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poetry

“Congenital Glaucoma”: Commentary

12 Jul, 17 | by amcfarlane

Dr Richard Ratzan gives us a commentary on his poem “Congenital Glaucoma, published in BMJ Medical Humanities, and explains why he decided to write about this case using the sonnet form.

This little girl – she was probably about 13 or 14; I don’t remember since it was about 10 years ago – was from Mexico, almost certainly illegally but I do not remember that for certain either. She was with 2 or 3 boys her same age. What struck me about the case – and prompted me to write about it – were the following: first, how animatedly happy they all were. In retrospect, given how devastated I was that she was not only blind but preventably so, I was impressed that this misfortune was not precluding their youthful joy. (Whether she was so joyful when the ophthalmologist gave her the official bad news in his office – as he did since I called him about her two days later – I do not know.) Secondly, as someone who makes it a practice to look in at least 3 to 4 sets of fundi a shift – I find it useful and I do not want to lose this skill, as I would were I to use it, as my residents do, only when I “need to”, e.g., for severe headaches or visual problems – I was astounded, as I have not been that many times in my professional life, by the sight of her fundi: each cup was a bottomless pit of featureless whiteness, with vessels falling off into them from the edge of her retina as though falling off the edge of the universe. (I was also acutely aware then, as I write “sight” now in the preceding sentence, of the irony that it was only my good vision that could diagnose her lack of it.) Thirdly, I was struck by how blasé about it my resident, a good PGY3, was. Yet again I marveled at young physicians’ lack of ability to marvel. Is it their lack of experience, the paucity of fundoscopic examinations (not that they do that many these days or ever will accrue a database with which to compare) against which to measure medical horror when they see it? Or is it simply a different attitude they bring to work, an unwillingness or youthful inability to see the wonder of clinical medicine when it rears up in front of you? It is not callousness, at least in this young resident’s case. And fourthly and lastly, I grieved at the tragedy of her being born in Mexico without the resources we in the U.S. take for granted. If her parents here had noticed her trouble seeing as a younger girl – as I am sure hers in Mexico had – she would have gone to an ophthalmologist and – case closed – gotten preventive therapy. No blindness. Which is why, as someone who knew little girls like this when I used to spend a lot of time in Mexico, I referred to it as a sacrifice – a sacrifice of Mexico’s poverty and inadequate health care. A sacrifice I tried to make more historical and poetic with references to pre-Columbian mythology.

Why a poem, and why and how a sonnet? I have been interested in telling medical stories, vignettes, case histories, in verse for years since there is an economy to verse and a freedom “to tell all the truth, but tell it slant” [ref 1], a quotation (the title of the poem, actually) from Emily Dickinson that my late physician-poet friend, John Stone – and a far greater poet than I – liked to invoke whenever he was asked the same question – why poetry? But why a sonnet and not a villanelle [ref 2] or a sestina [ref 3]? It is the liberating mode of poetry and the simultaneous discipline, the challenge, of packing everything into a tightly defined package of a sonnet’s 14 lines. First I must squeeze the facts of the case into the octet, the first 8 lines, and then the exposition of the ideas, which exposition will only work if I have been successful in the first 8 lines, into the terminal sestet, the final 6 lines. Although Shakespeare usually uses the last two lines as the “volta” (Italian for “turn”, the axis point at which the poet gets to the crux of the poem) of the sonnet, I almost always follow the Petrarchan model using a sestet to “wrap up” the case. What I find most challenging is the tension between being too economical – writing solipsistically cryptic references only I understand – and prosaically literal. The former borders on the opaque (Wallace Stevens can pull it off; I can not). The latter is the case history we have all learned to use when dealing with other medical listeners. In between is poetry. As my second son said with amazement some years ago, upon hearing that I had attended a standing-room-only poetry reading by Mary Oliver at Smith College, wondering what the big deal was about poetry, “Poetry is incomplete prose. There are words missing.” (I didn’t have the heart to tell him that his definition of poetry was a veritable haiku. I did not want to ruin his day.)

References

1. Dickinson, Emily. “Tell all the truth but tell it slant”. Poetry Foundation. Accessed May 5, 2017.
2. Williams CK. “Villanelle of the Suicide’s Mother”. Reviewed by Ratzan RM. Accessed May 5, 2017.
3. Hadas, PW. “To Make a Dragon Move: From the Diary of an Anorexic. Reviewed by Donley C. Accessed May 5, 2017.

