Cell 2 Soul: The Humane Health Care Blog

The Call of Stories

"The Universe is made up of Stories, not atoms."

Muriel Rukeyser

Maple Leaves

Marginal Notes: Revisiting Walden

 
Chimaphila maculata, Britton and Brown, 1913

I struck out along the north shore, heading west along the ancient path now bounded by wire fencing on either side.  Periodically, I passed a break that allowed direct descent to the water on large natural stone steps.  Mist was rising from the surface of the water, stirred by a slight morning breeze.  more»

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for 32 years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Rest Your Frontal Lobe

It's summertime in New England -- and all here are struggling to cram the days with activity.  REST YOUR FRONTAL LOBE, attributed to Dainin Katagiri, is a koan to mull over.  

Administrivia: We have a good group interested in the Nantucket gathering.  It's called a "Gam" in homage to Melville who used this arcane word for a "gathering of whalemen" when discussing Nantucket sailors.  To whet your nautical soul see: 36 Hours on Nantucket.  Think about resting your gray matter on this island in the sea with us in October.

There's a program on our local public radio station called, "The Academic Minute."  Sounds deadly.  Not always.  Yesterday, Amit Kumar, a professor of English from Vassar College spoke about V.S. Naipaul's rules for writers.  Just as we are readers, we are also writers.  I thought you might enjoy this simple list:

V.S. Naipaul's Rules for Beginners

(It is said that Naipaul's father, a journalist gave these rules to his son, an aspiring writer)

    1. Do not write long sentences. A sentence should not have more than ten or twelve words.

    2. Each sentence should make a clear statement. It should add to the statement that went before. A good paragraph is a series of clear, linked statements.

    3. Do not use big words. If your computer tells you that your average word is more than five letters long, there is something wrong. The use of small words compels you to think about what you are writing. Even difficult ideas can be broken down into small words.

    4. Never use words whose meaning you are not sure of. If you break this rule you should look for other work.

    5. The beginner should avoid using adjectives, except those of colour, size and number. Use as few adverbs as possible.

    6. Avoid the abstract. Always go for the concrete.

    7. Every day, for six months at least, practice writing in this way. Small words; short, clear, concrete sentences. It may be awkward, but it's training you in the use of language. It may even be getting rid of the bad language habits you picked up at the university. You may go beyond these rules after you have thoroughly understood and mastered them.

At Play in the Woods of New England

The year is 1977 and Art Brownstein, a Southern California surfer dude has just finished his first year of med school on the East Coast.  He recently resurrected the journal of his escape to the New England wilderness.  Much has changed in the past thirty-three years, but the fastness and fascination of these forests and mountains abides.

His chronicle begins: "At the end of my first year at Jefferson Medical School in Philly, I spent the night before summer vacation making a cardboard sign that said “Maine.”  I intended to hold it by the side of the road while hitchhiking, as I had planned a two-week solo outing to the woods of Maine, New Hampshire, and Vermont to celebrate the successful completion of my inaugural year in med school. My initial destination was Katahdin, sacred Mountain of the aboriginal Penobscot peoples, northernmost point of the Appalachian Trail, and the first place where the sun hits the East Coast on its daily transit of America. Read on:  Download BarefootThe Woods Brownstein1 .

You can contact the author at:  Doc Art.

Winter Storm

two day snowstorm – bleak
blankets this wide white world – Lo!
ruby red berries

Williamstown, Massachusetts 12/21/2008   Here in the Northeast, it has snowed now for over two days, and while that does not qualify for any record, the proximity of this storm to the Yuletide, reminds some of us of Dylan Thomas's lines: 
One Christmas was so much like another, in those years around the sea-town corner now and out of all sound except the distant speaking of the voices I sometimes hear a moment before sleep, that I can never remember whether it snowed for six days and six nights when I was twelve or whether it snowed for twelve days and twelve nights when I was six. 

It is bleak and cold here.  In my circumambulation  of this town during the storm, I chanced upon some bright berries which contrasted gaily with the blankness.

