So, here I am, finally back home and it feels like a typical Saturday. The dog, cat, and I snug in my study by the fire and there's snow falling -- on the day before Easter. The fire is a necessity since the furnace tends to treat this end of the house like something to be avoided at all costs, but the snow was a complete surprise. Alas, it doesn't show in the photo -- so much for good intentions.
On Monday, my Obstetrics-Gynecology -- OB/GYN for short -- rotation begins at Maine Medical Center. In the meantime, my head is still revolving around pediatrics, an experience that turned out to be as surprising as this morning's snow. I had some contact with children during my rural medicine rotation, although not enough to describe it as traditional family medicine. It was mostly an adult practice, but what I learned applied to every age group. A physical exam is still a physical exam, whether the patient is seven or seventy.
One thing I noticed from my first day in pediatrics was how much more fun it was, working with kids, than adults. I mean, you can play with kids and they appreciate it, even when they're sick. That said, playing has a significance few realize: it's not simply about being charming or cute. And this is something I knew going in, thanks to a number of children who, over the years, have been willing to be my tutors. Play is the language children speak, particularly with one another, and not all adults are familiar with it.
I love words, written and spoken, their derivations, structure, the interplay of grammar and syntax that may span what we fear is an uncrossable abyss of hurt feelings, anger, and disappointment. I love it, too, when communication sidesteps the vocal cords and heart to heart is the dialect spoken eye to eye. Play is like that. When you let down your guard and become genuine with children, allowing yourself to be as vulnerable as they are, you make connections and establish rapport, sometimes without even saying a thing. Not unlike psychotherapy.
Before this rotation, I wasn't aware how essential play is for me as a clinician. I mean, I've always tended to joke with patients whenever it was appropriate because humor can be disarming; it creates a space in which we may be mutually human. But with children, it's not so much about creating a space as it is stepping into one that already exists, and the question becomes, can we forget ourselves well enough to become real with children, and believably so?
The hardest part, it seems to me, is relating to kids in ways they find meaningful and their parents endearing while maintaining an air of professional competence at the same time. It's one of those dance steps they don't teach in medical school. I suppose that's also why they call medicine a practice -- even on the best of days you're never completely certain you haven't tread on a few toes.
(Photo copyright 2011 by the author)
"Thickly Settled," read the yellow triangular traffic sign. Not the usual warning variety, I'll admit, but it works for Hancock Village, a double row of houses and a Baptist Church situated almost right on the state line between Western Massachusetts and New York. Greater Hancock extends further north, past Jiminy Peak Ski Area, to Williamstown, but the Village itself is smaller. I'm writing, on this warm, quiet-as-a-grave, Sunday morning, appropriately enough, from the Hancock Cemetery. It isn't that I'm particularly fond of cemeteries, but my guess is the dead are less likely to bother interrupting me to ask what I'm doing, so as long as my computer battery holds out, here I sit.
There's nothing like a rotation in pediatrics to remind you how little you know about children. What's this got to do with cemeteries? Nothing, really, I just wanted to share where I was writing from and how I'd gotten there. My real topic is pediatrics. So, anyway, six years as a Scoutmaster I thought might give me some expertise and I suppose it did, at least where boys age 11-18 are concerned.
Theirs was the generation of Arrowsmith and Guns N' Roses and my Bronco II rocked to their beat along the highways and hedges of Texas. Among their fellows I can count my classmates and future colleagues. Does that make me feel old? Hardly -- they got me out of myself and into life in ways that endure to this moment. Because of them, my CRV rocks to Lady Gaga and I'm not afraid to walk into an examining room with a kid with undiagnosed ADHD, bouncing off the walls.
Some things you don't get in the rarefied atmosphere of Scouts. For instance, a little guy who tinkered with the tiny flashlight at the end of my stethoscope, a trinket I claimed from Army recruiters who visited my school a couple of years ago, before allowing me to listen to his breathing. His mother said, more than a little surprised, "He's afraid of men, but he's good with you..." I resisted pushing the envelope to look in his ears. He didn't like the idea and I wasn't willing to risk our nascent therapeutic alliance, shaky as it was already. Besides, the nurse practitioner would have to do it immediately after me and once was my patient's limit. I'll see him eventually for a follow-up visit and hope the rudiments of our friendship are still intact.
