Sunday, March 27, 2011

Thanks, Norm.

The coffee in my brand new mug from the Norman Rockwell Museum this morning, tastes as good as I hoped it would. The material from which a mug is made and the manner in which it's fired, really does impact flavor, you know. For instance, dark roasts taste cleaner in my white bistro mug with the letters U-N-E stenciled down the side in blue (see Pink Hats, chapter 9). In The Black Dog pottery mug given me by my dog and cat for Christmas last year, dark roasts seem to mellow. The Rockwell, as I think this new one should be christened, strikes me as midway between the other two, but we'll find out, once I'm back in Maine and writing on some bleary, early morning. That's the acid test, when I can barely see the keyboard, what's the coffee like then?

How I happened upon The Rockwell is a story in itself. I thought the museum housing this treasure was located in Sturbridge, 50 or so miles east of here, my destination on the 30th for an osteopathic students' conference. "Not so, Mr. Schuyler!" to borrow a line from Lord Lindsey, Chariots of Fire (1981). It's in Stockbridge, a little town memorialized by James Taylor in his song, Rockabye Sweet Baby James, the merest drive down the road with a turn left, then right, then back left, from here.

I was wandering through Richmond, a village that reminded me of my home away from home in Maine because both are mostly countryside and locating a "town" is an exercise in futility. If there was one once, there's not one anymore. But it's a lovely place and it felt so familiar I was on the outskirts of West Stockbridge before I knew it. A gentle nudge on the steering wheel from an oddly convincing feeling took me past the real Nook and Cranny coffee house (Pink Hats, chapter 3), up a long ridge, over the Mass Pike, and all of a sudden, out of nowhere, I saw a sign directing me to the Norman Rockwell Museum, 3/4 miles away. And they say there's no unconscious.

I grew up reading old copies of The Saturday Evening Post I found at my aunt's and having Rockwell's covers take me out of my comfort zone in the West through my imagination to parts unknown. It was his "Stockbridge Main Street at Christmas" that led me to think I might make a home somewhere in New England someday. Standing in front of the original and trying to explain what that meant to a beautiful septuagenarian on the museam staff, reminded me trying to say anything at all at moments like this is useless. I'm going to choke up, so I may as well shut up and write about it, instead. But I never do and we both end up crying because childhood dreams have finally come true.

Standing outside his studio was like hanging with a pal who knew the things about you your family would never understand. I was the kid raised on Country music who fell in love with classical. It baffled my father worse than anything adolescence could have thrust into his path. Why his son, of all sons, liked "high brow," quite frankly, blew his mind. That was alright, I couldn't explain it either. Johnny Cash and Marty Robbins would just have to learn to share the stage with Brahms and Beethoven. Rockwell somehow knew what this was like because he created images that were just as evocative and made just as much sense to me. Like Stockbridge at Christmas. And a few minutes later, I was right there, standing across the street from the Lion's Head Inn, in New England, of all places.

Thanks, Norm.

(Photo of Norman Rockwell's studio on the grounds of the Norman Rockwell Museum copyright 2011 by the author)

Saturday, March 26, 2011

"I Like Pie," He Said.

He was sprawled full-length on the examination table when I walked in the room. He looked at me with an intriguing smile and a playful gleam. "I like pie," he said. That, I wasn't expecting.

I told him I liked it, too, at the same time his sister, a towheaded, adorably cute and shy five year old, turned big blue eyes on mine, then buried them in her mother's skirt.

"I like cake, too," he said, trying to regain my attention from his sister.

"So do I, especially chocolate."

"Chocolate's my favorite."

If the little guy was sick, he sure could cover. Before mom could explain why they'd come to the doctor's office, my partner in conversation informed me, "But I'm better now." Why am I not surprised?

He'd been wheezing a couple of days ago and was having the same problem just about this same last year. Mm. His sister had a runny nose and had one also last spring. Sounded like seasonal allergies for her and perhaps a little bit of asthma-like symptoms for him. "I'm hungry."

"I am too, but we're not calling out for pizza," I responded, winking.

Pizza wouldn't have satisfied, anyway. What he and his sister wanted was something I could only approximate. My curiosity was approaching the outer limits of the Richter Scale, so I shot their mother's hand a quick glance. No ring. That doesn't prove anything, but the kids' father hunger can't be denied. Mom was doing a great job, but she was still mom, and they missed her other half.

Waving as they walked down the hall left me feeling I wished I'd hugged them, instead.

I'd listened to their lungs, looked in their ears, evaluated their health. I just hope I was enough of their doctor to be a little bit of a "dad," too, when they needed him.