Wayne Winterrowd, our botanical Vergil, identified the red delight as "Ilex verticillata, the native American deciduous holly, in the South sometimes called 'Possum Haw.'  Ilex is the genus to which all hollies belong, including of course the evergreen American Christmas holly and the English holly, with shinier leaves, both much used in Christmas decoration..."  To read more about this wonder of winter: Download Ilex

Asperger's Syndrome

In the August 20th, 2007 issue of The New Yorker, Tim Page, music critic for the Washington Post, reveals that he had been diagnosed with Asperger's Syndrome, "in the course of a protracted effort to identify - and, if possible, alleviate - my lifelong unease". The article is Parallel Play, A lifetime of restless isolation explained, by Tim Page

It can be found at: Tim Page Asperger's and is well-worth reading.

There is also an NPR Fresh Air interview with Tim Page at: NPR Page  This page has links to other NPR pieces on Asperger's syndrome.

Experiment of Green

Pine Cobble -- May 23, 2007

A little Madness in the Spring
Is wholesome even for the King,
But God be with the Clown -
Who ponders this tremendous scene -
This whole Experiment of Green -
As if it were his own!
                                        --- Emily Dickinson

Williamstown Main St. -- May 23, 2007

May 23, 2007

Orphan Patients: Long and Short

Cell 2 Soul Editor Brian Maurer submitted a fine commentary on two recent articles.
One, on the specialty of Adolescent Medicine, was featured in a recent NY Times piece.  It was discussed in a recent C2S Blog entry "The Awkward Years."
The other on Geriatric Medicine was in the April 30th New Yorker magazine.

The Long and the Short of It
By
Brian T. Maurer

Recently I saw an adolescent boy for a routine physical exam.  As he was disrobing in the exam room, our medical assistant handed me a sealed envelope along with his chart.  The envelope contained a one-page letter from his mother, asking that I address several concerns:  his frequent visits to the nurse at school, recurring headaches, a question of substance abuse, self body piercing, and the discovery of a cache of gay pornographic magazines in his bedroom.  I had been allotted 15 minutes in my busy afternoon schedule for this visit.
It’s a small wonder that a decade after adolescent medicine became a board certified subspecialty, it is largely shunned by doctors seeking to advance their careers—only 466 certificates in adolescent medicine were issued from 1996 to 2005. In the same period, 2,839 were issued in geriatric medicine.
Yet despite these numbers, geriatric medicine is in no better shape, as Dr. Atul Gawande attests in his recent New Yorker article, "The Way we Age Now" , “Despite a rapidly growing elderly population,” Gawande writes, “the number of certified geriatricians fell by a third between 1998 and 2004. Applications to training programs in adult primary-care medicine are plummeting, while fields like plastic surgery and radiology receive applications in record numbers.”
Why these trends?  According to Dr. Gawande, “Partly, this has to do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partly, whether we admit it or not, most doctors don’t like taking care of the elderly.”
I would argue that the same logic follows for adolescent medicine as well.  Regardless of whether you consider adolescents as pediatric, family or internal medicine patients, they all require extended office time to address their issues and concerns.  This is a luxury that most high-volume private primary care practices can not afford.  And then again, as is the case with the elderly, most doctors don’t like taking care of adolescents.
What can be done to remedy the situation?
“Nothing,” according to Chad Boult, a geriatrics professor at Johns Hopkins. “It’s too late.”  Gawande reports that “creating geriatricians takes years, and we already have far too few. This year, just three hundred doctors will complete geriatrics training, not nearly enough to replace the geriatricians going into retirement, let alone meet the needs of the next decade.”
“Boult believes that we still have time for another strategy: he would direct geriatricians toward training all primary-care doctors in caring for the very old, instead of providing the care themselves. Even this is a tall order—ninety-seven per cent of medical students take no course in geriatrics, and the strategy requires that the nation pay geriatricians to teach rather than to provide patient care.”
In my estimation, the same strategy may hold up for adolescents, most of whom are cared for by pediatricians.  But the pediatric clinician must be willing to devote the time to care for the adolescent patient.
So, what did I do with my adolescent patient?  As it turned out, he knew nothing about his mother’s note.  I addressed her concerns with him, point by point.  After I examined him, I discussed the results.  We talked about his issues.  With his permission, I spent some time conferring with his mother afterwards.  She was grateful, and so was he.  “I never had a physical exam like this before,” he remarked as he left.
I felt immensely satisfied for a moment, until I stepped in to see my next patients—a pair of seven-year-old twin boys with severe behavioral problems and ADHD.  As I glanced at my watch before entering the exam room, I noted that I was already half an hour behind.