There are little girls, seven going on 27, and others so shy they can't tear their eyes away from the shadow of daddy's chest and it's a challenge to do anything. We manage, sometimes with tears and mostly without, for which I'm grateful. A visit to the doctor can be traumatic even when there's a lollypop waiting at the end of it. Kids need to know coming to see the likes of me isn't always a reason to be sad.
It's more the therapist in me than anything else, whispering the wisdom of Carl Rogers, i.e. every patient deserves unconditional positive regard, whether they're old enough to put it into words or not. A smile, a wave goodbye, or the five year old who insisted I get a sucker, too, it all spells out the same. We find a space outside fear and uncertainty where we can connect.
I'll walk to my car sometime around five or six in the afternoon, dog tired.
And feeling good.
(Photo of historic Hancock Cemetery copyright2011 by the author) 
To be completely honest, I've rocked back and forth between remiss and downright absent-without-leave more often than not these past three weeks. And for that I sincerely apologize. The intellectual drain of rotations is as severe as the physical strain and it's getting so that weekends are my only time to contemplate writing. I do fantasize about it at other times, but usually when something cute, wonderful, or memorable has occurred, by the time I'm home, my mind is lucky if it can say, "Huh?"
Now, this condition is not uncommon. Most of my friends are tap dancing around their mid to late 20s and when one of them comes home, so slow and heavy are the footfalls up the stairs, you'd think they were summiting Everest. Rotations are tough and residency is tougher. I've got pals here from my entering class in psychiatry, surgery, and internal medicine and they're the pudding's proof. Tired R All of Us.
But there's more than that and I'm thoroughly enjoying the dormitory environment here in the "osteopathic ghetto," as I've christened it, since the apartments in our converted house are occupied by my classmates. Barely a knock before opening the door to shout is about as polite as we get.
About week ago, a few of us spent Friday evening playing Guitar Hero, a serious challenge, I discovered, for those of us who really know what to do with a six string. The game is about counting but we want to get down with the rhythm and be "big rock stars and live in hilltop houses, drivin' fifteen cars," even if the audience is only electronic and fame and fortune as fleeting as a flip of the switch.
Oh yeah, that's right, you read it here first, Beggar plays Guitar Hero and will again -- first chance he gets. I may have a hard time getting my brain to think in the evenings, but chasing that neon rainbow? Hey, you only live once.
(Creative Commons image by Kermitz72 via Flickr; I Wanne Be a Rock Star, words and music by Nickleback)
The coffee in my brand new mug from the Norman Rockwell Museum this morning, tastes as good as I hoped it would. The material from which a mug is made and the manner in which it's fired, really does impact flavor, you know. For instance, dark roasts taste cleaner in my white bistro mug with the letters U-N-E stenciled down the side in blue (see Pink Hats, chapter 9). In The Black Dog pottery mug given me by my dog and cat for Christmas last year, dark roasts seem to mellow. The Rockwell, as I think this new one should be christened, strikes me as midway between the other two, but we'll find out, once I'm back in Maine and writing on some bleary, early morning. That's the acid test, when I can barely see the keyboard, what's the coffee like then?
How I happened upon The Rockwell is a story in itself. I thought the museum housing this treasure was located in Sturbridge, 50 or so miles east of here, my destination on the 30th for an osteopathic students' conference. "Not so, Mr. Schuyler!" to borrow a line from Lord Lindsey, Chariots of Fire (1981). It's in Stockbridge, a little town memorialized by James Taylor in his song, Rockabye Sweet Baby James, the merest drive down the road with a turn left, then right, then back left, from here.
I was wandering through Richmond, a village that reminded me of my home away from home in Maine because both are mostly countryside and locating a "town" is an exercise in futility. If there was one once, there's not one anymore. But it's a lovely place and it felt so familiar I was on the outskirts of West Stockbridge before I knew it. A gentle nudge on the steering wheel from an oddly convincing feeling took me past the real Nook and Cranny coffee house (Pink Hats, chapter 3), up a long ridge, over the Mass Pike, and all of a sudden, out of nowhere, I saw a sign directing me to the Norman Rockwell Museum, 3/4 miles away. And they say there's no unconscious.