(Creative Commons image by RachelEllen via Flickr)

Tuesday, March 22, 2011

First Night On Call

Well, here I am, my first night as a medical student -- a medical anything, for that matter -- on call. In point of fact, it may not turn out to be much since I'm covering for an outpatient pediatrics practice. Most likely, any parent ringing up tonight will get the nurse practitioner who will triage the case and we'll see the child tomorrow. My job is to keep tabs on the E.R. and it's one I share with my attending

In the event a patient's parent decides tomorrow is not soon enough for Johnny or Joanie to be seen, my attending will get a call from the E.R. informing him it's time to awaken me from a sound sleep and get my eager backside down the hill from the apartment I share with another osteopathic medical student, and perform an evaluation. Then, on the assumption my attending's presence is legitimately required, I'll call back and summon him from hearth, home, and his spouse's warm feet, to join me in a game of Guess What I'm Sick With?

Should he decide his presence is not absolutely essential and his confidence in me well-placed after all, he may simply confirm my diagnosis and treatment plan, and inform the E.R. doc to implement the orders he's asked me to write and intends on signing first thing in the morning. The real morning, that is, when sane people are supposed to get up, not at 3.00 AM when night owls, insomniacs, and medical students prowl the streets looking for trouble in all the right places.

How all this came about is, I've been doing my pediatrics rotation out here in Western Massachusetts, in the Berkshire Mountains, and my assigned attending physician has taken a week off. No, it wasn't me, this has been in the hopper quite some time. So, she asked a colleague to take me on for a week and he does his own call. Noting the eager gleam in my eye when he mentioned this tidbit, naturally he didn't want to disappoint. And the truth is, I've been looking forward to tonight since my internship days in Boston, and there was no way I was going to let him have all the fun.

So, we shall see how the night unfolds. I may not do a thing. Then again, it's a full moon and as psychiatric mythology would have us believe, anything goes. It doesn't really and psych admissions are no more prevalent on full moon evenings than they are on Friday the Thirteenth. It just feels cool to say it that way and have the uninitiated think we're cool for being in the E.R. when anyone with a lick of sense would be in bed, sound asleep. But I'm not dozing this one out in an on-call room; I'm snug as a bug in my little alcove of a bedroom one step off the kitchen, where I'll be be until duty calls. Or my attending. whichever comes first.

(Photo of Berkshires Medical Center copyright 2011 by the author)

Saturday, March 12, 2011

The Mouse Writer

Coffee in hand, I was starting to get comfortable this morning, wondering about the next step to take with Pink Hats and a Mack Truck, when I heard what sounded like a triumphant announcement, "Spring has sproing!"

"Don't you mean, 'sprung,'" I asked, pausing between sips.

"No, I meant what I said. It's too nice outside my window for traditional spellings and pronunciations. On top of that, 'sproing' gets a reader's attention." He definitely had mine, completely.

"Well, what are we going to write about?" he asked, stressing the personal plural pronoun as though the endeavor was predictably corporate.

"What do you mean, we? Have you got a mouse in your pocket?"

"Very funny. Witty, even. Better than your usual attempts at humor, I must say, and speaking of which -- whom might be better -- how could I have myself in my pocket? Just because I am a mouse, doesn't mean I'm also a contortionist."

I was talking with Hinsley, my inking partner, as he's fond of describing himself and what the writing process would be if my laptop were a typewriter. I suppose you could liken "inking partner" to a drinking partner, except neither of us wakes up hungover. Anyway, he's a little grey fellow about the size of a 16 oz. mug of deep, dark, nutty, English brown ale, clad in a red plaid waistcoat and scarf, with a tail nearly as long as he is tall. I rescued him from a fate worse than death, or so he said it would be, when we met at Starbucks this past Christmas. I was doing my annual shopping, looking at coffee accessories, when I felt him tug at my sleeve.

"You've got to help me," he said, whispering breathlessly, as though he had just completed a 100 yard dash before his competitor, the Jamaican sprinter, Usain Bolt, could get out of the starting blocks. "See that woman over there? Not the pretty one, she works here. I mean the other one, the woman with bags on each arm and even larger bags under her eyes. The one who smells like she bathed in her grandmother's perfume and then sprayed herself with an entire bottle for good measure. She bought a friend of mine last year and he hasn't been heard from since. Come on, be a chum."

I wasn't certain whether his concern was the result of spending far too much time inhaling the caffeine-injected atmosphere, but he was cute (psst, don't tell him I said this, he really does hate it) and as his tag read, The Mouse Writer, I truly felt compelled to act. Writers have to stick together. So, now he sits, happily, on the bookshelf across from me, guarding a medical text dated 1866 alongside his friend, Barclay, a similarly-sized raccoon I discovered a few years ago, trying to scramble out of a drawer in my late mother's secretary. Destined, I think, to become a dog toy, he managed to burrow into some old papers and there he stayed, safe but forgotten, until he heard me inspecting the contents of the old cabinet after my father was gone.

