THE POETRY OF MEDICINE

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 40^th 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 25^th 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.