I grew up reading old copies of The Saturday Evening Post I found at my aunt's and having Rockwell's covers take me out of my comfort zone in the West through my imagination to parts unknown. It was his "Stockbridge Main Street at Christmas" that led me to think I might make a home somewhere in New England someday. Standing in front of the original and trying to explain what that meant to a beautiful septuagenarian on the museam staff, reminded me trying to say anything at all at moments like this is useless. I'm going to choke up, so I may as well shut up and write about it, instead. But I never do and we both end up crying because childhood dreams have finally come true.
Standing outside his studio was like hanging with a pal who knew the things about you your family would never understand. I was the kid raised on Country music who fell in love with classical. It baffled my father worse than anything adolescence could have thrust into his path. Why his son, of all sons, liked "high brow," quite frankly, blew his mind. That was alright, I couldn't explain it either. Johnny Cash and Marty Robbins would just have to learn to share the stage with Brahms and Beethoven. Rockwell somehow knew what this was like because he created images that were just as evocative and made just as much sense to me. Like Stockbridge at Christmas. And a few minutes later, I was right there, standing across the street from the Lion's Head Inn, in New England, of all places.
Thanks, Norm.
(Photo of Norman Rockwell's studio on the grounds of the Norman Rockwell Museum copyright 2011 by the author)
He was sprawled full-length on the examination table when I walked in the room. He looked at me with an intriguing smile and a playful gleam. "I like pie," he said. That, I wasn't expecting.
I told him I liked it, too, at the same time his sister, a towheaded, adorably cute and shy five year old, turned big blue eyes on mine, then buried them in her mother's skirt.
"I like cake, too," he said, trying to regain my attention from his sister.
"So do I, especially chocolate."
"Chocolate's my favorite."
If the little guy was sick, he sure could cover. Before mom could explain why they'd come to the doctor's office, my partner in conversation informed me, "But I'm better now." Why am I not surprised?
He'd been wheezing a couple of days ago and was having the same problem just about this same last year. Mm. His sister had a runny nose and had one also last spring. Sounded like seasonal allergies for her and perhaps a little bit of asthma-like symptoms for him. "I'm hungry."
"I am too, but we're not calling out for pizza," I responded, winking.
Pizza wouldn't have satisfied, anyway. What he and his sister wanted was something I could only approximate. My curiosity was approaching the outer limits of the Richter Scale, so I shot their mother's hand a quick glance. No ring. That doesn't prove anything, but the kids' father hunger can't be denied. Mom was doing a great job, but she was still mom, and they missed her other half.
Waving as they walked down the hall left me feeling I wished I'd hugged them, instead.
I'd listened to their lungs, looked in their ears, evaluated their health. I just hope I was enough of their doctor to be a little bit of a "dad," too, when they needed him.
(Creative Commons image by RachelEllen via Flickr)
Well, here I am, my first night as a medical student -- a medical anything, for that matter -- on call. In point of fact, it may not turn out to be much since I'm covering for an outpatient pediatrics practice. Most likely, any parent ringing up tonight will get the nurse practitioner who will triage the case and we'll see the child tomorrow. My job is to keep tabs on the E.R. and it's one I share with my attending
In the event a patient's parent decides tomorrow is not soon enough for Johnny or Joanie to be seen, my attending will get a call from the E.R. informing him it's time to awaken me from a sound sleep and get my eager backside down the hill from the apartment I share with another osteopathic medical student, and perform an evaluation. Then, on the assumption my attending's presence is legitimately required, I'll call back and summon him from hearth, home, and his spouse's warm feet, to join me in a game of Guess What I'm Sick With?
Should he decide his presence is not absolutely essential and his confidence in me well-placed after all, he may simply confirm my diagnosis and treatment plan, and inform the E.R. doc to implement the orders he's asked me to write and intends on signing first thing in the morning. The real morning, that is, when sane people are supposed to get up, not at 3.00 AM when night owls, insomniacs, and medical students prowl the streets looking for trouble in all the right places.
How all this came about is, I've been doing my pediatrics rotation out here in Western Massachusetts, in the Berkshire Mountains, and my assigned attending physician has taken a week off. No, it wasn't me, this has been in the hopper quite some time. So, she asked a colleague to take me on for a week and he does his own call. Noting the eager gleam in my eye when he mentioned this tidbit, naturally he didn't want to disappoint. And the truth is, I've been looking forward to tonight since my internship days in Boston, and there was no way I was going to let him have all the fun.
