I am not a poet but for years, poetry has been a part of my (almost)
daily routine. In the early morning, coffee cup in hand, I enjoy Garrison Keillor’s
online The Writer’s Almanac (http://writersalmanac.publicradio.org/);
I savor poems found in our major medical and other journals; and discover gems
sometimes in the most unlikely places. There must be thousands of poems in
folders in my library while poetry books spill off their dedicated shelves. Perhaps
it is not surprising, then, that poetry is a routine part of my medical armamentarium.
Whether working with students or professional and lay audiences on a wide
variety of topics, poetry informs, clarifies and “softens” almost every
discourse.
For the most part, poetry relevant to medicine is spare. It conveys a
depth of imagery, reality and emotion absent in most medical discourse. Poetry
challenges our intellect while speaking to our deepest fears, hopes, dreams and
uncertainties. Poems ensnare us with their shapes, rhymes, rhythms and
cadences, their punctuation or lack thereof. Every word counts. We are
challenged to read between the lines and sense what is unspoken or perhaps
unknowable. Essentially, poems are like patients – they all require close
attention and interpretation.
Recently, at my 40th medical class reunion in Australia, I shared
with old friends a few poems, all written by physicians, which create a
commentary on our experiences in
medicine rather than those of our patients. I thought my fellow Fellows might
appreciate this collection too. First, though, let me begin with a short poem
by Honorary College Fellow, John Stone, who gave several marvelous readings at
the College prior to his untimely death in 2008.
Death
I
have seen come on
slowly as
rust
sand
or
suddenly as when
someone
leaving
a room
finds the
doorknob
come
loose in his hand
― John
Stone
Here in just eight short fragmented lines is the entirety of death – the
slow erosion of the body by age or disease, or the sudden snuffing out of a
life, the inevitability of it all.
For many of us our first intimate encounter with death was in Gross
Anatomy. Are we surprised, then, that almost every major physician-poet and
many students have penned a “dissection” poem, reflecting on their tenure in
the Lab? Listen to the wonderful metaphors for elements of the body – caves,
canyons, faults, flowers, minerals, oil – in College Fellow, Jack Coulehan’s
poem “Anatomy Lesson”:
Anatomy
Lesson
When I move your body Do
not mistake these tears.
from its storage drawer, These
tears are not
I brush my knuckles, for
your bad luck
Ernest, on your three-days nor
my indenture here,
growth of beard. Cheeks, but
for all offenses
wet with formaldehyde, to
the heart―yours, mine―
prickle with cactus. for
the violence
My eyes burn and blink of
abomination.
as if a wind of sand Think
of my tears as rain
blew through the room. staining
your canyon walls,
filling
your stream,
Bless me, Ernest, touching
the blossoms.
for I cut your skin
to learn positions ―Jack
Coulehan
and connections
of your parts―caves,
canyons, fissures, faults,
all of you. Show me.
Show me your flowers,
your minerals, the oil
of your spleen.
Dr. Coulehan, internist and palliative care physician who has read from
his work several times at the College, jokes that he and his table mates named
their cadaver “Ernest” so they could tell their parents they were working “in
dead earnest.” Ah, the stories we all could tell! In sharp contrast to Dr. Coulehan’s
lyrical poem is this pungent little gem by one of my medical students:
Reflection On Anatomy
Six students
huddled around a body on a table
Like
crapshooters in some morbid casino
The scent
of human bodies
Like old
stale beer
On my
clean hands
—Ethan
Payne
One way or another we finally became interns or the equivalent thereof. While
tourniquets and other paraphernalia have given way to e-tools in our pockets, pulmonologist
Phillip Cozzi captures so much of that year in this whimsical poem:
Intern
Beyond the handsome grey-haired
men who grace our walls
with stately charm. Beyond the
present chairman who
is warm and unassuming though he
speaks in pearls
and has a world-class reputation,
by repute.
Beyond the crease-sharp minds of
our attending staff.
Beyond their certain fatherly
intelligence,
mature beyond their years. Beyond
their ready laughs
and smarts. Beyond the
street-sharp, heart-wise residents
you find . . . O no . . . the
lowly intern, awkward mole,
no friend to sun. Ridiculous, he
looks the clown
with safely pin or tourniquet
from every buttonhole
and only his ineptitude is near
renown.
Yet you might fight to love the
slow-foot worm
who plods and plods through daily
chores so utterly
methodically for even he survives
and even he’ll emerge,
despite his former grubby self, a
butterfly.
