So the year winds down its final hours, and I sit at my kitchen table with a book of Proust on my knee, a Diet Coke at my hand, listening to Michael Doucet's Cajun Christmas album. I couldn't imagine it much better, except for the cell phone nearby reminding me that I am on call. (If I weren't on call I can promise you that Diet Coke would have Jack Daniels in it.) Hopefully the ER won't interrupt me while I squeeze a few final words out.

It has been a year of many patients, and I would like to think I learned something from them. Some of my patients came to see me for trivial reasons, others for serious, and some brought with them true suffering. Suffering is one of those things that is irreducible in human experience. When we suffer, we can't explain it away, or ignore it, or pretend we are happy. Suffering often doesn't allow much else but itself.

It gives me sorrow to see people suffering, but also, I must confess, a certain measure of awe. For some people suffer with dignity, and look far more human in their pain than they ever did when they were well. I had a patient this year who was 98 years old, and when I asked her how she felt, she said, "How would" (wait, there's the ER again -- chest pain -- for me and the admission) "How would you feel if all your friends and relatives were dead?" She turned out to be a nice woman in the end, just someone ready for it all to be over.

As a doctor, I get to see a side of the suffering patient that even close family members rarely see. The courage, the hope, the effort. Sometimes the regret and the letting-go. It is always majestic, and shows how in suffering even the most insignificant people can burn with the brilliance of the Light in the East.

Hopefully I will see less suffering this year than next. But however much I see, I trust that in that suffering I will find not only the worst but also the very best.

And if, this coming year, it is my turn to suffer, I pray that my patients have taught me this lesson well.

Dear Horace,

Thank you for your Christmas card. I appreciate your remembering me around Christmas, and I know you are quite busy. This only makes the card that much more meaningful. I also appreciated your little note. Your handwriting is quite good for someone who only types on the computer. In my day a young man's character was judged in part by the quality of his handwriting.

I know it is rare these days to get a personal letter by U.S. Post, but this is what I am used to. Perhaps it will be the last personal letter you, or anyone you know, will ever get. You might consider submitting it to the Smithsonian one day.

Your questions surprised me. For some reason I thought your mother had explained these things to you quite some time ago. Perhaps it would have been better if I had simply telephoned, but my mind works slowly these days and it took some time to figure out what I wanted to say, so this seemed the better way. You may be in the habit of opening your mail over the trash can, as I do. However, your answers will take some time, so I suggest you lean against the kitchen counter and rest yourself a few moments while you read.

First of all, the easy one. I had a brother once named Horace. He was a World War II veteran, and rather eccentric. He was eight years older than I, and never had any children of his own. When your mother was pregnant with you she had every intention of naming you Johnny, but Horace wrote (in another one of those annoying epistles!) passionately urging that you be named after him. "I will die without an heir," he said. "Please give me a namesake." He promised to give you his life's savings in his will. He died when you were two, and as for his life savings, we found that he had quite lost his mind to what doctors now call Alzheimer's but at the time we only knew as senility, and someone has swindled him out of all he had. He was a nice man, though. Horace is a good name, although I know in can be shortened to an ugly epithet that you were likely subjected to in grade school. I trust as you get older you will appreciate it more.

Your mother could have answered this question as easily as I have. My guess is that she referred it to me because she knows I like to tell stories about dead people more than she does.

As to the other question. Although you know me now as a sophisticated city girl, when I was a child I lived in a small town named Cairo in the American South. (I don't know why I am in the habit of saying American South; many countries have southern regions but there is only one South, by my accounting.) My father was the town lawyer, and we were fairly well off -- especially after the oil money came to town. I attended a small private school, and led what I can now only call a sheltered life.

One day at school, our teacher announced that a professional pianist would be performing for the entire student body. The teacher handed each of us a card. It read, "Howard Finkle, Concert Pianist." To the left  of the name was a stately treble clef, elegant and assertive as bold handwriting. It was a business card. Now, Horace, I know that in these days of electronic printing business cards are commonplace, but in those days they were the exception, so this item was to us quite an artifact.

We filed into the school gym. Finkle eschewed the stage, instead rolling the baby grand piano into our midst. We sat in a circle around. He wore a golden tie and a fine, dark blue suit of a quality unknown in Cairo. He spoke a few words to us, and then sat down to play. He played only classical music, but when I heard the first note, I no longer believed there was any other kind. He played for almost an entire rapturous hour, then closed the lid on the keys, thanked us, and left without ceremony. Later the teacher told us that Mr. Finkle was new to town, and would be giving lessons to children interested in learning the piano.

