in this suburban practice. more»

My latest installment of Notes from a HealerThe i’s Have It — 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)