―Phillip
Cozzi
Oh yes, we remember those who spoke in pearls and the descending
hierarchy of the hospital!
When I came to the U.S. in late 1971, many things surprised me including
the paucity of women in medicine (35% of my graduating class was of the “fairer
sex”) and the differences in terminology and acronyms used in various medical
settings in the American cities where I worked. This poem captures the essence
of my disquiet:
Misunderstanding by Eric L. Dyer, pulmonologist
Morning rounds, the intern’s
order:
Discontinue
TLC,
a word and three letters puzzling
to me,
displayed so near approaching
death
and this cold robot of volume and
flow
quantitating every breath.
How inappropriate, it seems,
to discontinue tender loving care
for this spare woman scored with
tears―
strange enough for me,
embarrassed to inquire of love
with a stethoscope tickling my
ears,
to ask her nurse
the meaning of this doctor’s
order.
Oh, she
reported,
that’s
Triple Lumen Catheter in this ICU.
So, now I understand
the meaning of TLC in room 262,
where we are headed this morning,
what a difference three letters
can make,
how much
the language of this work has
changed.
It’s striking to see the “cold robot of volume and flow/quantitating
every breath” counterbalanced with the soft fuzzy notion of “TLC,” and the poet’s
empathy for the patient contrasted with her objectification as “room 262.”
Anesthesiologist Audrey Shafer captures another aspect of medical life, the
often uneasy balance between work and parenting, in her lovely poem “Monday
Morning”:
Monday Morning by Audrey
Shafer
In
the prelight
A
heavy sound from upstairs
I
turn from the front door
to investigate.
My
three-year-old son stands
naked
in the soft penumbra of dimmed
hallway light
Clutching
his favorite blanket
picture book and well-rubbed
panther
to his chest.
His
toes curl on the wooden floor.
I
am dressed and beepered―
No
snuggling in the warm water bed this morning
floating back to sleep till
sunlight wakens.
Instead,
we hug.
I
kiss
his thin neck.
I
feel his small breaths.
His
bedroom door stands closed,
heavy in shadows.
At
the operating suite,
The
residents still at lecture
The
patient not yet here,
I
enjoy the rote motions―
follow the green snake tubing to
the ceiling
barbotage dissolving drugs in
syringes
snap open the laryngoscope.
Around me
all is bright pristine ordered
Primed.
Sterile
instruments attend in precise, metallic rows.
I
try to recall his just awakened warmth
in that brief moment
before
The
patient arrives
Naked
under hospital issue
Ready to
sleep.
How many times have we all felt guilty about “abandoning” our children
and then been forced to recognize the pleasure in our jobs?
As we all know, “doctor bashing” is a popular sport, especially in the
media, and “playing God” is a frequent charge levelled at the most humanistic
of physicians. In this wry poem, oncologist Marc Strauss eloquently captures
that tension between physician and patient:
Not God
I
thought to delay the answer, camouflage
it,
by waiting until he asked another
question.
But he prefaced the question with
I
know you’re not God. This is commonly said
to
me, second in frequency only to What
would
you do if it was your father, or wife,
etc.
I accept this statement of my undeity
to
be rhetorical, a mechanism to permit me
to
be imprecise, to use phrases like “it depends
upon
many factors” and “a range of.” But lately
I’m
increasingly tempted to say, How do you know
I’m
not God? What gives you such certainty?
Do
you say this to your lawyer, accountant,
or
mother-in-law? And, if I’m not God then why
Ask
me a question that only God can answer?
¾Marc J. Straus
(As a
side-note, Dr. Strauss’s play Not God: A
Play in Verse, in which this poem is to be
found, was
performed at the College in November, 2008.)
While the nature of bedside rounds has changed dramatically over the
years and many of us lament the current prevailing standard, endocrinologist John
Wright gives us a wonderful “take” on this ubiquitous aspect of medical
training through the lens of a landscape architect training an intern. One has
to love that “punch” in the final stanza.
Bedside Rounds by John
L. Wright
I thought
of bedside rounds
when my
landscape architect called to ask
if it was
okay to bring an intern with her.
Of
course, I say,
remembering
the many years I enjoyed teaching
and the
few times the housestaff
honored
me
with the
Best Teacher award.
So today
she’s here to help me reshape
the back
lawn to support
structurally
and aesthetically
a new
bluestone walk, its slow curve
leading
to a new red cedar porch.
For sure,
this is
not a matter of life and death
but after
an hour
of
traipsing around with her yellow tape
and spray
can of orange, water-soluble paint,
asking
the intern what she thinks of this border
or that
elevation
I begin
to resent them
―the
little games they play.