Perhaps you can imagine the uproar that ensued. Every child at our school returned home that day and begged his or her parents for piano lessons. I expect the scenes played out in every home as they did in my own: My parents sat at the kitchen table, expressions of skepticism on their faces, saying to me, "Martha, you took piano lessons two years ago. You never practiced. No one has touched the piano in the year since you stopped." "But Momma, Daddy, please," I implored. "Mr. Finkle is different. He is a great teacher. Oh, you have to let me. You just have to."

A few days later Momma called Mr. Finkle and asked him to add me to his list of privileged students. It was a very long list. All of the -- how shall I put this -- well-bred children signed up. Mr. Finkle, it seemed, was an instant status symbol in Cairo.

Excitedly I waited for my first lesson. When the day finally came, I tucked a few of my old lesson books under my arm and walked the four blocks to Mr. Finkle's house. (I know this may be a bit of a shock to you, Horace, but in my day parents thought nothing of letting their nine year-old daughters walk unaccompanied four blocks. Don't ask me to explain it. It was a different time.) Mr. Finkle was living in Dr. Sartoni's house, renting it while the distinguished doctor took a 6 month sabbatical in Italy. The doctor's home was always known as the most elegant in town, but somehow Finkle's presence enhanced even this aura of fineness.

I went in, and waited in the foyer some minutes as Mr. Finkle completed the prior lesson. The student, Tommy, a grade ahead of me in school, left, and Finkle let me in. Finke taught in a remarkably elegant velvet smoking jacket, though he never smoked during his lessons. I presented him my lesson books, but he set them aside. "Martha, I want to see what you can do." I stared at the keyboard, unsure how to proceed.

"Ah, my dear Martha, it is as I suspected. Your teacher taught you scales, taught you to read notes and keep the beat, but you have never learned how to play a song, have you? I want to teach you music, not scales."

And music is what he taught me. He told me to put my lesson books away and he gave me sheet music to practice with. Every week I went, my heart beating eagerly, half because I loved music and half because I had a hopeless crush on the instructor.

Mr. Finkle, rumor had it, came from New York. He had a regular job with an orchestra, the story went, but unfortunate circumstances forced him to give up the job. He was a friend of Dr. Sartoni, and had moved to Cairo for a respite. He was as popular with the adult community as with the children. The adults admired his musical talent and understood that he had led a remarkable career in New York, although, like the children, they lacked knowledge of some of the particulars. One community grandame created a considerable stir when, on a trip to Florida, found a record of Schubert recordings that featured our dear Mr. Finkle as a soloist. The record made the rounds in town for quite some time, adults and children alike crowding secretly around record players to marvel over his interpretations, even though most of them knew next to nothing about classical music.

The maestro himself, as some took to calling him, was seen all over town in the company of some of Cairo's finest ladies. This caused me no end of jealousy, sometimes even to the point of tears. Finkle's taste in female companionship was as discerning as it was in music. I would like to think that eventually I would take my place among Fulsom county's most beautiful and sophisticated ladies, but at age nine I had maturing yet to do. He could be nothing more than my teacher.

Mr. Finkle remained with us for only four sweet months. I will now relate the circumstances of his leaving -- and no, Horace, I have not forgotten your question; your answer is coming shortly. By early November, now known for his exceptional skill, Finkle was approached by several local church congregations to lead their Christmas concerts. He signaled an initial willingness, but when he learned that most of our local churches were fundamentalist and he was being asked to play some of the most stalwart hymns in our repertoire, he declined. After an initial reticence, he at last explained himself. "I cannot participate in your religious celebrations because, you see, I am not Christian. I am a Jew, and not an exceptionally good Jew at that, though I would never go so far as to say that I have abandoned by beliefs. On the other hand, it would be disingenuous of me to pretend to be Christian. 'Jingle Bells' I can play. Maybe even 'Silent Night' if the mood is light enough.  But it would be improper for me to lead you in anything more serious. My apologies."

His apologies were not well accepted. When the townsfolk realized Mr. Finkle was not Christian, they began to withdraw their children from lessons. The best local ladies permitted themselves to be seen with him less and less often. My parents broached the question of withdrawing me from lessons also, but facing an outburst of tears, they backed off.

