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)
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