Book Review – A Body of Work: An Anthology of Poetry and Medicine

9 Mar, 17 | by cquigley

Corinna Wagner and Andy Brown (Eds.) A Body of Work. An Anthology of Poetry and Medicine. London, Bloomsbury, 2016, 532 pages

Jack Coulehan, MD, Center for Medical Humanities, Compassionate Care, and Bioethics, Stony Brook University, Stony Brook, NY 11794 USA

At first glance medicine and poetry seem like strange bedfellows. Yet, consider the fact that medicine has strong roots  in the world of art and symbols, and poetry can often be, as the editors of A Body of Work put it, “the deep music of bodies in pain.”  Because of its brevity and immediacy, poetry occupies a special place in the medical humanities movement, which seeks to explore issues of illness, suffering, and healing through the lenses of literature, history, philosophy, cultural studies, visual arts, and other humanities. In their introduction to A Body of Work, editors Corinna Wagner and Andy Brown ask rhetorically, “Poetry: What Is It Good For?” This brings to mind the famous lines from William Carlos Williams’ late poem “To a greeny asphodel,” “It is difficult to get the news from poems, / yet men die every day / for want of what is found there.”1 Perhaps poetry is like a vitamin, required for human flourishing, if not survival.

Several anthologies of poems about illness, disability, medicine, and healing have appeared in recent years. In addition, anthologies of poems written by doctors, nurses, and other clinicians are available. Does A Body of Work contribute anything  substantially new to this genre? The answer is a resounding Yes. The book’s subtitle, “An Anthology of Poetry and Medicine,” could be loosely applied to the earlier collections, but A Body of Work is the first to take the conjunction “and” quite seriously: not just an anthology of poems with the relevant subject matter, or poems written by medical practitioners, but rather an exploration of the relationship between poems and medical beliefs at the time of their writing.

Wagner and Brown situate poems in historical and cultural context by including excerpts from medical writings of the same period. These allow the reader to understand, at least to some extent, the mindset of the poet and his or her original audience.  Because in each major section, poems and medical texts are arranged chronologically, the reader may also observe how medical understanding of a poem’s subject matter evolved over several centuries.  This contextual approach creates a dialog between poetic and medical expression.

The Body of Work is divided into eight topical chapters: Body as Machine; Nerves, Mind and Brain; Consuming; Illness, Disease and Disability; Treatment; Hospitals, Practitioners and Professionals; Sex, Evolution, Genetics and Reproduction; and Aging and Dying. Within each section, poems are arranged chronologically, as are the excerpts from medical writings that follow. Consider the first chapter, which explores the metaphor of the body as machine. One of the first selections is by an anonymous 19th century poet who wrote:

Observe the wonderful machine,

View its connection with each part,

Thus furnish’d by the hand unseen,

How far surpassing human art! (p. 29)

 

In later poems this Enlightenment metaphor is variously affirmed, transformed, critiqued, and denied. For example, in the mid 19th century, Walt Whitman firmly rejected the mechanical man in “I Sing the Body Electric”: “And if the body were not the Soul, what is the Soul?” and “If anything is sacred, the human body is sacred…” (p. 33) In the early 20th century, D. H. Lawrence extolled the self-healing powers of body and soul, “I am not a mechanism, an assembly of various sections…” ( p.38) By the 21s century, poets were writing  about their bodies with considerable irony, as in Jean Sprackland’s “Supraventricular Tachycardia.” The body is distinctly flesh, but not a machine, “my excitable cells don’t wait for the messenger.” (p. 68)

Similarly, medical elections in this chapter range from Julian Offray de la Mettrie’s explicit Man a Machine (1749) to Varieties of Religious Experience (1902), in which William James argued that such medical materialism is a “too simple-minded system of thought.” (p. 81)

Chapter 2, “Nerves, Mind, and Brain,” the evolution of poetic and medical perspectives on mental and nervous disorders. Take, for example, melancholy. John Keats (1820) spoke in the third person when he described melancholy as a spirit that may fall “sudden from heaven like a weeping cloud” on helpless man. “His soul shall taste the sadness of her might / And be among her cloudy trophies hung.” (p. 88) A century later,  Edward Thomas, internalized melancholy, “What I desired, I knew not, But what e’er my choice / Vain in must be.” (p. 94) However, by the 21st century, poets have begun to assert their determination to fight and win at least small battles over depression, as Jane Kenyon wrote in “Having It Out With Melancholy.” Though “pharmaceutical wonders are at work,” she told her antagonist, “Unholy ghost, / you are certain to come again.” (p. 115) Medical writings from the 18th to early 20th century reflect a dramatic change in beliefs about the etiology of melancholy, from George Cheyne (1733), who claimed the illness was attributable to the damp climate, rich food, and sedentary lifestyle in England, to Sigmund Freud, who explained the disorder in purely psychodynamic terms.

