Saturday, December 28, 2013

The Laboratory and The Pulpit

While yesterday's post was obviously humorous, it demonstrates the use of creative license. A "Hearing Curve," in actuality, is the product of an audiogram, a clinical measurement of hearing loss, though it easily became something else in the service of a story. Its use illustrates how we can apply a term in a number of ways, some more accurate than others. 

Take "myth," for example. The way I used it and recently, its most common use, suggests a fairy tale at best and an outright falsehood at worst. As I've said before, however, "myth" refers to a fictional story that serves as a vehicle for truth. Notice the difference. Not a "false" story, but a fictional one that may have some connection with history. It's like a film credit attributing the screenplay to "real events" while certain details having been altered to render the story more interesting. 

The myth of Jason and the Argonauts and the pursuit of the Golden Fleece depicts the extent to which one will go and the dangers one will face, to lay hands on a treasure. For all we know, Jason may have been an ancient Greek sailor known for acts of bravery and a desire for wealth, but even if he wasn't, we can identify with him. My journey through medical school was definitely one in pursuit of "treasure." I even seem to recall facing the many-headed Hydra in the form of first-term gross anatomy. I'm sure I wasn't alone in that experience.

Myth represents a type of creative license, taken for the purpose of communicating truths that might otherwise elude us. Truths that do not lend themselves well to factual or common sense explanation. The writer of Genesis was confronted by such a difficulty. How to explain why people do terrible things, why evil seems always present, even in the very best of circumstances.

Imagine a quiet, solitary oasis somewhere out on a Middle Eastern desert, a few thousand years ago. The night sky is littered with stars and a family sits round a campfire telling stories before the children are shooed off to bed. One of them asks her father, why do bad things happen? The father gathers his thoughts and says, "Mm, well, once upon a time, before there was anything at all, there was God and everything was peaceful. Then he made humans and gave them the capacity to love and make decisions in the same way he was able. Things were fine until their choices went awry, creating a pattern subsequent generations have followed far too closely. In short, my daughter, evil is present because some of us act evilly and have done so since the dawn of time. We are responsible for much of the evil we see."

Problems arise when we insist the elements of a myth have greater significance than its meaning. The first chapters of Genesis weren't meant to explain the origin of life. They were meant to explain how humans, even when they reside in paradise, will make bad choices. An ideal environment can be the setting for murder as easily as a ghetto. Genesis was intended to set forth the basis for ethical behavior and mutual responsibility.

Science and religion really are talking about two different things. Conflict results when persons of faith mistake the language of myth for fact and persons of science believe them. Darwin wasn't the enemy and our children don't need protection lest "evolution" turn them into amoral beasts. Faith poses no threat to science because faith, from the beginning, has been about relationships. Literalism is the enemy, attacking both science and faith with equal ferocity, utilizing "divide and conquer" as its chief strategy. The laboratory and the pulpit are where this battle should be fought, faith allied with science, determined to overcome ignorance and do so together.   

(Creative Commons image by the mad LOLscientist via Flickr)

Friday, December 27, 2013

Scientific Myth-Busting and The Hearing Curve

It is a little known otologic fact that hearing improves with age. 

You don't believe me. 

You've heard and read and perhaps even experienced the opposite. Well, I'm sorry to tell you this, but hearing loss in adulthood is an urban myth desperately in need of busting and we're going to do that, right here and now.

The truth is, hearing develops, declines, and recovers in a manner comparable to an inverse bell curve, a phenomenon known as The Hearing Curve. We start out hearing rather well in our elementary years as evidenced by the fact that our parents can't open a can of pop on the other side of the house, quietly as a mouse, with the barest hisssss of carbon dioxide escaping, without us hearing them and calling out, "I want some!"

With the onset of puberty, hormonal changes occur, resulting in observable physical changes such as increased vertical growth, the appearance of secondary sex characteristics, and gradual hearing loss that peaks at about age 16, usually coincident with the passing of one's driving test. We know this to be true because teenagers listen to LOUD music, particularly in the car. They talk LOUDLY and make LOTS of noise doing absolutely nothing.

Adulthood is marked by the gradual recovery of hearing acuity, accelerated in some cases by childbearing and child-rearing, and becoming most noticeable in the mid-40s to 60s. Adult hearing can actually become highly sensitive to the most subtle of sounds. For instance, the creek of the front door when teenaged son creeps in past curfew can awaken the soundest of sleeping fathers more readily than a gun fired off beside the bed. The best medical evidence for hearing improvement in adulthood, however, derives from the observation that parents the world over shout at their teenaged children who, naturally, are listening to LOUD rock and roll, "Turn that crap down!" It's obviously painful, otherwise why say anything at all?

So much misunderstanding and familial conflict could be avoided if parents only knew the truth. When asking, for instance, if their teenaged daughter or son was "deaf" when told to take out the trash, help with dinner, or clean their room, what a great thing to know that, yes, their teenagers were in fact, quite deaf or so close to it as to make no difference. Furthermore, that it's only temporary, literally "a stage" they're going through. On the other side, just as it takes becoming an adult to realize one's parents aren't stupid, it takes becoming one to be able to hear what they're saying without misinterpreting their shouting as expressions of anger or frustration. Everyone benefits.

It's really quite amazing what the teensiest bit of scientific myth-busting can do to improve our lives and relationships. And we did it all without mentioning "evolution." Isn't that amazing?

(Text copyright 2013 by the author -- written with tongue firmly planted in cheek)

(Creative Commons image by Rob Gallop via Flickr)

Tuesday, December 24, 2013

Doc Bugs and Me

One of my favorite places to shop is anywhere Christmas decorations are sold. When I was growing up, my mother instilled in me a real love for rare, unusual, or antique ornaments. Thanks to her, the drawers of my ornament cabinet contain bells and glass bobbles that date from her childhood before the War (as World War II was known in our house). Over time I've added my own preferences for traditional wooden soldiers, dogs, moose, and cartoon characters, notably Snoopy and Woodstock.

One ornament has special meaning for me -- the one in the photo. I picked up Doc Bugs, as I call him, in a little out of the way place called The Spruce House, in Estes Park, Colorado. It must have been late fall, during my first year of premedical studies, when I found him hanging on a rack all by himself. Lone ornaments are hard to resist, especially if they stir up an emotional connection and you realize leaving the store without them is a mistake. 

Well, Bugs Bunny and I go way back. Tall, wise-cracking, with big feet, like me, he was my favorite cartoon character when I was a kid. Only this time, instead of his trademark carrot, he was holding a stethoscope and smiling as though he knew a secret I didn't. Right off I was certain he'd been "waiting for me" and took it as a sign that someday I'd be in his shoes, or paws, as the case may be. The next year, I came upon another version of the medical bunny, a ceramic Bugs looking rather distinguished in a long white coat holding a hospital record, another portent (except for the "distinguished" part). 

It's funny how, when pursuing a dream, you latch onto things that symbolize its fulfillment to give you hope. I'm not superstitious, but I definitely believe in the power of images to fuel our ambitions and sustain us spiritually. When such things hang on a Christmas tree, itself a very rich symbol of life and new birth, they take on deeper significance. It's as though they participate in all the tree represents and pass it along when we're most in need.

Doc Bugs has done that for me the past fifteen Christmases. Each year, taking him out of his box and hanging him in plain view has been an act of faith and each year I promised myself my time was coming. Last night, bringing Doc Bugs out once more, I said to my long-eared alter ego, "Well, Bugs, this is your first Christmas as a real doctor." It just so happens, it's mine, too.

May you have the most wonderful and joyous of Christmases and the happiest of Holiday Seasons.

(Photo copyright 2013 by the author)

Monday, December 23, 2013

The Night Train to Christmas

"Nite train!" he called, waving with one hand and holding his daddy's with the other, as they walked out the door. I'm guessing he was probably four years old and he'd been playing so quietly, it wasn't til he spoke that I realized what held his attention. 