Who’s
lawn
do they
think they’re talking over
anyway?
Without doubt we’ve observed amazing advances during the past 50 years
in medicine. Surgeon Maria Basile captures the essence of that change and puts us
medical “elders” squarely in our place in her poem “Dinosaurs”:
Dinosaurs
Marveling
at
stainless
wires
they used
to close
everything,
the skin
over
an absent
breast,
the bone
over
an open
heart,
how could
we know
how could
we know
cutting
cracks in calloused hands
making
sutures sing,
trying
and tying
as silk
became Vicryl
catgut
turned chromic,
that we
were the dinosaurs,
that heat
would denature
blood
vessels and tumors,
sound
beyond sound
could
cauterize and cut,
nanochips
would
replace the retractors
we clung
to
and the
eyes so tired
from
reading.
―Maria A.
Basile
How could we know? How could
we know. But hasn’t it been exciting, rewarding, and, yes, fun along the way?
This last poem is by Tim Metcalfe who practices family medicine in
remote, rural Australia. It is a tour de force that takes us from the shock of
the Anatomy Lab to the trauma of our early clinical years, from anger at the
injustices we so often encounter to sorrow at our own naivety and helplessness
in the face of human suffering. Drawing
on the Australian aboriginal concept of “the dreamtime” and the wisdom
attributed to aboriginal tribal elders, Metcalf ends with an image that is hard
to forget. This doctor finds resolution to the exigencies of a life in medicine
by simply being with his patient.
STAGES OF
DYING
(after E. Kubler-Ross)
denial
In anatomy class
we cut textbook lines
into the dull clay of our body.
We shook dismembered hands,
and bragged of cricket with arms and balls
for a joke.
We washed the formalin from our hands
for the next two days.
shock
A pregnant girl collapsed.
The scalpel cut quick and deep.
Her grey belly peeled apart.
The monitors ticked:
a mechanical requiem.
White gloves pulled out the baby
cold and dead like the streets
I wandered half that night.
guilt
As an intern
I was anxious, and obedient.
To cure at all costs
was the boss’ creed.
I had no time for the old woman
we made betray her faith.
Soon after the transfusion
She died of cancer.
anger
Some drunken bastard
hit this woman with his car.
Her young breasts quivered
each time we thumped her chest.
Over half an hour
her face, burned alive,
set cold, branding for life
the mind of her child.
sorrow
Was it happy, his final memory?
This poor bloke, purple-faced
and next in line for death?
I was naive, yesterday,
regarding his broken heart.
Today it wouldn’t go anymore.
Tonight I was drunk.
There were tears, briefly.
acceptance
I went to see an elder on his beach up north.
He didn’t say much.
There was this sky-blue dreaming;
the ocean its lucent mirror,
flawless like an egg.
I heard he died around sunset.
That night a warm breeze blew
the soothing tune of the sea.
―Tim
Metcalf
I hope these poems have whet your appetite for more! Please watch for
details of the College’s first Poetry Competition that will be launched in
November and for a poetry event on April 21, 2015 that will honor the 25th
Anniversary of National Poetry Month.
Poetry
References:
“Death” by John Stone. From In All
This Rain (1980), Louisiana State University Press.
“Anatomy Lesson” by Jack Coulehan. From Medicine Stone (2002), Fithian Press.
“Reflection on Anatomy” by Ethan Payne. Class of 2012, Drexel University
College of
Medicine.
“Intern” by Phillip Cozzi. In Journal
of General Internal Medicine, circa 1992.
“Misunderstanding” by Eric L. Dyer. From Annals of Internal Medicine. 1993; 118 (8):
647.
“Monday Morning” by Audrey Shafer. In Blood & Bone: Poems by Physicians, ed. by
Angela Belli & Jack Coulehan.
University of Iowa Press, 1998: 72.
“Not God” by Marc J. Strauss. From symmetry.
TriQuarterly Books, Northwestern
University Press, Evanston,
Illinois; 2000: 17.
“Bedside Rounds” By John L. Wright. JAMA,
283 (14), 2000: 1795.
“Dinosaurs” by Maria A. Basile. JAMA
301 (17), 2009: 1746.
“Stages of Dying” by Tim Metcalf. In Verbal
Medicine: 21 Contemporary Clinician-Poets
of
Australia and New Zealand, ed. by Tim Metcalf. Canberra: Ginninderra
Press,
2006.
— Rhonda
L. Soricelli, MD. 9/28/14.