The Body of Work contains countless such resonances between medicine and poetry that, from a medical humanities standpoint, give considerable added value to the more than 300 fine poems collected within.

However, the book does have one somewhat surprising deficit, given the editors’ avowed intentions. While contemporary poetry is numerically overrepresented (as is appropriate), the most recent medical writings date from 1919, aside from a brief excerpt from William Carlos Williams’ Autobiography (1948). Thus, most of the poems reflect dramatic developments in the understanding of illness that occurred in the last hundred years, while corresponding medical pieces are absent. Certainly William Röentgen’s “On a New Kind of Rays” (1905) and Joseph Lister’s “Illustrations of the Antiseptic Method of Treatment in Surgery” (1867) led to significant advances in the world of medicine, but haven’t similar developments in mid to late 20th century also radically influenced poetry about illness and healing?

Despite this caution, I strongly recommend A Body of Work to anyone interested in poetry about illness, or poetry and medicine, especially students of the health care professions and their teachers.

Poetry Book Review: Owen Lewis’s Best Man

30 Nov, 16 | by cquigley

best-man-frcov-copy

 

Best Man by Owen Lewis. Dos Madres press, 2015

 

Reviewed by Wendy French.

 

Best Man has just been awarded first prize in the Jean Pedrick Chapbook prize from the New England Poetry Club. When you read the poems you can certainly understand why Lewis’s work has received this recognition.

Edward Hirsch’s epigraph features at the beginning of the collection and is entirely apt for all that follows:

Look closely and you will see

Almost everyone carrying bags

Of cement on their shoulders.

 

How universally true this is. Although our bags of cement may be entirely different from the ones that Lewis carries, they are nevertheless present. It is for this very reason that Best Man can speak to each and all its readers.

The poems focus on anger, regret, failure and love. They are about all that it is to be human, and specifically to love a brother in a hopeless situation.

In the collection, each of the poems stands alone, but together they tell a story of dependency, support, and of the fight against a battle with drugs and addiction. The story needed to be told. I read the book as a single unit from beginning to end, as the poems together record a  young man’s life and were written from the standpoint of despair. Once I started reading, I felt compelled to finish. Lewis truly captures the pain and anger that he, an older brother, felt towards his sibling who was, as well as destroying his own life, destroying that of his parents, his grandmother, indeed his entire family. I was totally engrossed in the unfolding narrative and desperate to find out how it would all end. In each of the poems there is a level of intensity that drives the words forward and into the next poem.

The collection opens with Post-script, Unwritten Letter where Lewis looks back over childhood and the familiar games that children play:

‘… like the children we were

digging through the backyard soil, determined to get to China,

                                                                               The spot under the swings

 

where our feet whisked the ground before each pendulum soar…’

 

These lines determine the relationship between two boys. The poem ends:

‘Wherever you’ve been you’ll have something to tell me. I expected

                                                                                              to know more.’

I had to re-read these lines as that situation, where we have lost friends and want to know more of their lives, is so familiar. Tragically for Lewis, the loss is that of his brother, whose full story will never be known. How did this fall into addiction begin?

This was a brave book to write and it took Lewis thirty years to be able to tackle the content. Lewis is not afraid to be truthful:

I am still mad at you.

Every week another call

 

from a burnt-out Bronx

neighbourhood,  or Brooklyn…

 

…our grandmother told me you were ok.

She cooked you a pair of fried eggs. 

 

The very fact of a grandmother feeding her grandson, hoping that this might bring him back to his senses, reveals a family pulling together and trying to overcome the situation. When you care for a loved one, you believe that food conquers distress. We all at times clutch at straws.

Lewis comes from a Jewish background and it is not until the fifth poem, Once, that we learn that his brother Jason had been adopted. Born to an Italian mother, Jason is brought into the Lewis household by Lewis’s grandmother.

 

…Once upon a time, it’s true,

the mother and brother, a pair,

looking out, a long wait

for the new baby to get there…

 

I’m your brother, and, so I’m…

 

Too long upon this time.

