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Hard Facts and Fiction

Brian T. Maurer

At Daniel’s first visit, it had been like pulling teeth to get this fourteen-year-old slip of a boy to talk. Despite my thirty years experience as a physician assistant, I hadn’t made much headway. I’d pose a question, and his mother would jump in to answer it. He’d slouched on the exam table, staring at the floor. Occasionally he’d lift his eyes to meet mine, then quickly look away.

Daniel’s mother had said she was concerned about him. He didn’t sleep at night; he couldn’t get up for school. He’d missed so much that he was in danger of failing his grade, and the year wasn’t even half over.

Daniel’s mother was not much taller than her petite, quiet son. She was dark, slender and attractive, with a blunt, sometimes brusque, manner.

“If you want to know what I think, I think he’s depressed–just like his father,” she’d said.

I had to agree: Daniel showed many signs of clinical depression.

“We separated last year, and I’ve filed for divorce,” his mother had said. “His dad’s a drinker, and he won’t get help. It seems like he’s powerless to do anything about it.”

I couldn’t help but wonder what was running through Daniel’s mind as he heard these words.

We’d discussed the possibility of trying a prescription medication at the first visit, and Daniel had reluctantly agreed. When I’d seen him again the following week, he’d seemed a bit better.

Today, during our third visit, Daniel almost smiled. He even offered a few words in response to my probing. “He’s making progress,” I thought as I walked him out to where his mother waited. I asked them to see me in six weeks.

Afterwards, I descended the dimly lit stairwell to our basement lunchroom, feeling emotionally drained. Perhaps my years of clinical practice were beginning to take their toll. Or maybe this quiet boy reminded me of my own struggles with depression during a turbulent adolescence.

After years of putting up with her husband’s alcoholism, I mused, Daniel’s mother had opted for separation and divorce. I wondered what events and expectations had led to that decision, and how his father’s loss might be affecting Daniel’s current state. I also wondered what it was like raising Daniel as a single parent.

When I passed the office book-swap box, a title caught my eye: A Tree Grows in Brooklyn. I picked it up. Vaguely, I recalled a movie by the same name. I flipped the title page: copyright and first printing, 1943.

That night, temperatures plunged close to zero. Over the weekend I mostly stayed indoors, lying on the parlor sofa with the book. The dog lay at my feet, welcome company while my wife was away for a few days visiting our daughter. 

The book turned out to be the story of a second-generation Irish-American family living in Brooklyn at the turn of the twentieth century. The mother works hard to support her husband and two children. The husband gets occasional gigs as a singing waiter through his union, although he can never seem to get ahead–his alcoholism trips him up.

One night the father doesn’t come home. On the second day they start looking for him in earnest. A cop discovers him huddled unconscious in a tenement doorway, and he is taken to the hospital. When his wife arrives at the ward, she finds him in a coma, dying from pneumonia. She sits next to his bed, watching over him until he dies.

Later, she argues with the doctor who is filling out the death certificate.

“What are you writing down there–what he died from, I mean.”

“Acute alcoholism and pneumonia….”

“I don’t want you to write down that he died from drinking too much. Write that he died of pneumonia alone.”

The parish priest convinces the doctor to acquiesce. The father’s age, listed on the death certificate, is thirty-four.

I read steadily into that Sunday evening and took the book to work with me on Monday morning, thinking that I might finish it over lunch.

When I arrived at the office, one of the office staff had laid a chart in the center of the desk blotter with a handwritten note attached. I bent down for a closer look, then slowly dropped into the chair.

It was Daniel’s chart. The note said that his father had died of alcoholism over the weekend. He’d passed away in a local hospital ward, his wife at his side.

I flipped through the chart. Daniel’s father was thirty-four years old.

Sometimes art mimics life; sometimes it’s the other way round. 

I left several messages for Daniel on his home answering machine, then sent a card. When I saw him the following week, I learned that he hadn’t been back to school since his father’s death. Meanwhile, his mother was seeking psychiatric care for herself.

I imagine a page turning and await the next chapter in this struggling family’s saga.

About the author:

Brian T. Maurer PA-C has practiced pediatric medicine as a physician assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect of patient care–what he calls the soul of medicine. Over the past decade, Brian has explored the illness narrative as a tool to enhance the education of medical students and to cultivate an appreciation for the delivery of humane medical care. To date he has published two collections of stories, Patients Are a Virtue and Village Voices. He can also be found at Brian T. Maurer’s Weblog.

Story editor:

Diane Guernsey


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