I was wandering through my favorite toy store, Tree Top Toys, in the Old Port. The Old Port is a gentrified section of downtown Portland that abuts the harbor (hence, the name) and could easily be mistaken for the backdrop for A Christmas Carol, especially during the Holidays. My attention was held by a Schilling display of wonderful classic tin toys that echo a time before batteries, when toys were wound up by keys and ran on pure imagination. 

The store was crowded, though not so much you couldn't move, and he stood in a corner, near the entrance. His father watched from a few feet away, holding baby sister in his arms and ensuring both daughter and son were kept occupied, freeing mommy to play Santa. I noticed them at first just in passing, like I'd noticed other shoppers, picking up puzzles or stuffed bears, turning them over to look for prices or stroking their soft fur and turning into children as if on que. Some items go to the cash register right there and then, others wait for dreams of sugar plums and a jolly old man with a sleigh to find their way "home."

Like a fictional doctor of my acquaintance, a four foot tall stuffed giraffe resting high on a display rack with a smaller one planted between his hooves and a smaller one yet, between his, caught my eye. The clerk told me she'd recently sold one exactly like the tallest to a little girl who saw him last Christmas, fell in love, and saved her allowance the entire year to raise the purchase price. I brushed away tears at the thought of her carrying him home. Christmas brings out the magic of the heart in ways we rarely anticipate.

 Working my way back to the entrance, I heard a small voice call, "Nite train!" and looked over to see him leave with his parents and wave as though the cars and engine understood. And maybe for him, riding the night train to Christmas, they did, indeed.

(Photo of horse-drawn carriage in the Old Port copyright 2013 by the author)

Sunday, December 15, 2013

So Much Fun

The snow started so timidly last night, I could count the flakes drifting cautiously past the shadow of my CRV, as though they felt self-conscious being seen. By midnight, their courage having grown in proportion to their numbers, enough had gathered for me to shovel an inch off the front patio; by morning, they reached, shamelessly, halfway to my knees. 

Depending on your inseam, that can be a lot or a little. Mine's 36 inches, so this was a lot. The dogs, by the way, agreed with me. When we went out for morning bathroom break #1, my Yellow Lab took one step, then looked at me and intuited, "Where did all this come from?" 

"From the sky, big guy," I responded, aloud.

Now, if I was a kid, an arguable point on days like this, I'd be torn between anticipation and lament. Anticipation because it snowed and that meant play, lament because it fell on Sunday and not Monday, guaranteeing a snow day. Overall, though, I'd be gladder than sadder since this much, this close to Christmas, ensures this year it will be white. 

We didn't spend much time shoveling snow when I was younger, certainly not in comparison to what I did today. My father would clear off the back walk to enable my mother to reach her car, but otherwise, we'd trudge through the drifts to the barn to feed the horses. If we'd had a snow thrower, it would have been different, but as they hadn't been invented yet, it makes no difference. Besides, dad was raised on a ranch where knee-deep snow was common and no one thought twice about it. 

I probably wouldn't think about it either, but for the fact that snow accumulates in Maine. At the foot of the Colorado Rockies, where I grew up, snow is like a relative, just passing through. Back here, the snow moves in and sets up housekeeping. I can count on the fingers of one hand the number of snow days I had in high school. Back here, it takes both hands and a few toes to keep track of them.

One thing is incredibly similar, though, between the snows of my older youth and those of the younger one I discovered as a medical student, and that is, any snowfall is a chance to play. My new snow brush -- the one I use on the car? -- has a  movable head that lets me pull the snow off the car in sections, creating little avalanches as I move from the hatchback to the windscreen. 

With snow flying in all directions and oblivious to the cold, it came to me: I cleared the cars the same way as a kid. All I had then was a straw broom, so my avalanches had to move away from me. The push broom from my father's shop was okay, but the brush was too soft to work very well. My new one is perfect and as it was then, creating avalanches is still, so very much fun.

Am I ever glad.

© 2013 All Rights Reserved (text and photo) by the author.

Saturday, December 14, 2013

Lawn Mower Face

Ten day's stubble, that's what women want to see on a guy's face, according to a recent study. Full beards mean good daddy material; heavy stubble makes us look like men. Personally, I wonder whether the female study participants (males in the study responded similarly) really want to snuggle up with Mr. Scratchy or they simply like "the look." 

Marketing likes it, that's for sure. Check out the male models in the latest L.L. Bean or Land's End catalog; almost every one has several days accumulation of 5:00 shadow. True, they're also young (20s, early 30s) and muscular, with finely chiseled facial features, characteristics no doubt chosen because of their presumed appeal to women. I'd like to know where all the mature male models have gone. You suppose, after a certain age, we don't have to try to look manly, we just do?

If maturity is a sign of masculinity, it's a darned good thing because whenever I've enjoyed more than a day of unshaven bliss, forget about women gazing at me with undisguised "I want to have your children" yearning on their faces. They only glance long enough to make a cross with both index fingers and point it in my direction. Makes me wonder if I've been watching too much True Blood (HBO) lately. Anyway, Daniel Craig's 007 looked pretty scuzzy in Skyfall (2013) after a few weeks hiding out in paradise. Even M noticed. So, what gives?

Maybe it's a shift in women's ideas about masculinity. Instead of a sensitive soul who wears his feelings on his sleeve, they want someone who appears and probably acts, a little tougher. Not in the sense he's inconsiderate or abusive -- qualities more accurately reflective of narcissism than genuine masculinity -- rather he has a kind of durability that says he can take life on the chin.

The authors of the study seem to think women consider a shaven face as too youthful, while a full beard makes men seem older, hence better candidates for parenting. Stubble characterizes the guy in the middle, situated on the cusp of masculinity. He has enough testosterone to develop a beard but not so much that he might be considered overly aggressive. "On the cusp," however, usually means "at the point of beginning." From that perspective, a man on the cusp of masculinity is still a boy, something worth remembering when you go out on a date. Appearances can be deceiving.

I have a sneaking suspicion character or manliness are more accurate terms for the qualities that came to mind when the participants viewed stubbly male faces. With a nod of the head to evolutionary psychology, I don't think women are so shallow as to be mainly interested in how closely we approximate our prehistoric ancestors. The problem is, unlike the onset of facial hair, character and manliness don't accompany puberty. They have to be earned and the proof a man possesses them is demonstrated by the way he treats others and the standards he maintains for himself, implying an investment in time and experience. We may be born male but we have to grow into manhood. Facial stubble may signal "sexy" but if Lawn Mower Face is all a fellow's got, he doesn't have nearly enough.  

 © 2013 All Rights Reserved

(Creative Commons image by Twaize via Flickr)
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Saturday, December 7, 2013

The Angel in the Hayfield

We were taking a late afternoon walk, my dogs and I, around the hayfield, trying to make the most of its company before snow buries it for another winter. We were three quarters the way around, counterclockwise, on the eastern side when I caught whiff of the familiar scent of Velvet pipe tobacco and the sound of a Maine accent I'd heard before, following it.

"So, how does it feel, bein' done and all? Ya ah a doctah, now, aintcha?"

He stepped out of the trees as he spoke, not an old man, but older than me, wearing a red and black buffalo plaid jacket, rubber boots, and a crumpled brown fedora. His took his pipe out of his mouth and gestured, "Nice dogs."

We'd met a couple of years ago when my yellow Lab and I got off the beaten path in the early twilight. He must have recognized the old man as well, because he made no move to growl. The black one, too, was uncharacteristically quiet and both sat, also uncharacteristically, as if on command. "Thanks," I said, "and yes I am, got my passing scores this week. I can't do much with it, though, since I'm not licensed, but that'll come. As to how it feels, I'm not sure. I can't quite figure it yet."

