Components of the abdominal exam and an approach for life?
Look, listen, percuss, and palpate. These are the steps to the abdominal exam. Medical school is back in session, and the 2nd year medical students focused on the exam this past week in their clinical suites. The order is different from other organs where palpation often precedes listening. (We palpate the chest wall before we listen ot the heart and lungs.) As we considered the many organs inside the abdomen, I realized that these steps aren’t a bad approach to life.
Look--observe your surroundings or the person(s) in front of you. Listen carefully to your colleague, friend or family, and your surroundings: the honks and voices on the street, birdsong and the wind in the tree branches. Maybe it’s best to skip percuss, unless we think of it as a way to assess what isn’t readily visible. In Doctoring, we are assessing the size of the liver, the location of the spleen, or a hidden mass somewhere in the organs. Finally, palpate or feel.
This week I can feel summer slipping into Fall here in Rhode Island. I’ve been kayaking as much as I can to keep myself grounded in our chaotic world and savoring these lovely days—cooler temperatures, less humidity. Neighbors, who have lived in the region for decades, informed me that the waterway I’ve called “the estuary” is named “Buckeye Brook,” colloquially "Bucky Brook," after the bait fish anglers caught in the past. These days, I see fish, but there are few fishermen. Bucky Brook is a small waterway that flows about a mile through brackish water; brackish meaning the mix of salt and fresh water. The foundation of an old mill still stands on one side. At high tide, I can paddle to the end. I often see osprey, egrets, great blue herons, swallows and occasionally a bittern or green heron. A black crowned night heron family has nested there every summer. My bird watching skills have grown since I’ve done more with the Audubon Society of Rhode Island (ASRI).
Reed and I attended the annual ASRI Osprey watchers gathering. We learned this year’s chick count is at a ten-year low. Cycles happen, but Chesapeake Bay where there are more researchers, found that over fishing of menhaden has left less food for osprey, and many parents could not support their chicks. Menhaden are the preferred food for osprey because of the fatty and calorie dense nature. The fish is also used for fertilizer and bait fish. Whether this year’s downtrend is part of the normal cycle or bodes worrying trends related to climate change is yet to be determined.
One of the osprey nests we watch is located in a sports fields complex on the top of a light pole in the soccer park. When workers updated the lights last winter and destroyed the nest, the osprey couple rebuilt it. (Osprey mate for life and often return to the same nest year after year. The average life span is 15-20 years.) Two other nests appeared in other parts of the complex: a light pole in the baseball park and another pole in the rugby area. We suspected that these were young osprey, returning home. These adolescent couples’ nests were less refined, one was a 2-decker, and neither hatched young. We said they were “playing house.” Osprey don’t hatch eggs until they are two or three years old.
These observations give me joy. The death of Dolly Parton this week, or the patron saint of Tennessee, as my Tennessee nephew calls her, was a reminder of how much joy someone can spread in a life lived with the values of kindness, inclusivity, authenticity, and a commitment to giving back. Stories about her generosity and good deeds have filled the news. PBS has a wonderful one hour story about her. These reports counterbalance the horrors and ugliness of the current administration and the suffering and pain it has churned into our world.
As you look, listen, assess, and feel your way through the minutes of each day, may you find moments of joy and snippets of peace in our troubled world.