Black walnut cake

May 5, 2006

The kindness of a special patient brought back a kitchen-full ofwarm memories for this doctor.

Mrs. Bloom was dying of cancer, and there was very little I could do for her. Yet each time she came to see me, she greeted me with her wonderful smile, and when she left, she would shake my hand, expressing deep gratitude for my care.

As the illness became more sinister, little threads of fear began to creep into her face and tug at the corners of her mouth. Now a handshake at the end of a visit was no longer enough; she needed a hug. Maybe I did, too.

Just before Thanksgiving, she brought me two bags of black walnuts that she had shelled by hand. Shelling black walnuts is hard work-I know, because I used to do it as a child, so my grandmother could make black walnut cake. Picking the nutmeats from the hard shells would leave my fingers stained and my cuticles ragged. How Mrs. Bloom managed to pry two bags worth of nuts from those shells with her arthritic fingers is beyond me.

My grandmother handed down the recipe to my mother, and I have memories of other winter nights, sitting next to the oil furnace, and chasing bites of black walnut cake with strong Louisiana coffee from the percolator. The wind whipped around the corners of the house with a low-pitched growl, but I was warm and safe.

My wife and I took Mrs. Bloom's walnuts with us when we went to visit my mother the weekend after Thanksgiving. When we produced the walnuts, my mom's face broke into a wide grin. We didn't have to explain what they were for-she knew. As she assembled the ingredients, she began to hum hymns, just as her mother had, and I think we all felt the presence of my grandmother in the room.

I brought some of the cake back home to share with Mrs. Bloom and her daughter. I hope that I was also able to share some of the sense of safety and comfort that black walnut cake has always meant for me.

Not long after, I sat staring at Mrs. Bloom's death certificate. Suddenly, our relationship was reduced to just this: a statement of how she died. Sometimes it seems like medicine itself has been reduced to paperwork-coding and billing, filling out forms. Time with patients shrinks to the bare minimum and technology replaces touch, as physicians slowly morph from healers into providers.

But as a doctor, sometimes I'm hungry for more, for a chance to connect with patients, to offer compassion, to share comfort, as I did with Mrs. Bloom. Once in a while, I long for the chance to eat black walnut cake.