"Makes sense," he said, kneeling down to pat the dogs, who wagged the tips of their tails in response, back and forth across the leaf-strewn stubble. "Fer all ya put inta this, it has to feel kinda strange, kinda like maybe ya don't know how to feel. That's understandable."

He's got good therapeutic technique, I thought, showing empathy and paraphrasing what I say while being non-committal. "To tell the truth, I'm a bit afraid to feel. In the past, whenever I've gotten this close, something always came up to get in the way. It's hard to believe there's nothing 'out there' lying in wait for me. Though there is finding a residency. Still, it's a little anticlimactic."

He nodded, stood up, and looked away to the west. A cloudless winter sky passing into sunset was his view. He puffed on his pipe in silence a moment or two before he spoke again. "How could it not be? Ya been doin' this, med school, what, seven years now? It's been more yer life than an education." The way he said it, sounded like "edgikayshun."

"Yes, it has, with all the good and some of the bad associated with it. Not everyone I know expected me to finish. I never had any doubt, I just didn't know when. Oddly, it feels like something I want to keep to myself instead of shouting from the rooftops. Almost like it's too...too..."

"Too personal? Kinda like havin' a baby? Ya tell ever'one after it comes, but ya don't mention anythin' 'bout how ya made it in the first place. I think that's 'bout right. Shows respect fer what ya been through." He turned his pipe over, knocking ashes onto the ground, and refilled it. 

"Listen," he said, "some things you gotta respect, things that make ya who ya'ah, what ya pay fer in ways you can't imagine when you staht out. You didn't know it would take seven years, you couldn't. Nobody could. What matters is, ya did it. Faced down all the demons and come further than ya evah thought ya could. Yuh've done what ya were s'posed to, what ya always been s'posed to. Time'll come fer shoutin' -- right now, just love it. Love it and respect it, cuz things like this don't come 'long ever day."

Before I could reply, he reached down and patted the dogs once again, "You take care uh this fella, ya heah?" They looked at me and wagged, leaves flying as though caught up by a breeze. "As fer you," he said, straightening up and looking me in the eye meaningfully, "Residency'll come too, don't worry, maybe where ya least expect it. Been good seein' ya." Then he nodded and walked back into the trees. 

"You, too," I said, watching the angel in the hayfield vanish as he was swallowed up by the woods. 

(Photo copyright 2013, by the author, all rights reserved)

Saturday, November 30, 2013

The Psychology of Tailgating: Part Two

Some time back I wrote a post about tailgating that included the lyrics to a song I'd written while still in Colorado. It came about one afternoon while trying to deal humorously with a BMW whose driver apparently decided my late father's beautiful '88 Cadillac was so fascinating he had to get as close as he could. My car was naturally flattered, but at 65 miles an hour, the attention wasn't exactly welcome.

Later on, I wondered about him, what motivated his behavior, was he thinking at all or was his mind far away on a beach? Why are some drivers unwilling to keep a reasonable distance? If they want to go faster, why not take the option to pass, especially if the dashed white line clearly says, "Go for it"? I think the same questions may be on the minds of those who've graciously read the first post and I'd like to offer a follow-up that errs less on the side of levity.

There are a lot of factors involved, I'm sure. A driver's attention is drawn away by a cell call as their foot depresses the accelerator proportionate to the intensity of the conversation. This is why you don't want to talk to your ex while the car is moving; tempers flare. Some drivers have psychiatric disorders that make it difficult to manage emotions, particularly under stress and driving can be stressful. Anyone who's ever been late for work knows there are times it's just hard to keep your emotions in check. Before you know it, you've forgotten other people have concerns besides yours and you're doing to them what you hate to have done to you. We're all human, every one of us.

But there's another issue I've observed, or think I've observed, since it reflects an attitude or personality trait and therefore can only be inferred. Some drivers behave as though their vehicle is a symbol of superiority and owning the road is their right and privilege. The presence of another car ahead of them sets off an intriguing cognitive process. If the car appears of comparable value to theirs, they are less likely to tailgate. Instead, they'll keep a respectful distance before accelerating around it. They'll glance at the other driver for recognition, nod and drive on. Strangers and clearly social equals passing like ships in the night. A car of lesser value or vintage, however, represents an imposition their self-importance won't tolerate. 

Now, why is that? Well, the presence of a lesser vehicle in front of them can be understood as triggering feelings related to shame. Not in the way we normally think of it, i.e. being embarrassed or ashamed because of something we've said or done. This is shame in the sense of feeling "less than," of being inferior. This experience may seem minor to you and me, but it's anything but minor to those who've oriented their entire lives around the idea they're deserving of preferential treatment. If you've been whispering to yourself the word, "narcissism," by the way, you get an A+.

Obviously, I don't think everyone who tailgates is narcissistic, but the behavior of some drivers leads me to think it's not uncommon. Consider how narcissistic individuals tend to be exquisitely sensitive to anything suggesting they aren't naturally superior to everyone else. We imagine them possessing the biggest house, newest car, and the most attractive of spouses. The reality is more diverse, though narcissism, generally, is characterized by almost a passion for control and a strong sense of entitlement. To the narcissist, our car constitutes a threat to their self-esteem; it's taking up space that rightly belongs to them. Finally racing past is their way of reminding us of the fact.

It takes very little to set off narcissistic rage, sometimes almost nothing at all. The thing to remember is, on the road or in daily life, it really is all about them, in the sense you aren't to blame for their misbehavior. You aren't inferior and they aren't superior. Accelerating dangerously or giving them the middle finger salute, only puts you at risk because your emotions have taken over your better judgment. They probably wouldn't get the point anyway. As easy as it is to become angry, it's far healthier to switch lanes or pull off the road briefly -- literally and metaphorically -- when it's safe to do so. No one's narcissism is worth an accident, or worse, becoming a statistic.   

(Creative Commons image by Eleventh Earl of Mar via Flickr)

Thursday, November 28, 2013

Grateful To Have Come This Far

On this chilly, breezy, sunny Thanksgiving morning, my gratitude list is topped by the mundane: I'm grateful to have power. Out here in the country, trees are plentiful and as you can see in the photo (pardon last winter's snow), they sometimes lean rather precariously close to the power lines. These particular ones are New England White Pines and are some of the oldest trees in the area, dating from the time of the Revolution. I'm very happy they resisted the forces of Nature once again and stood firm in the face of high winds.

I'm also grateful the hayfield wasn't completely under water when the dogs and I went out for their morning business. It rained yesterday, in case wherever you are isn't close to where I am and you came through the day dry. It rained enough that the Saco River estuary I call a stream, flirted with overflowing onto the west side of the field. It didn't and we only tramped through shallow ice-encrusted puddles instead of an ankle-deep pond.

Lately, the awareness I've completed medical school creeps up on me at odd times and I feel incredibly grateful. Watching 60 Minutes the other night, the lead story concerned veterans in treatment for post-traumatic stress disorder. If you happened to see it, too, you may recall one of them saying he missed the camaraderie, the feeling of brotherhood, that developed within his unit. It was a closeness he was certain he'd never feel again, a closeness you had to experience to understand. I immediately identified with what he was saying, having gone through my own version alongside the members, especially, of my entering medical school class.

Maybe it's because I'm slightly older or prone to reflection. Maybe it's because it took me so long and entailed so much to become a medical student and then remain one to the end. Maybe it's none of these. I do know that because of all we shared, I'm not the same person who walked into our first year classroom in August 2006. Looking back, I was insecure, unsuspecting, and thoroughly wet behind the ears. So we all seemed, one way or another. We grew up together, facing death in Gross Anatomy and crawling on our bellies across a no-man's land strewn with disease indices and day-long exams, the like of which we couldn't ever have imagined.

I'm not sure whether it's the nature of our experience or the company we keep in the midst of it. For me, the company was as important as the landscape in which we found ourselves and found each other. Sitting in my comfortable chair with one dog stretched between my legs and the other curled up beside us, looking back on it all is a luxury I once only dreamed about. Now I dream about those who struggled by my side and I'm grateful to have come this far.