 

The poems are dark yet also uplifting because of their honesty. Lewis never tries to excuse his brother or to make excuses for himself in how he responds to addiction. This collection gives readers permission to confront their own demons and to write about them. No one is going to judge us or our reactions. Lewis has shown us how to do it. He has not abandoned his brother but is still talking to him after thirty years. Jason still has a prominent place in Lewis’s life and he listens to what his brother may be saying to him from beyond the grave. Lewis is working through his own feelings and is trying to make sense of his inexplicable loss. He never once blames his brother as an adopted force that came into the family, but fully accepts that Jason is his brother, and that he died at the age of twenty three.

The poems are beautifully constructed and restrained. They explore the chaos that addiction can bring to a family. Jason’s girlfriend, also hooked on heroine, is behind some of the late night frantic phone calls that Jason makes to Lewis. I have the feeling that Lewis helped to sort out the chaos that still existed in his mind about his brother’s death by writing this elegy. It seems that Lewis’s second marriage to Susan was the catalyst for this collection. He wanted to introduce Susan to Jason, and vice versa. In the poem Introducing, Lewis writes:

 

Under the chuppah

The rabbi will call: Yaacov ben Simcha…

 

You’ll ride on my shoulder –

 

Best man!

 

These poems are compassionate:

 

And what of the family’s soul,

Mother, as if you already knew

his disquieted soul won’t find peace…

 

ruthless:

 

Your breath is foul from rotten

meat. Your nostrils flare me

fresh in the cave of your furry hug.

 

 

nostalgic:

 

Remember how each year

we’d come back, have to learn

the beach all over again?

 

confused:

 

… you don’t know how

you passed a bill to the cashier

or how she passed you change

and why she is smiling or how

your hand cold lift the cup…

 

angry:

 

Okay brother,

Give me what you got.

A kick to the solar plexus.

 

full of searching:

 

This morning, the hour of haze,

a blackbird called through my window

with some urgency. (I think it was you.)

 

This fine collection would be very helpful for any family involved with a loved one going down the addiction route. The poems are energetic and the energy released will speak to many who are trying to understand this destructive path. The poems could act as a personal counsellor by offering the different stages of grief. Each reader can digest the content at his or her own individual pace.

The book would also be a useful teaching tool in the narrative medicine field as it demonstrates how personal stories paint a lucid and detailed understanding of the subject.

But first and foremost it is a book of poems that Owen Lewis has dedicated to his younger brother who died at the age of twenty three while hooked on drugs. The poems reflect a tragic story of a young life wasted.

Best Man should be widely read as these fine poems hit hard upon the dormant tragedy in all of us that perhaps looms around the corner. Lewis’s work depicts an unsettled world that is within each of us. From the outset, we realise that we are not in for an easy read.

A finely produced book, Best Man has an arresting cover depicting youth, confusion, and the beauty of snowdrops that appear in a touching poem, Thaw.

I hope that for Owen Lewis the thaw has begun with the publication of this work.

 

Wendy French

wendyfrench.co.uk

 

Wendy French, Thinks Itself A Hawk, poems from UCH Macmillan Cancer Centre. Hippocrates press, 2016

Reclaiming Reflection: Creative Writing and the Medical Humanities (3)

16 Sep, 16 | by cquigley

 

 

Reminiscence Bumps: self-mythology and the landscapes of the mind

by Eleanor Holmes

 

When I think about the landscapes of the mind, I recall the undulations of the brain’s surface. The ridges and valleys of cortex, the gyri and sulci I had learnt about in my neuroanatomy classes aged nineteen. Those white plastic tubs we eased open to reveal two, pale grey hemispheres floating in straw-coloured formaldehyde. That clinical but distinctly organic smell of burnt rubber, astringency and wax. How we sliced sections of brain with something that resembled the knife my father used on home-cured ham. How surprisingly soft it was to cut.

Prior to starting my Spring School creative writing week at Newcastle University in 2014, I had read Pieces of Light: The New Science of Memory by Charles Fernyhough. It has been an invaluable source of information on the latest scientific research on memory, particularly autobiographical memory, but it has also been hugely inspirational as a piece of science writing (or creative non-fiction). Two things particularly stood out to me when reading the book and in researching this subject. Firstly, the notion that memory is random and secondly, that it is ultimately self-serving. As Charles Fernyhough states and the American writer and physicist Austin O’Malley wrote:

“Memory is a crazy woman that hoards coloured rags and throws away food.”