So, we shall see how the night unfolds. I may not do a thing. Then again, it's a full moon and as psychiatric mythology would have us believe, anything goes. It doesn't really and psych admissions are no more prevalent on full moon evenings than they are on Friday the Thirteenth. It just feels cool to say it that way and have the uninitiated think we're cool for being in the E.R. when anyone with a lick of sense would be in bed, sound asleep. But I'm not dozing this one out in an on-call room; I'm snug as a bug in my little alcove of a bedroom one step off the kitchen, where I'll be be until duty calls. Or my attending. whichever comes first.
(Photo of Berkshires Medical Center copyright 2011 by the author)
Coffee in hand, I was starting to get comfortable this morning, wondering about the next step to take with Pink Hats and a Mack Truck, when I heard what sounded like a triumphant announcement, "Spring has sproing!"
"Don't you mean, 'sprung,'" I asked, pausing between sips.
"No, I meant what I said. It's too nice outside my window for traditional spellings and pronunciations. On top of that, 'sproing' gets a reader's attention." He definitely had mine, completely.
"Well, what are we going to write about?" he asked, stressing the personal plural pronoun as though the endeavor was predictably corporate.
"What do you mean, we? Have you got a mouse in your pocket?"
"Very funny. Witty, even. Better than your usual attempts at humor, I must say, and speaking of which -- whom might be better -- how could I have myself in my pocket? Just because I am a mouse, doesn't mean I'm also a contortionist."
I was talking with Hinsley, my inking partner, as he's fond of describing himself and what the writing process would be if my laptop were a typewriter. I suppose you could liken "inking partner" to a drinking partner, except neither of us wakes up hungover. Anyway, he's a little grey fellow about the size of a 16 oz. mug of deep, dark, nutty, English brown ale, clad in a red plaid waistcoat and scarf, with a tail nearly as long as he is tall. I rescued him from a fate worse than death, or so he said it would be, when we met at Starbucks this past Christmas. I was doing my annual shopping, looking at coffee accessories, when I felt him tug at my sleeve.
"You've got to help me," he said, whispering breathlessly, as though he had just completed a 100 yard dash before his competitor, the Jamaican sprinter, Usain Bolt, could get out of the starting blocks. "See that woman over there? Not the pretty one, she works here. I mean the other one, the woman with bags on each arm and even larger bags under her eyes. The one who smells like she bathed in her grandmother's perfume and then sprayed herself with an entire bottle for good measure. She bought a friend of mine last year and he hasn't been heard from since. Come on, be a chum."
I wasn't certain whether his concern was the result of spending far too much time inhaling the caffeine-injected atmosphere, but he was cute (psst, don't tell him I said this, he really does hate it) and as his tag read, The Mouse Writer, I truly felt compelled to act. Writers have to stick together. So, now he sits, happily, on the bookshelf across from me, guarding a medical text dated 1866 alongside his friend, Barclay, a similarly-sized raccoon I discovered a few years ago, trying to scramble out of a drawer in my late mother's secretary. Destined, I think, to become a dog toy, he managed to burrow into some old papers and there he stayed, safe but forgotten, until he heard me inspecting the contents of the old cabinet after my father was gone.
Forgotten or lost toys are one of life's saddest things, I think. I don't know why, exactly, maybe it's the lost memories that go with them. Perhaps it's the reason I keep them, an old Lionel steam locomotive, fire trucks, and a couple of faded, worn teddy bears. They aren't much, I suppose, but they were mine and still are. They remind me of a line from Kenny Loggin's, The House at Pooh Corner.
After all's said and done, I was watching my son,
sleeping there with my bear by his side;
So, I tucked him in and kissed him, and as I was going,
I could swear that old bear whispered, 'Boy, welcome home...'
"Are you going to reminisce all day? I don't know about you, but I'm ready to work!" Mouse Writers are inclined to impatience.
"Aren't we telling your story? Surely, that counts, wouldn't you agree?"
He hesitated, tugged on the bottom of his waistcoat, straightening it, and said, "Well. Yes, I do believe you're right. Proceed, maestro, but please, please don't say anything about my being cute. I just don't think I could 'bear' it, should your views on the matter become public knowledge. I do have my dignity, you know."
"Oh, I know, all too well. As to cute, however, I'm sorry, but the cat's already 'out of the bag,'" I said, playing the pun card back to him.
"Now why did you have to go and say, 'cat?!'"
(Photo copyright 2011 by the author. The House on Pooh Corner, words and music by Kenny Loggins)