(Photo copyright 2013 by the author, all rights reserved)
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Monday, November 25, 2013

The Death of a President

In psychiatry, a great deal depends on timing, including the correct diagnosis. For instance, while you may have experienced or witnessed a traumatic event or may have had prolonged exposure to highly stressful, traumatic, or abusive conditions, you can't be diagnosed with PTSD unless your symptoms have persisted longer than six months. Under six months, we call it acute stress disorder. PTSD symptoms can persist a long time.

Looking back, I definitely think 9/11 resulted in the semblance of a nation-wide case of PTSD from which we've done a fairly good job of recovering. We're more alert to danger but less likely to shut down the entire country over an isolated, local threat. We're no longer quite so eager to send in the troops at the sound of gunfire on the far side of the world. Life has begun to approximate "normal," though we're more aware of our vulnerability and the memory of tragedy is still there and always will be. Even the extreme political right seems more intent on defeating the president's health initiative than tackling terrorism. I don't think we've done as well with November 22, 1963.

I've often thought the free love, abundant drugs, and Tune-In, Turn-On, and Drop-Out mentality of the 60s was more an expression of anger -- acting out -- than typical adolescent rebellion. For the first time in our history, almost an entire generation gave the establishment the middle finger. Its hero was dead, LBJ had taken office, the Warren Commission was established, there was a national day of mourning, and now, it was time to move on. But this generation wasn't ready yet, and we would all have to wait for Kubler-Ross (On Death and Dying, 1969) to inform us the funeral was only the beginning.

Watching the 50th anniversary of the Kennedy assassination programming the past few days, I've been struck by how often someone uttered the phrase, "People don't want to think Kennedy could have been struck down by a single individual, acting alone. The magnitude of his personality as president seems to demand much more."  I'm not certain this is accurate. I don't believe his personal magnetism or his role as the nation's leader are nearly as important as the magnitude of his loss. Ongoing conspiracy theories and the tendency of 2/3 of Americans to doubt the findings of the Warren Report symbolize the depth of grief many still feel, as well as an abiding need for it to be recognized. Mistrust of government may have burst into full flower with Watergate, but it is rooted in the mismanagement of national grief over the death of a president.  

This is likely an unfair generalization, but there is still some truth in the statement that Lyndon Johnson's generation was more accustomed to putting tragedy behind them than paying close attention to what it means and mourning its significance. Anyone who's watched the HBO presentations of Band of Brothers (2001) or The Pacific (2010), or talked at length with veterans from the Great Generation knows how exceedingly reticent they are about digging up old wounds. The idea that the country as a whole needed time and leadership in the matter of grieving was unheard of in 1963. In a very real sense, we needed a president who understood and embraced his role as nation's chaplain as well as it's chief executive. Unfortunately, this was not one of JBJ's strengths, in contrast with our current president who has been known to take hours comforting the victims of gun violence.

I was also struck by the numbers of interviewees who commented on how America had changed, subsequent to the assassination. They lamented a loss of optimism, hopefulness, and the belief anything was possible. Whether those feelings are shared by all is debatable. There were and still are, sectors of the population that make no secret of their hatred of Kennedy and the causes he and his brothers championed. Nevertheless, his loss was felt by far more and the feelings associated with it have lasted far longer than anyone might have imagined. 
Grief isn't resolved, if it's ever truly resolved, by assigning blame, getting even, and nursing the satisfaction gained from a moment of passion. We learn to deal with our losses, to live with them, making them part of ourselves, by refusing to play down their impact and brush them away like crumbs from the table. Grief has to be honored and mourning respected if we're ever to regain the optimism, hope, and sense of the possible that seems forever out of reach when we feel bereft. If there are lessons worth learning from the past 50 years, this is one to take to heart. 

(Creative Commons image of eternal flame at grave of John F. Kennedy by Tim Evanson via Flickr)
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Friday, November 22, 2013

Remembering Where I Was, How I Felt, and Why

They say days like today, you always remember where you were when you got the news. I was in my classroom, it was lunchtime, and a fellow student rushed in, out of breath, and announced, "Kennedy's just been shot." I was too young, I suppose, to understand what that would mean, though I recall going through the rest of the afternoon with a feeling of tenuousness in my stomach and I couldn't wait to get home. 

Two years earlier, during the presidential campaign, an older teacher admonished our class that if JFK was elected, "we'll be under the Pope." Obviously, that never materialized but it reflects the mindset of some at the time. Change was difficult for them to envision and embrace, not unlike it seems now. All I knew was, my parents voted Democratic, they liked Kennedy's youth and energy, and neither cared whether he was Catholic, Baptist, or Jewish. He served in the military as had my father and we watched PT-109 (1963) with pride. 

That night, though, we watched the news all evening long. The information was mixed and we weren't certain from one minute to the next whether he'd survived or not. All I really remember was midnight and the screen flashing the American flag. The national anthem played, my mother wept, and so did I. Dad, as always, was the pillar we leaned on, but I vaguely remember him wiping his eyes as he led me down the hall to bed.

Days later, I stayed home from school and we watched the funeral. Everything and everyone moved so very slowly, to me it seemed endless. I had met death twice by then, my dog and pony both having passed away two and three years earlier. But I'd never encountered it in human form and seeing John Jr. and his sister, I was so glad it wasn't my father we were laying to rest.

In November 2000, it would be, replete with military honor guard, the firing of rifles, and a bugler playing "Taps." I wasn't thinking of John Jr. and Caroline then, nor was I thinking of their father. Not until later, when Barack Obama was running for president and I felt the same optimism and hope my parents talked about in 1963. Not until a snowy day in Portland when I met John's brother, Ted, campaigning for the president. And not until today, when I remembered where I was and how I felt and why.

(Creative Commons image by the smuggler via Flickr)
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Wednesday, November 20, 2013

Healthcare Without Politics: The Future is Now

Is it even possible anymore, healthcare without politics? 
I don't know, but I hope so. I'd hate to think the only place it could exist was Disney World. I hope we can reach the point midst all the  maneuvering and jockeying for power and influence where our concern for those who need healthcare exceeds its value as political capital. Sadly, we're not there yet.

Back in the day when, for the average person, Blue Cross/Blue Shield was pretty much the only health insurance game in town, coverage protected in case of catastrophe, i.e. hospitalization. I've described in other posts my own experience of kidney stones necessitating two major surgeries. My family paid out of pocket for outpatient doctor visits and prescriptions, grateful our Blue Cross policy meant the cost of my hospital stay wouldn't hit us with the force of a tsunami carrying the threat of bankruptcy in its wake.

At the time I was recovering from kidney stones and for a few years thereafter, doctors were reimbursed by insurance for services rendered. It was called a fee-for-service system. More services meant greater reimbursement. Eventually, managed care firms came into existence and in the effort to control the costs of operation, they established criteria that must be met, justifying tests and procedures, before  insurance claims would be paid and doctors reimbursed. Soon it became necessary for providers and/or policy holders to obtain authorizations for treatment before managed care considered itself obligated to pay. If you think about it from a business perspective, this makes sense. A company can only pay out so much before it is unable to pay at all.

The road to hell is lined with good intentions, as the saying goes, and while management of healthcare costs was doubtless a factor in the evolution of managed care, we have to remember, healthcare insurance is still a business and the first priority of any business is to make a profit. To accomplish this goal, a business has to increase revenues and/or reduce expenses. Determining which procedures or medications were clinically indicated, ostensibly based on empirical evidence, was one way of setting limits on expenses. Refusing to cover pre-existing conditions was another. Over time, decisions of medical necessity were taken over by managed care and stories of treatment denial, some of them truly horrible, started surfacing. You've heard them on the nightly news as have I.