Forgotten or lost toys are one of life's saddest things, I think. I don't know why, exactly, maybe it's the lost memories that go with them. Perhaps it's the reason I keep them, an old Lionel steam locomotive, fire trucks, and a couple of faded, worn teddy bears. They aren't much, I suppose, but they were mine and still are. They remind me of a line from Kenny Loggin's, The House at Pooh Corner.

After all's said and done, I was watching my son,
sleeping there with my bear by his side;
So, I tucked him in and kissed him, and as I was going,
I could swear that old bear whispered, 'Boy, welcome home...'

"Are you going to reminisce all day? I don't know about you, but I'm ready to work!" Mouse Writers are inclined to impatience.

"Aren't we telling your story? Surely, that counts, wouldn't you agree?"

He hesitated, tugged on the bottom of his waistcoat, straightening it, and said, "Well. Yes, I do believe you're right. Proceed, maestro, but please, please don't say anything about my being cute. I just don't think I could 'bear' it, should your views on the matter become public knowledge. I do have my dignity, you know."

"Oh, I know, all too well. As to cute, however, I'm sorry, but the cat's already 'out of the bag,'" I said, playing the pun card back to him.

"Now why did you have to go and say, 'cat?!'"

(Photo copyright 2011 by the author. The House on Pooh Corner, words and music by Kenny Loggins)

Friday, March 11, 2011

Jack the Ripper in Polartec

The things that unite us are greater than those that divide us, as President Barack Obama is fond of saying. The trouble is, I sometimes have a problem believing it. People seem prone to allow everything from the petty to the profane to come between them in the name of ideological purity. But that's one of the qualities I most admire about him, he believes the best even when I'm in doubt.

For instance, take the guy in a pickup truck a couple of days ago -- there were two guys in two trucks, actually, one and then the other. Both got my attention by surprise. You see, all day I'd been encouraging patients to control their cholesterol levels by losing weight, altering their food choices, and getting regular exercise. Sure, there are medications we can prescribe for high cholesterol, but those are mostly for levels that can't be readily controlled by other means. The idea is to get busy doing the things that eliminate the need for medications later on.

On my way home, thinking about a nap, I realized I ought to be practicing what I'd been preaching, so I drove down a nice, quiet country lane, pulled off to the side, set the emergency flashers, and headed off on foot. It was chilly but I had my gloves and jacket and figured I'd work up a sweat soon enough. I'd barely gotten a couple of blocks when I was startled by a horn honking and turned around to see Pickup Truck Driver #1 slowing down and lowering his passenger side window.

"Do you need a ride? Is that your truck back there?" he asked, gesturing with a thumb hooked in the direction of my CRV.

"No, I'm just walking for exercise, but thanks for stopping to ask," I replied. He gave me a curious look, as though he wasn't sure he'd heard me correctly, or if he had, was it time to call the police and have me delivered to the local looney bin. I smiled and did my best to look like a sane, harmless tree hugger who didn't know any better than to walk when I could have easily driven. It apparently worked, because he shook his head and drove off, waving pleasantly. It really was considerate of him to stop, you know? I couldn't help feeling appreciative for small town Mainers.

About two minutes later, another truck stopped and its driver, a white-haired fellow in his 60s with a great smile, asked if the vehicle he'd seen on the side of the road back yonder was mine (sound familiar?). I said yes, and he also offered me a ride. There I was, a complete stranger, and in less time than it takes for the average commercial break on television, I'm offered assistance by two guys, neither of whom apparently gave it a second thought that I might be Jack the Ripper in Polartec. Stephen King, on the other hand, would have a field day.

What is remarkable about all of this is the fact that I've got an Obama campaign sticker displayed on my rear bumper and the second guy stopped anyway. What's remarkable about that? Well, as he drove away, I saw a sticker on his rear window that read, "Don't blame me, I voted for the American." I guess Barack was right, after all. On this country road, at least, ideology be damned. What matters isn't the flavor of your politics, but being willing to help if someone needs it.

(Photo of a dairy farm near Skowhegan, ME copyright 2011 by the author)

Thursday, March 10, 2011

Missing Mondays and the People Who Live There

Well, today was my last day of rural medicine and if I didn't have to be someplace else, I could easily show up for work on Monday without a second thought. You see, I've gotten rather comfortable dodging the potholes and frost heaves on the road paralleling the Kennebec River on the way into town, and encountering patients in the grocery and hearing them say, "Goodnight, Doc," even though they know I'm a student, has warmed my heart. Being treated as though I was expected to stick around has been wonderful and it's made leaving far more difficult than I could have imagined six weeks ago. I'm going to miss those Mondays.