Horace, I am embarrassed at the behavior of my neighbors, to be sure, but I would be remiss if I led you to believe that the honorable man was ostracized. Nothing of the sort happened. He simply ceased to be the center of attention is all.

At last Mr. Finkle announced to his remaining students that he would be leaving town. I was, needless to say, devastated. As a child who naturally thought the world revolved around her, I had thought my loyalty to him created a bond between us that would never be broken. In my last few weeks I learned as much as I could. Christmas week was nearing, and I practiced at home harder than ever, perhaps with the foolish hope that if I showed enough promise as a pupil, he would change his mind. He and I never spoke about his social situation until the very last lesson.

In our town, citizens maintained a Southern sense of dignity in our interactions with each other, meaning that we pretended not to be curious about each others private lives even as we prodded into every secret. I knew some things about him, therefore, that I never revealed that I knew; but in the end I had to know the answer to the question burning in my child's heart and understood that I would only find out if I asked.

Midway through the final lesson, I burst out: "Mr. Finkle, I hope we are not chasing you out of this town!"

He paused, his fingertips resting on the piano keys. "Oh, of course not, my dear Martha. It is simply that last summer I lost my job in New York, and this fall it was offered back to me. After some soul searching, I decided to accept. I like it here in Cairo, but I cannot pursue the career I want to in a town this small. That is all."

"Mr. Finkle," I said, "You told the people in town that you do not believe in Christmas. If you do not believe, how do you live during the Christmas season? I mean, everyone else is celebrating. You must feel so left out!"

"Sometimes I do, but often I don't. I often find it within myself to celebrate along with the Christians. Up to a certain point of course."

"How can you do that if you do not believe?"

Mr. Finkle got up, and walked over to a bookshelf where he kept a large collection of sheet music. He ran his finger along the shelf, finally selecting an item and sliding it out. He walked back to the piano and stood by the bench.

"Martha, when I was your age I lived in a strict Jewish household. I was learning the piano as you are now, and I heard a piece of music I thought was the most beautiful I had ever heard." He took the music and placed it on the piano. I read the words on it: "Jesu, Joy of Man's Desiring."

"It is still one of my favorites. I think the man who wrote it is one of the greatest composers of all time. He believed the sentiments of this work, and wrote many other sacred Christian pieces. Since I love the man who wrote this, I love his beliefs -- through him. I will always remain a Jew, but I will also have deep respect for the beliefs of those I care about. When I think of Christmas, I think of "Jesu, Joy of Man's Desiring," and pieces like it, and love Christmas through the hearts of the composers who create such unearthly harmonies. This is what music is all about, at least for me."

I left there in tears, and went to visit him one more time before he left town, but that is the main part of my story. Mr. Finkle, I am told, went back to New York and resumed a distinguished career. As a concert musician, I am not sure he ever gave lessons again, and I sometimes flatter myself thinking I was his last student. But I don't know that.

This then, is the answer to your second question. I have no idea why I waited so many years to tell this story to you. You know your Grandma Meyers has never been at a loss for words, but for some reason I have always held this one close to my heart. Now you know.

And so, when you come to your aunt's house on Christmas, you will for the twenty-first time hear your old Grandma labor out "Jesu, of Man's Desiring" with her bony fingers on the old piano, knowing why I hardheadly insist that all of you listen to it. God, I hope your aunt remembered to get the thing tuned this year. Last year's performance was horrible, but it wasn't all my fault. I have been reminding her to call the piano tuner since September.

I look forward to seeing you when you get back from school. Hugs and kisses.

Your Grandmother,

Martha

As 2007 comes to a close, everyone is busy making up his "Best Of" list. Books of the Year, Movies of the Year, Sports Events of the Year, Ad Nausem Lists of the Year. After decades of being shut out, I have decided, damn it, this year I get my turn. So, knowledgeable reader, below please find my Best Products of 2007 list.

Personally, I think best product lists are biased towards high tech. Just because something is high tech doesn't mean it is better than the thing it replaced. Here are some products that were challenged for supremacy in 2007. The challengers failed pathetically.