Despite public outcry, doctors' frustration with a growing insurance beuracracy, and the efforts of congressional leaders like the late Senator Ted Kennedy, insurance reform lagged. Ours is a free-market economy, it was argued, competition lies at the heart of the American Way. Socialized medicine in Canada and Europe, opponents declared, provided poorer quality care and ours was the best in the world. The reality, however, failed to live up to the evidence even as the arguments proliferated.

Families on the verge of collapse because of alcoholism or drug abuse may resort to performing an intervention, confronting the substance abuser who is unwilling or unable to get treatment themselves. Not dissimilarly, someone had to intervene if healthcare insurance was going to obtain the "treatment" it had long needed. Relying on competition to even the field failed to yield more affordable coverage and the number of uninsured Americans continued to grow. Either free-market theory was wrong or the industry discovered how to prosper in spite of it. Although many believed there were good reasons for reforming the system, there was insufficient motivation for the system to reform itself.

Enter the Affordable Care and Patient Protection Act, the function of which is to enable one to obtain affordable healthcare insurance and provide protection against potential abuses by the insurance industry. Under its umbrella, patients can no longer be denied coverage because of preexisting conditions. The determination of medical necessity has been placed back into the hands of those who are committed to serve the needs of patients. Doctors now have the right to review private insurance company files that identified physicians with high utilization patient populations and directed new referrals to those whose patients were regarded as healthier and therefore cheaper to insure. 

It's not a perfect solution but imperfection doesn't automatically render it a bad one. If anything, we're discovering it's a work in progress and we'll need to adjust and adapt it as we go. I don't think it represents a step toward socialism anymore than the Selective Service represented a step toward a police state. Most of us are too smart to believe that line, even if politicians aren't smart enough to find a better one. 

The Affordable Care Act is an attempt to reform a system sorely in need of reform, not only for the sake of patients and policy holders, but for its own sake as well. As with any intervention, the insurance industry finds change painful and naturally responds with anger, disbelief, and a desire to bargain, hoping to retain something of the status quo. Over time, acceptance will ensue and the industry will find itself better off for the changes that have been made. In the meantime, we're past the point of no return; pretending the good old days were the best days is a fantasy and Fantasy Land is for cartoons. We live in Tomorrow Land and the future is now. 

(Creative Commons image of Walt Disney Politics by sbwoodside via Flickr)
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Thursday, November 14, 2013

Doctors and Spirituality: Nothing is Etched in Stone

On the premise one agrees spirituality is important to medicine, as I argued in yesterday's post, that's only where the story begins. There are even more questions to be raised about its management in the clinical setting. For example, who is best qualified to inquire about spirituality and, besides, isn't it an end-of-life issue? What if a patient asks their physician to pray with them and s/he is an atheist? These are real concerns and as a minister on the cusp of medical residency, I'd like to offer a perspective.  

Customarily, religious or spiritual preference is noted in the intake interview and becomes part of a patient's chart. Whoever does the intake should ask, at least generically, about the significance of religion, faith, or spirituality. During times of stress, changes of life, or when treatment decisions can be affected by religious beliefs, it's especially appropriate for the physician to broach the subject. When patients come to the clinic, they anticipate seeing a doctor they know and have come to rely on. The doctor-patient relationship provides an ideal basis for talking about what health or illness means to them, personally. As I define it, such conversations reflect "spirituality" in its most basic sense.  

Naturally, you'd assume spirituality to be an end-of-life concern but it surfaces at other times as well. For instance, couples who have been relatively uninterested in religion often express a desire to reconnect with family religious traditions when a newborn enters the picture. As a first-time pastor, I discovered young children in the home was associated with parents attending church regularly. Family atmosphere, the potential for children to learn moral principles, and social contact with other parents were important factors in the decision to become involved. Midlife is another time when spirituality may take on new significance. The point to remember is, spirituality and relating -- intrapersonally and interpersonally -- go hand in hand, and most of us are best at both while we're still breathing.

The question of qualifications is one that has far less importance for spirituality than the practice of medicine. Doctors are accustomed to referring patients when a specialist would be better qualified to be of help. Spirituality, however, doesn't require technical expertise to be addressed meaningfully. Patients don't expect their physician to be a theologian. What they expect is consideration, respect, and empathy. If we can't provide these qualities, we've got far bigger fish to fry than whether we can explain why bad things happen to good people. And for the record, even ministerial folk have a hard time with that one, if they're honest about it. As long as we stay in touch with our humanity, we've got all the qualifications we'll ever need.

Well, then, what about physicians counseling with integrity when their own convictions concerning spirituality are at odds with patients'? While statistics indicate physicians who are fairly comfortable bringing up spirituality tend to be persons of faith, there's absolutely no reason why this should be considered necessary or even advantageous. For one thing, it's not about what we as physicians believe or disbelieve, anyway. For another, there are a number of potential points of disagreement with patients, including music, politics, caffeine or decaf, none of which require us to alter our convictions to be medically effective. In any case, introducing spirituality into the conversation is never an occasion for us to persuade, convert, or pontificate.

Admittedly, possessing a spiritual orientation may seem helpful, but it can also create problems. The innocent presumption that you know what a patient is talking about since you're able to identify with their experience may result in failing to ask follow-up questions. Conversely, patients may withhold information believing a common experience tells you all you need to know. In situations like these, having no spiritual orientation or one that differs from your patient can be an advantage because it requires us to explain ourselves rather than err by relying on assumptions.

Finally, in the matter of praying with patients, I'm reminded of a wonderful line from the film, Oh, God (1975). John Denver's character asks God (George Burns) if they might just talk now and then, to which God says, "You talk, I'll listen." If a patient should ask their doctor to pray with them, whether or not they are persons of faith, offering to listen reverently while the patient prays is spot on. If they should ask you, as their doctor, to pray on their behalf, there is no harm in gently explaining your convictions should they differ from your patients'. By telling the truth you maintain your integrity and confirm your trustworthiness. Furthermore, your honesty tells your patient that you value them too much as persons to pretend to be someone other than who you are. The result could very well be a much stronger bond between you.

Admittedly, in this essay I haven't gone anywhere near the truly difficult and painful spiritual/ethical issues of blood transfusions and Jehovah's Witnesses, abortion, or faith-based objections to teenage birth control and HPV vaccination. My interest has been on what you might call "bread and butter" spiritual concerns, but demonstrating respect, empathy, and truthfulness is essential in any situation involving religion or spirituality. We struggle, do our best, make mistakes, fall down and get back up, mindful that where spirituality is concerned, nothing is etched in stone. 

(Creative Commons image by john-norris via Flickr)

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Wednesday, November 13, 2013

Why is Spirituality Important to Medicine?

That's a good question. Why is it? Well, to try and formulate what I hope will be an equally good answer, we should begin by defining our terms, though I'll tell you right off, precise definitions are elusive. "Spirituality" can suggest devotion to a particular religious tradition, but often as not, it refers to something that has little or nothing to do with organized religion. It may signify a feeling of relatedness to something and/or someone greater than ourselves or express the way a person conceives of their life unfolding. It may describe a personal sense of meaning and purpose or the conviction there is no purpose, that life is a series of random events possessing no more significance or predictability than the numbers drawn in the lottery. "Spirituality" literally can mean almost anything; it all depends on how we use the word.

Sigmund Freud called religion and by extension, spirituality, a "universal obsessive neurosis," inferring it was associated with psychological ill-health. His most famous student, C.G. Jung, disagreed and considered spirituality essential to a patient's well-being. Individuation -- the process of achieving fully conscious self-realization -- could be nurtured by a spiritual orientation as well as psychotherapy. But instead of relying on the doctor and patient relationship, spirituality activates archetypal images residing in the unconscious that enable us to feel grounded and genuinely connected with the deepest aspects of ourselves, a process some call "soul work." Unlike Freud, it wasn't the practice of spirituality that troubled Jung; it was its neglect that created problems requiring psychiatric help.
Jung gave considerable attention to Christian images and theology in the development of Depth Psychology, but he also drew on other forms of spiritual expression, including Hinduism, Islam, and the study of alchemy. In the I Ching, for instance, Jung discovered a useful instrument for revealing his own unconscious motivations. He regarded the symbols that recur throughout the I Ching, religion and mysticism as comprehensible images of a mature and fully integrated self.