Working in a private practice in a small town has been the fulfillment of a fantasy I've entertained since the 1990s when I first saw the film, Doc Hollywood. Although I've mentioned this on numerous occasions, I'm bringing it up now because the idea of having experiences similar to those depicted on screen was an important one at a time when the dream of going to medical school was very far away. So far, in fact, that I hadn't begun giving it serious consideration. You could say, I was still in the "wouldn't it be nice" stage, back then.

Fifteen or so years later, I'm a student who's only used his stethoscope on other students or model patients, pretending I have more than a vague notion of what I'm doing. I thanked God for all the times I'd taken blood pressure readings as an inpatient psychiatric clinician because at least I could do that with a modicum of confidence. I'd taken illness histories while performing psychiatric intakes, so I had that down, too, but there was much that was "new" in every sense of the word. I owe a word of thanks to every patient who smiled and let me fumble my way through our initial interview, trying my dead level best to do no harm in the process.
And especially to those who said it didn't hurt each time I stuck them with a needle administering a TB test or allergy shot, whether it did or not. They were braver than I would have been, had it been me.

I'm grateful because each morning and each afternoon brought me closer to walking into the examination room feeling it was my business to sit down and ask, "What brings you here today?" And, upon hearing what each person had to say, knowing how to lead us on a fact-finding mission together, discovering what name we ought to give their problem and what we might do about it. At first I was wrong as often as I was right, but neither my patients nor my preceptor were eager to find fault and things gradually got easier and I got better. Another reason why I'm going to miss Mondays.

Most of all, I'm going to miss talking over the day's census in those precious minutes before all hell breaks loose, working through lunch and sharing an orange if there's time, greeting patients in the waiting room and chatting about the snow or road conditions like we've known each other all our lives. I'm even going to miss the blasted wall-mounted blood pressure unit that always sent me running for my portable cuff because I never could get the knack of dealing with its idiosyncrasies. The past six Mondays have been good ones, and despite being someplace new, seeing new patients and learning new things, I'm still going to miss Mondays in that tiny little town on the Kennebec River and most of all, the people who live there.

(Photo copyright 2011 by the author)

Friday, March 4, 2011

Lessons from Fred Astaire

I feel a bit like Jessie Livingstone of Pink Hats and a Mack Truck, when she likened Dr. Bob Z to George Harrison on the cover of Abbey Road (chapter 10). You know how it goes when you meet a person who strongly resembles someone famous and it's hard to get the connection out of your head. Well, it's that way with my current preceptor. He not only looks and sounds like actor/dancer Fred Astaire, the two have similar mannerisms. Not that I'm anywhere near old enough to speak about Fred from personal experience, but if you check out some of his films on Turner Classic Movies, you'll see what I mean.

I'm nearly through this rotation, sadly but also gladly, and pediatrics is looming on the horizon in the Berkshire Mountains of Western Massachusetts. Sadly because I've thoroughly enjoyed every moment in north central Maine as I've said in numerous posts, and gladly because it means I'm moving on to something new. I've gotten to work with a few younger patients on my current rotation, mostly school age and teenagers, and they've been a lot of fun. I'm looking forward to seeing more like them as well as babies and itsy-bitsy kids.

I'm especially grateful to my preceptor for his willingness to "throw me in the briar patch" of patient care. Having to call upon things I've tried out on campus and do so now, in real-life situations, has been a challenge that's forced me to address my weaknesses. You can dodge some of that in the lab, relying on your student status and the fact that your patient is a paid actor, the presumption being, you'll get it eventually. But when your patient is truly short of breath, looks like death warmed over, and tells you they feel sick as a dog, you've really got to stand and deliver. I love that. It means I have a chance to do something that can genuinely make a difference.

Now, how much can a medical student actually do? That depends. Naturally, I can't pull out the old prescription pad, scribble something down, and hand over faith and hope on a 3 x 5 piece of paper. Still in all, I can do a careful history and physical exam, try to cover as many bases as I can, and then decide on the best course of action in collaboration with my attending's greater experience. It's more practice and practice creates confidence. I can't begin to tell you how good it feels, walking into the examination room and seeing someone for the first time, knowing the tools in my kit are ones I can meaningfully use.

There was a time, not all that long ago, when my black canvas doctor's bag with all its esoterica within, seemed like an appealing stranger. Now, I carry it with me every day, and feel a little naked without it. One morning its contents were as cold as the wind blowing off the Kennebec River and the next, as warm as my dog's greeting when I come home at the end of the week. I don't know when the change occurred, but it has and I'm glad I was there to experience it for myself. I guess you could say it's what happens when you have a chance to take lessons from "Fred Astaire."

(Creative Commons image of Fred Astaire and Ginger Rogers on the cover of Life Magazine, 1938, by Zooomabooma via Flickr)

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