1. The Book. One day a hundred years from now someone is going to reintroduce the book as "Text without the Internet or Batteries!" But for the present, we endure a recurring story. Every year someone comes out with a fantastic new digital product that is guaranteed to end the reign of the printed volume. The claim usually made is that the New Product is "just as convenient as a book." Which always leads me to wonder what good a $500 product is if it is just as good as something I can check out of the library for free. Why does the world want to re-invent the perfect product? With a book you sit and read. With an electronic gizmo you sit and read and drain the batteries. Throw out the batteries and you've got a great product there, pal -- oh, yes, a book!

The best thing about books is that they are never technologically obsolete. There are people reading 3000 year-old books right this minute. Meanwhile, I have a video tape in my closet today that I bought in 2004, and I can't find a working VCR to play it in. 'Nuff said.

Congrats, Book! The champ and not going anywhere. And now for the runners up.

2. The Toothbrush. As with the book, every few years somebody tries to put the toothbrush out of business. Years ago we got the electric toothbrush, then the Water Pic, and now this latest push for disposable electric toothbrushes. Even floss has failed to keep pace. The manual toothbrush is a classic: Inexpensive, portable, requires no batteries ever, and works in any location from the back seat of the car to the airplane bathroom at 30,000 feet.

And the great thing about the toothbrush is that, once you have worn it out, it's great for putting polish on your shoes. (Try doing that with a Water Pik.) No batteries, good for your health, and 100 percent recyclable. In other words, the perfectly green product.

3. M & Ms. There are better candies in the world, I'll admit. But chocolate that never melts gets high marks in my book. You've got the colors, the crunch, the cascade of chocolate when you put a half dozen in your mouth and bite down. And M&Ms enjoy the best quality a junk food can have: they are abundant and cheap. When Godiva chocolates cost $11 for a 52 ounce bag I'll consider switching them into this spot.

4. The Electric Guitar. I played an electric Gibson throughout high school and can say without reservation that it alone rescued me from complete banishment to geekdom. If you have a child who is exhibiting dorkish behavior, get him or her this instrument without delay.

Think about this: You are alone and unobserved, listing to music on your MP3 player. Suddenly your favorite song of all time from your college days comes on. You start mouthing the words, lip syncing, and you start moving your arms rhythmically, grasping a what? -- an air guitar. Admit it, you've done it. Anyone out there who plays an air harp can go straight to the back of the class.

5. Beer. And I'm talking about good old fashioned locally brewed beer, not that mass-produced hooch advertised on football games. If I want to drink filtered water tainted with a few drops of brewed extract I'll do that myself, thanks. Real beer has real flavor and real style. And it is real cool. You can drink a beer at a wedding, a barbecue, a ballgame, a Presidential inaurgural ball, a papal coronation, or a women's mudwrestling match and not seem out of place. Say the same, Dom Perignon.

6. The Toilet. Let's give credit where credit is due. Science may have made great strides in the last century, but no one has improved on the basic john. It's clean, efficient, works with the operator in a comfortable sitting position, and best of all, you don't have to look if you don't want to. Sure, some tinkerers have marketed toilets with built in phones and HDTV screens, but they are just gilding a lilly. A lilly, admittedly, that doesn't smell like a lily, but a magnificent object nonetheless. If you ever meet a techhead who tells you the iPhone is the greatest invention in human history, bet him $100 that you will do without an iPhone for a month if he will do without a toilet. In 30 days when he comes crawling back to you to pay you your money, remember to clip Best Product #7 to your nose first.

7. The Clothes Pin.

Joyeaux Noel et Bonne Annee!

Perhaps this week I made the biggest mistake of my life. I bought my son a set of drums.

The story goes like this. About a year ago, I bought my daughter an electronic keyboard. It was not an expensive one, but the idea was to see if she showed any interest in it, and if so, to consider arranging lessons. She showed some interest, and we set her up with an instructor at a little music store in town. Since she is very young, the lessons are not entirely structured, but aim to cultivate interest in the piano in the future.

It went well, except that my 4 year-old son immediately competed for playing time. We set up a few lessons for him, and he did well. However, whenever he went to his lesson, his teacher had to pry him off the drum kit in the practice room with a crowbar. After talking to the teacher, we split the lessons into 15 minutes of piano, and 15 minutes of drums. He seems to like the drums much better.

That put us in Spera's Music shop last week, looking at three different child-sized drum kits. As I compared different kits, I envisioned a future of jangled nerves, midnight practice sessions, and visits from the police. We got the set anyway.