If we think of spirituality, therefore, as the expression of a powerful desire or need that, when adequately addressed, leads to a feeling of wholeness, we can begin to let go the notion that spirituality must be opposed to science and reason. True, spirituality is irrational in the sense that it's an intuitive process, but irrational doesn't equate with anti-rational. It simply means spirituality "knows" in a way that sidesteps reason or logic. We call this relying on "flashes of insight."

You could say, intuition operates like saltatory conduction in the brain and spinal cord. Some nerves, particularly the longest ones, are wound about with a substance called myelin, making them look like a string of hotdogs placed end to end. An electrical signal travels along a nerve by leaping between the spaces between one "bun" and the next until it reaches its target. This type of signaling is much faster than the stepwise transmission employed by nerves that don't require "rapid transit" for communication. Similar cognitive leaps characterize intuition, though we may have to retrace our steps in order to explain to others how we "arrived at the station," so to speak.

Quaker philosopher Elton Trueblood described post-WW II America as "the cut flower generation," and identified its critical existential problem as disconnection from its psycho-spiritual roots. Cut flowers look very nice in a vase, but they don't survive very long that way. Spirituality can be understood as an intuitive effort to find one's place in the universe, to put down roots and establish a sense of belonging.  

Although most people probably think about seeing a doctor or psychiatrist when they feel ill or they've got a problem, medicine is moving toward a model that promotes health and wellness. You take your car to the mechanic for regular maintenance, why wait until you're sick to see your physician about health maintenance? If your doctor is an osteopathic physician or psychiatrist, attending to the mind-body-spirit triad lies at the heart of their medical philosophy. "Spirit," like "spirituality," can mean many things, but as physicians, recognizing and cooperating with its presence means we wish to promote wholeness, a type of wellness that touches a patient through and through, that improves their quality of life and the lives of those around them. 

(Creative Commons image by NA dir via Flickr)

Friday, November 1, 2013

The Ghost I Wasn't Expecting

Short of Carbon-14 dating, I'd be hard put to tell you the age of my barn with any precision. That said, the off-center double doors, gableless roof angled low enough to walk on, and rough, hand-hewn post and beam construction fit together with hand-carved nail pegs (photo), strongly suggest it's stood its ground at least 183 years, if not longer. The names of those who raised it are pieces of historic mystery, but between its walls, one of them fell and his life was no more.

It had been a warm autumn day. September, maybe October. Probably October. Haying season was over and the sun drifted slowly down past the line of yellow leaved oak and maple that formed the western boundary of his field. He was in the loft, raking loose hay back from the edge, tucking it into the enormous pile towering above his head and spreading from one end of the barn to the other. He'd done this daily after feeding time since they'd gotten in their first crop, rain and shine, sometimes negotiating the snow he measured in feet between his house and the barn on skis he fashioned himself. 

"You be careful," his wife admonished, when he stepped out the kitchen door that afternoon. She said the words so often he could mouth them with perfect timing, though not with impatience or irritation.  She'd ended each of her letters, written while he was serving in the Continental Army, the same way. He understood what she meant. 

"I will, don't worry," he said, like always. He knew what he was doing and he was careful. Heights didn't bother him in the same way they did his father. Growing up, he'd saved the old man a dozen times, grabbing him by the shirt collar when he teetered too dizzily near eternity. There was no reason to think he'd fall and if he did, it was only a few feet, eight or nine at most. He'd fallen that far, or so it felt like, from the back of the Shire draft horse that pulled his plow. True, the ground isn't a wooden floor, but it's hard enough and one fall is as good -- or bad -- as another, he told himself.

Besides, what troubled him wasn't man-made. It was owls and bats roosting in the corners where the roof rested atop the walls. More than once he brushed the bats away when they awoke at dusk and headed for the open doors. He kept a broom in the loft for just such occasions. It wasn't so much they bothered him, but his wife thought them ugly, they frightened the children, and their acrid dung turned the barn into an outhouse in the summer heat.

"I'm coming," he shouted, in response to his wife's call to supper. 

Cool weather and we're done with bats for another year, he thought, tossing his rake onto the hay stack and turning to descend the ladder for the night. What happened next he couldn't say but suddenly, a large winged shadow was flapping round his head. He ducked and waved his arms, trying to ward off what surely must be a devil or an angel who mistook his barn for the local publick house. He never saw the dark grey barn owl with its white, heart-shaped face and wingspan the length of his arms stretched wide, that started at the sound of his voice. Nor did he see the edge of the loft until he was in mid-flight and then, only fleetingly.

At first, he feared he was dying, and a few agonizing seconds passed before he found his breath again. He wasn't hurting but his head felt wet, so he rolled to one side and slowly raised himself to his knees. That's when he noticed his right hand pressing into his right hand. He stood up quickly, backed up several paces, and stood there, looking at himself lying on the floor with blood draining from his head into the cracks between the boards. It's odd what crosses your mind at times like this. All he could think was, "I knew I should have laid those boards closer."

Concerned his delay was a portent of what she feared the most, his wife called again. With no answer forthcoming, she ran to the barn, stopped in the doorway, and raised a flour-dusted hand to her mouth. Watching her weep, helpless to convince her he was fine, that he was right there, next to her, he began to weep as well, cursing whatever it was that permitted him to survive a war and let him die like this.

They laid him to rest in the cemetery behind the Congregational church he and his wife had faithfully attended all their lives. Years later, she was placed next to him and eventually, their children with their husbands and wives, sons and daughters, too.   

Halloween in New England plays havoc with the imagination and mine is no exception, though lately I've begun to have serious doubts about the distinction between real and imaginary. Earlier this evening, for instance, I went out to the barn to switch on the exterior flood lamp on account of a recent episode of what appears to be nocturnal adolescent trespassing. A few hours later, as I was getting ready to turn in, I glanced out the living room window and observed the barn door swing wide and close again. I locked it, I was certain; there was no wind, and the only cars in sight were mine.

With my heavy Maglite flashlight in hand, I walked out to the barn, trying to steel myself to sound braver than I felt. My steel turned to molten lead when I realized the door was locked as tightly as it had been when I snapped the padlock shut at sundown. Common sense called it weariness, the beer I didn't have with dinner, or time to get my eyes checked. I also knew I had few choices if I wanted to know the truth. 

With hands trembling so badly I may as well had Parkinson's, I slipped the key into the lock, took a breath and stepped through the entry cut into the frame of the large, double doors. That's when I saw him, sitting on a bale of hay toward the far end, his back against the wall, with a long thin stem stuck between his teeth. He could easily have been relaxing after a hard day's work. I reached over and turned on the remaining lights, thinking maybe I do need to get my eyes checked after all. And then he moved. 

I couldn't have if I'd wanted to. My feet were planted as though they'd taken root and despite my pounding heart and a cold sweat breaking out across my back, I stood there, hand on the light switch, watching as he got up and walked the length of the barn toward me. "This was mine once," he said, gesturing with a wave of one hand, "now it's yours?" Dry-mouthed, I couldn't speak and nodded, instead. "Mm. You don't farm, do you."

Somehow I managed to whisper, "No, I'm...I'm almost a doctor...I...who...who are you?"

"Not the ghost you were expecting?" He said, cryptically. "Too bad you weren't around the night I..." He looked away for a few seconds and I thought he'd lost his train of thought when he turned back to me and said, "There are some things you should know about your barn." 