AIDS Education

It is inspiring to read pieces like the one which follows. It reminds me of Margaret Mead's bon mot: "Never doubt that a small group of thoughtful, committed citizens can change the world.  Indeed, it's the only thing that ever has."

Mount Greylock Senior Raising Awareness About AIDS
By Bonnie Obremski, North Adams Transcript
Article Launched: 02/27/2007 11:32:53 AM EST

Download Peacock.pdf

Alexandra Peacock of Williamstown, center, a senior at Mount Greylock Regional High School, poses with students in Zambia, where she worked last summer as an AIDS youth educator. Submitted photo

Tuesday, February 27
WILLIAMSTOWN — A Mount Greylock Regional High School senior believes Berkshire County youth should be more informed about AIDS, even if some of her teachers are little squeamish about her direct approach.
Alexandra Peacock, of Williamstown, said Friday she is compiling a series of three, short presentations documenting her summer experiences as an AIDS (acquired immunodeficiency syndrome) youth educator in the Dominican Republic and Zambia. The presentations are part of her senior project, which is a graduation requirement.
"I went to one adviser and I said I wanted to raise AIDS awareness among local teens," Peacock said. "She said she didn't think AIDS really affected kids from Berkshire County. She said I should do presentations on drug education. At first, I said 'OK.' Then, I realized that wasn't what I wanted to do at all. We hear so many presentations on drugs, no one listens to them anymore."
She told this to her teachers and her adviser approved a focus on the kinds of support networks that are available to people with AIDS.
Peacock met another obstacle, however, when she offered to teach the same kind of AIDS education games to the school's seventh- and eighth-grade students that she had been teaching 9-year-olds in Africa. She said the activities were deemed inappropriate to school officials because of the sexual subject matter.
"We're just more protected here, I guess," Peacock said. "The kids in Africa were so open."
Peacock traveled to the Dominican Republic in May and to Zambia in July to join her older sisters, who are working in AIDS education. Paula and Elizabeth Peacock, graduates of Mount Greylock, are earning graduate degrees in health and medicine. Alex Peacock said she intends to study pre-medicine at Bowdoin College in Brunswick, Maine, in the fall.
Peacock said her sisters became interested in AIDS education after losing an uncle to the virus. Peacock said she never knew her uncle, but admires the work of her sisters.
Some of the teaching games Peacock helped facilitate used soccer as a tool. Children would learn how one's actions have consequences by dribbling a soccer ball through a set of cones. If the ball hit one of the cones, the whole group would have to do push-ups. Other games used balls with words such as "sex" and "AIDS" written on them. A group would toss the balls around and end up with one that was different than the one they'd started out with.
"Some kids think it's funny, but it really does help show there are consequences," Peacock said.
Peacock, a varsity soccer player, said she is finding other ways to raise AIDS awareness in North Berkshire without coaching her teammates about the negative consequences of unprotected sex. She is putting together slide shows and a short film of interviews with people who have a message about AIDS.
She said she is still unsure where and when the presentations will take place and who will ultimately be in the film. So far, she has contacted local high schools to ask if they would invite a presentation about her experiences in AIDS education. She said she will film interviews with her father and her senior project mentor, Kareem Khubchandani, assistant director and queer life coordinator at the Williams College multicultural center.
Peacock said she prefers to teach those younger than her.
"That way, they listen to me more," she said, smiling. "I don't know if people around my age will listen because, well, I'm kind of small."