I have played the guitar for many, many years, and though I am not that good at it I have always felt the transforming power of playing an instrument. In our world music is everywhere -- in the stores, in the movies, on television, even in doctor's waiting rooms -- making music probably the most pervasive art form in all the world. There are two kinds of music aficionados in this world, those who have played an instrument and those who have not. I feel real pathos for those who have not. Nothing teaches an appreciation for music like spending hours sweating over a song, figuring out the fingering, the chord changes, perfecting every note. Playing and listening to your own music is a little like living in a house you have built with your own hands. Just as the builder knows every nail, every rafter, and every inch of moulding and why it belongs there, the musician knows every note of the song, how the song hangs together, why the chords progress as they do, why a certain chord sounds better as a barre than voiced with open notes -- everything. I know of nothing in any other art that provides the same satisfaction of artistic ownership of someone else's work, except possibly acting in a play. Memorizing a poem is not the same, tracing a drawing is not the same. For me, not even cooking a recipe and doctoring it to my own taste yields the same feeling. Singing a song very well comes close, but only when the singer has real musical understanding of the song -- crooning, sadly, doesn't count. When I play a song on my guiter, it is mine until the last note dies out.

People who have never played, but only listen, never appreciate music on that level. The musician approaches a musical recording the way a carpenter approaches a piece of furniture -- with knowing, an appreciation, at the touch, of the quality and meaning of the product. To truly love music, you must have played. Not well, necessarily, but well enough to appreciate the craft of soundmaking.

All of which is to say that I intend my children to learn an instrument. Hopefully well, but at least well enough to appreciate what others do.

In some ways I am very pleased that my son may one day become a drummer. The drums are much more difficult to play than they appear. Most people can pick up a drum and find a beat, but truly accomplished drummers bring cohesion and meaning to songs. On occasion, I definitely do listen to a song and think, "That song was beautifully drummed." (Some songs that have impressed me that way include Steely Dan's "Aja," Dave Brubeck's "Take Five," Louis Armstrong's "West End Blues," Miles Davis's "So What," and "Rock and Roll" by Led Zeppelin.) Because guitars are cheap and instruction is easy to find, there are a fair number of guitarists around. The same goes for the piano. But there are three popular instruments where accomplishment is hard to find: the drums, the standup bass, and the harp. Musicians who are good at any of these three have their pick of gigs. The barriers for each of the three is similar -- mainly the size and expense of the instrument. Guitarist learn by packing up their instruments and going to play with friends. This his hard to do with drums. On the other hand, a really good drummer can attract his guitarist friends to his house for the novelty of jamming with hip percussion. This thought is gives me papitations even as I type.

If my son plays, and if he gets good, he will have people calling him to join their bands for the rest of his life. He'll be the Hep Cat. Strummers will come and go, but he with the sweet skins will always have musical pals. Mistrustful neighbors also, but this is a small price to pay for being in demand, if you ask me.

So let there be drums.

Since I am, at least on paper, a board-certified pediatrician, I take a small amount of pride in raising my children by the book. Of course when I say raising I use the term loosely, since anyone with eyes can see that my wife does the raising and I fill in as an occasional advisor. Still, when I exercise influence, I like to think that I follow the behavioral guidelines I learned as a pediatric resident.

Somewhere in the rulebook it says that a good parent should not indulge a six year-old daughter by carrying her when she decides she does not feel like walking. An able child should walk on her own, no matter how much she carries on. And while the parent may acknowledge that one of the reasons said daughter wants to be held is jealosy that a much younger sibling gets to be carried, nevertheless the rulebook remains clear: Hang tough.

My medical and personal judgment should prevail. Make the girl walk. She's no baby, it's good for her. Be the parent you are supposed to be.

Then the devil starts to whisper in my ear. This little girl -- yes, still little -- barely tops 60 pounds. I have been, ahem, working out lately, and am capable of carrying a 60 pound sack of potatoes several hundred yards in varied terrain without any real problem. The real temptation then follows. My girl will continue to grow, and one day I will not be able to carry her any more. One day, I will not be strong enough to walk a hundred yards myself, much less carry my little bird along with me. And though my daughter is yet very much a child, she presently will acquire that sense of dignity that will preclude her ever again allowing me to carry her in public.

One day very soon I will carry her for the very last time.

And so, if you visit a shopping mall in the New Orleans area this Christmas season, you may see a middle-aged doctor carrying an oversized bundle down the electronics aisles. Promise you won't laugh too hard.