(Photo of beams and hand-hewn nails copyright 2013 by the author)

Tuesday, October 15, 2013

The Liberty Bell: Just the Two of Us

Well, I did it again, said I'd talk about one thing and neglected it for another. Yesterday's post was supposed to be about Independence Hall and the Liberty Bell, but reading over it, I'm darned if I can find any reference to a bell. What is it they say about good intentions? 

I suppose, without realizing it, the omission was intentional. Independence Hall was the main attraction and my primary reason for driving downtown in the first place. I really didn't think about seeing the Liberty Bell, despite all the times I've watched National Treasure (2004). It simply didn't cross my examination-addled mind.

That's the thing about medical boards exams, if I've never mentioned it before. They're exhausting. Whether they test your command of first year science material, second year disease processes, or physical exam skills, by the time you've finished, you've got every reason to be justifiably weary. Whoever first described them as "marathons" was exactly right. They feel like 26 hard-fought miles whose successful completion depend as much on adequate sleep, nutrition, and psychological preparation, as upon whatever study and skills review you may have done. Which helps explain why I couldn't entertain seeing both Independence Hall and the Liberty Bell at the same time; by then my brain had seriously limited space and Independence Hall won the toss.

The moment I saw the Liberty Bell, however, thanks to the comment of a passing stranger, was more than a surprise, though definitely all of that. The last thing I expected was that it might be even remotely accessible. Especially considering how my efforts to position myself on the Independence Hall side of Chestnut Street for a closer shot of Washington's statue were quickly suppressed by a guard whose face clearly stated, "Don't Tread On Me." Spending the night in the Philadelphia hoosegow didn't seem like the best way to pad my resume, so I retreated across the street like Washington's forces fleeing New York ahead of the British. 

Oddly enough, where the Liberty Bell was concerned, there were no guards to be found. Then again, the glass enclosure surrounding it isn't the sort of thing a graffiti artist with a piece of chalk could insult, whereas the brick facade of Independence Hall isn't quite so resilient. But I liked that, their absence, I mean. It gave me a chance to stand a mere few feet away from it, nose pressed against the glass like a Dickens character, just me and the Liberty Bell, just the two of us. Maybe it comes from all those days spent wandering the meadows among the trees as a kid, the sense that inanimate objects aren't soulless, but to me, it felt like I was in the presence of something sacred. 

The Liberty Bell hangs in solitude, as though nothing else is quite worthy of its company, and the structure in which it is housed could easily be a glass cathedral. Maybe my theological background is coming out and someone else might view all of this quite differently, and that's fair to say. Still, there's something about the Liberty Bell that made me feel it ought to be shown reverence. It was the only thing I wanted a photo of myself alongside that afternoon. The unnamed tourist, the one who drew my attention to it, was my photographer.

The memorial itself is a city block long and the President's House or it's framework, lies at the far end. Walking back toward Independence Hall, I had to stop and gaze at the Bell again, truly feeling loathe to leave. The hour was getting late and I needed to, but I didn't want to. I can't explain it, but there's a beneficence, or better yet, a holiness about the Liberty Bell. Not the fearful, overpowering mystery of a burning bush, more like the gentle, suffer the little children to come unto me, sort of holiness. A holiness born of vulnerability, one the Liberty Bell was foundered with and that became evident when it rang. But even now, when it appears silent, it is not silent.

Draw near. Closer. Closer still and listen. Listen as I did. Can't you hear it whisper? 

(Photo copyright 2013 by the author.)   

Monday, October 14, 2013

Independence Hall, Itching for a Fight

Like most kids raised outside of New England, I suppose my earliest tour guide through Colonial America was Walt Disney. Televised reruns of classic films like Johnny Tremain (1957) and the animated Ben and Me (1953) coupled with my imagination to turn me into an idealistic young member of the Sons of Liberty or Benjamin Franklin's collegial churchmouse, depending on the moment. By the time college rolled round, I was a prime candidate for a major in history and when 1776 (1972) was released, I fell in love. With the movie, that is. There was a girl at the time, but that's another story and love wasn't destined to be the key player in our plot line.

Independence Hall is another matter. When Benjamin Gates was there, in National Treasure (2004), I was still in the throes of seeking medical school admission. It was the second of a three year process that ultimately led me to Maine and a farm on the banks of the Saco River in a town founded in 1772. But medical school is time consuming and Philadelphia miles away. It wasn't until this past week that the spin of fate's roulette wheel dropped me into place within a stone's throw of the building in which the Declaration of Independence was debated and signed.

As I wrote yesterday, I'd been in Philly for a day -- actually, two, one to settle in and get a decent night's rest, the second to repeat a medical board exam. I wasn't sure when I'd be finished, so I scheduled my flight home for late in the evening. Done at three, there was time to drive by Independence Hall, if nothing else. At least I could say I'd seen it. Well, you can guess the rest. Once I saw it, I had to find a parking space that wasn't reserved for carriages, and get as close as I could. 

A skeleton crew of park rangers or police, I never quite figured out which they were, had everything cordoned off, but it was still possible to walk along South Fifth St. and place my hand on the outside wall of Philosophical Hall, that adjoins Independence Hall on the north. Philosophical Hall is where Benjamin Franklin founded the American Philosophical Society. Immediately across the street is the Library Building, the site of the first public library in America, also founded by Franklin, whose statue adorns the facade over the entry.

I wasn't prepared for how it would feel, seeing Independence Hall for the first time. It's different from Boston and Patriot's Day or Maine and First Parish Meeting House, where the Declaration of Independence was first read aloud in this part of the Colonies. After the battles of Lexington and Concord, the war moved south. One of my neighbors, or he would have been had I lived in 1775, Lieutenant Samuel Merrill (his restored farm is Jessie Livingstone's dream house in Pink Hats), fought at Bunker Hill. I'd have been there with him, if I could. But what I mean is, there is a comfortable quality, almost an ordinariness in the best sense of the word, about the Revolutionary period up here -- it seems less formal, cozier, more familiar. It's everywhere you look. It's like visiting an old friend.

Independence Hall is surrounded by downtown Philadelphia. It's an urban environment and it was back then, too. As urban as you could get in 1776 when street sweepers cleaned up horse manure rather than cans and candy wrappers. Once you get past that, there's a feeling that virtually seeps out of the cobblestones. It was as though I was part of something electric, exciting, on the brink. There's a tension in that historic square mile that hasn't dissipated one bit in three hundred years. Visit City Tavern and you're certain Jefferson and John Adams will be there, plotting Revolution over a pint. One sight leads to another and before you know it, you're reaching for your flintlock, itching for a fight. 

I liked Philadelphia. It's a young city and a friendly one. The residents drive like bats from hell on the highways, but meet them anywhere else and they're pleasant and easy to engage. It's a city, nevertheless, and Portland is big enough for me. I loved Independence Hall and the Liberty Bell, but I love our homespun version up here even more. I'm sure Lt. Merrill must have felt similarly, when he left Boston behind for his farm on the banks of the Saco River.  

(Photo copyright 2013 by the author. Additional images of Independence Hall may be seen here.)

Sunday, October 13, 2013

Once Upon a Rainy Afternoon

I was standing across the street from Independence Hall when I heard a woman's voice behind me, "Turn around." I obeyed, and in the dim light of the rainy, grey, late afternoon, about thirty feet away, saw a golden outline. My breath caught in my throat as I said, "Oh my God, it's the Liberty Bell." I must have looked like a child on Christmas morning when another tourist and her husband smiled and told me where I could get even closer. I hurried to the window they indicated and there it was, as though waiting for me all these years.

I'd never seen Independence Hall, either, until minutes earlier. I was in Philadelphia for a medical licensing exam and had a few hours to kill before my flight home. The day before had already turned miraculous when, while searching for a discount store to purchase a few items I needed at the last minute, I noticed the sign for Valley Forge park. I couldn't believe it. I'd wanted to go there quite badly, but it looked too far on the map and this was a business trip, or so I told myself. Yet, there it was, as though it, too, had known I was coming and had waited long enough.

The park was closed, naturally, because of the governmental shut down. The Tea Party members of Congress, ironically named for those who sought liberty of conscience rather than the freedom to impose their views of conscience on others, weren't aware I'd be in Philadelphia, I'm sure. But Valley Forge had other ideas because Washington Memorial Chapel, dedicated to George Washington and located immediately across the street from Valley Forge, was open. 

I turned my rental car into the parking lot so quickly I'd have been a road hazard to anyone unfortunate enough to be following close behind. The church, an active Episcopal parish, is built in the classic English Gothic style with a bell tower drawing the eye skyward. Cannon -- period artillery pieces, some field, some naval, but all of them veterans that bombarded the British -- guard both sides of the entrance and line the grounds to the west and north.  

Inside is a lovely nave with stained glass on four sides. But it's not ornate, as you might expect, and the only statue is one of a young Washington on the side of the bell tower. It has the feel, however, of a castle, but since I've never been in a real one, it's really how I imagine it to be. I encountered a parishioner near the altar who answered my questions and listened, indulgently, as I described the turn of events leading me there. And that's how it seemed, as though my presence was no accident, even if it was.

Behind the church is a log cabin replete with walk-in fireplace that serves as a gift shop. At first, I thought I could be happy with a large mug bearing the image of winter 1777, but then I noticed the brass cannon. A British six-pound field gun, the staple of the Continental Army. Solid brass, about ten inches long and four high, I could see it sitting in my study, alongside smaller versions from the battlefield of Saratoga, Ft. Ticonderoga, and Maine's Ft. Knox, named for Henry Knox, who directed cannon fire against the advancing British at Bunker Hill. I left with the mug and the cannon.

Valley Forge is beautiful this time of year and probably more so at Christmas. The Christmas of 1777 was different. Wind blowing off the Delaware River, snow mixed with icy rain, Valley Forge was anything but beautiful to the sick and starving, ill-clad Continental Army, nearing total collapse. On a good day with mild traffic, you can drive the 43.5 miles from Valley Forge to Trenton in less than an hour. Marching the same distance, feet wrapped in rags, must have been agony. If you haven't seen The Crossing (2000), with Jeff Daniels as Washington, I'd encourage you to see it. Even members of the Continental Congress were unaware how close was defeat that bitterly cold Christmas morning.

I can easily identify with George C. Scott's character in the 1977 film, Patton, standing among the ruins of ancient Carthage and recounting how it was when the Romans conquered the city. Not that I believe in reincarnation, I don't mean that; it's just that history has always been a living thing for me and visiting those places where the course of human events was profoundly altered, I can't help but feel as though I was there, if only for a while, once upon a rainy afternoon.

Tomorrow, Independence Hall and the Liberty Bell.     

(Photo copyright by the author, 2013. Additional images of Valley Forge may be found here.) 

Sunday, September 1, 2013

Behind the Scenes with Dr. Bob Z and John Livingstone

I love a good backstory. More than deleted scenes, it tells the tale behind the scenes, the storyline that may or may not find its way into print or onto film. Backstory means getting a glimpse of the life J.K. Rowling imagined, but didn't fully reveal, for Harry Potter between his final duel with Voldemort and the end of the story, 17 years later. Similarly, I've been taking a long look at the conversation between Dr. Bob Z. and Jessie's father, John Livingstone, on the occasion of John's birthday, in Pink Hats 20: Untarnished and In Uncharted Territory, and I'd like to tell a bit of their backstory.

Let's start with the basics of what we already know about them. John has been widowed and raised three children, putting them through medical and veterinary school, on his own. At 72, he operates a full-time, large-animal veterinary clinic along with his son and serves part-time as an unpaid pastoral minister in his late wife's church. Bob is 62, divorced, and his father is dead. A former opthalmologist, he eventually changed direction, completed a second residency in pediatrics, and has a busy practice in Portland. This isn't your typical confab between a young man starting out and an older, established parent of the bride-to-be. Our characters are grown men who have experienced some of the worst and best life has to offer.

If Bob were thirty years younger we'd naturally expect their exchange to have a somewhat different tone as well as focus. Bob would nervously do his best to speak convincingly of his love for Jessie and describe his prospects for the future. John would patiently offer advice about life, marriage, and what he himself has learned about being a good son-in-law. But that's not the case here and the conversation has to ratchet up several notches to take this into account. Bob is a mature man and he and John are more likely to relate as peers, a subject that comes up again in A Different Drummer.  

The pace of the conversation is also different. Both are direct, get to the point, no nonsense New Englanders. John has known marriage was on his daughter's mind since visiting with Jessie several weeks earlier (Life is too Short for Playing it Safe), so he's had time to do some thinking. It would make sense for him to have talked it over with her siblings, too. We can presume he's been observing Bob throughout the festivities, noting how he, Jessie, and the rest of the family interact, and no doubt, he's formed some impressions. By the time the two of them are sitting on the front porch, I think it's safe to say, he's already got a pretty good idea whether he's going to bless their relationship. What he needs to hear are the reasons for doing so in Bob's own words.

Now, unlike a younger prospective husband, Bob has clarify why he believes he should ask for Jessie's hand. I'm reminded of medical school admissions interviews and having to explain, Why do you want to undertake something of this magnitude now? It's not exactly the kind of question you're going to get if you're 22. Though John appears to casually break the ice by saying, "So, you want to marry my oldest daughter," what he's thinking is, Sooner or later Bob's going to ask, why not make it easier on us both? Bob knows he really doesn't need to ask because asking, in itself, implies a power differential that doesn't exist between peers. He wants John's blessing, however, because he understands how important her family is to Jessie. Asking, for him, is an act of love. It's undeniable proof he means it when he says, "She's always been more important to me than I was to myself." John also knows they don't need his approval -- Jessie can make her own decisions -- but Bob's desire to seek it anyway says a great deal about the kind of man he is and the kind of man she's getting. 

There is another element these men have in common, besides Jessie, that alerts us to the possibility their conversation will take us in directions we might not imagine. Both are admittedly skeptical about religion. John deals with his doubts by actively debating with his faith. Bob is more of a theologian than he gives himself credit for, but his theology is existential; it grows out of his experience of living and loving. John's is, too, but it bears the marks of conscious reflection and that enables him to help Bob make sense of, and give expression to, the deeper implications of what he's feeling and saying.

While some relationships entail one partner secretly wishing to remake the other into a romantic ideal, Bob openly wishes he was more like Jessie. He admires her as much as he loves her. He tells John that he feels as though he's being changed as a consequence of their relationship, but he's not sure how to describe it. He feels, not "young" as we'd expect, but "new and untarnished," which is much different. John interprets Bob's experience in terms of baptism -- death and resurrection -- and points out how some relationships, such as his with Jessie's mother and now theirs, can be profoundly transforming. What Bob is describing isn't simply a metaphor; it's real and observable. In essence, he says, relationships like yours don't come along every day, but when they do, there's no mistaking them. John can see the effects in his daughter and Bob can see them in himself.

I like this conversation and I hope I'm not alone. It reflects not only Bob's appreciation for Jessie and her family, but also the quality of his experience of being a son, an often neglected aspect in romantic relationships. How well we  integrate our same-sex parent into our identity as adults has an enormous impact on the kind of spouse we're capable of becoming. Bob exemplifies someone who, despite his father's absence, maintains their relationship through memory and demonstrates its influence in the way he treats those he loves. His children won't know their paternal grandfather like they'll know John, but through their father, they'll know him just the same. 

(Creative Commons image of a front porch such as the one where John and Bob have their conversation by nanetteturner via Flickr)
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