The randomness of memory is something that has often struck me. Why do we remember odd, apparently insignificant facts and not the things that would seem more important when looking back on our lives? Why can I recall the sandwich filling (garlic sausage) my brother threw out of the window that blocked the guttering, aged thirteen, but cannot remember the name of the actor who lodged with us? How can I remember the cigarette brand and packaging my grandmother smoked (Benson and Hedges, Silver) and a conversation we had about a TV programme aged fourteen but cannot remember any of the details of her funeral?

 Yet it is the small details, those seemingly random colourful rags that stick and then float to the surface when we recall the past, especially it seems when writing about it. It is particularly that rich period for memory from our teens to our twenties, the reminiscence bump that Charles Fernyhough writes about in Pieces of Light, that keeps emerging in my writing, whether I want it to or not.

“A British study showed that when autobiographical memories were cued verbally, there was a predictable peak between the ages of eleven and twenty-five: the well replicated phenomenon known as the reminiscence bump.”

The majority of the poems I wrote in 2014 for the Spring School fell into this verbally cued reminiscence bump. On the first day of our course, the poet Bill Herbert asked us to think about “where am I from?”, followed by “where do I identify as home?” This led to an exploration of self and belonging that I initially found hard to write about. I was born in Bristol, we moved to the Midlands when I was seven and there I stayed until I left for Nottingham University.

I disliked living in land-locked Warwickshire and didn’t manage to change this land-bound situation when I moved to Nottingham for university, but at least I had moved north. I have always been moving north, by increments, as well as edging closer to the sea. I had wanted to go to medical school in Newcastle but didn’t get an interview. I wonder whether it is really a coincidence of fate that led me to the North East (Durham initially and then Newcastle) or something that needed to happen; a kind of embodied genetic pull to this landscape next to the sea. Tynemouth is where I live now, positioned on the mouth of the Tyne and next to the North Sea with its wild surf and beaches, stretching up the Northumberland coast to Scotland like a golden thread. This is the place I am now most likely to call home.

What emerged from Bill Herbert’s class was a need to write about my birth, my mother and our at times difficult relationship. It was a theme that was to flow through all my submitted poems, along with water as the element that I most identify with. Bill also encouraged us to think of body as place, by reading an extract from Paterson by William Carlos Williams, a theme that resonated with me and the obsession I have with writing about the human body and my memories of anatomy and dissection from medical school.

It is now clear to me (after six years of pursuing a writing life alongside medicine) that when I write I don’t always decide in advance on form, I just like to write. It is later that I make a decision as to whether I am writing poetry, prose or script, when looking back over the words. Fiona Evans took our scriptwriting class mid-week and I was encouraged when she advised us not to be tied to form or structure. Her session also introduced me to Marina Carr as a playwright, specifically her play By The Bog Of Cats. As we read sections of this script it felt to me to be very poetic and suddenly the idea of scriptwriting seemed less daunting.

Learning about performance and the concept of the clown with ‘Miscreations Theatre’, and the history behind the art form with Helen Limon as facilitator, also influenced my poems, particularly the idea of embracing the ridiculous. The importance of being able to laugh at yourself I hope comes through in my writing. Black humour, said to be a medical trait but more often than not a coping strategy for the difficulties encounters of healthcare work, is something I often explore when writing about medicine and health. Too easily my writing can stray towards the subject of death; my father jokes that it is my favourite topic. It is perhaps an occupational hazard but I hope to strike a balance between being respectful of serious subjects whilst seeking out the humour inherent in most human interactions.

In William Fiennes’s class we were asked to draw a map from memory. I ended up drawing a detailed plan of my childhood home where we lived from the age of seven to sixteen, and wrote about the memories attached to this house. Here it seemed was an endlessly rich seam of childhood and teenage memories in terms of a reminiscence bump that still feels very vivid to me. I liked the idea of writing about my territory being invaded and many stories bubbled up from this exercise. I hoped it would link several themes together by highlighting an aspect of my growing up and the emergence of identity. This aspect of identity as an internalised life-story is another recurring theme in my writing, one that is so clearly linked to reminiscence bumps and the reason psychologists believe this age looms so large in people’s memories.

I am aware that much of what I’ve learned in creative writing workshops is that these small details – proper nouns, the use of all five of the senses when we write – that help to bring our writing alive. This must be linked to the way we remember. When we write we are creating a world (the world) for the reader, just as we do for ourselves when we remember the past. Memories are not stored like files in a cabinet, they are created anew each time we recall the past. We narrate our lives as serves us best at the time of recollection.

Childhood memories particularly are often recalled through collaborative acts of remembering, like a collage. I know that in a number of the poems I have written some details I’ve had to ask my mother about, as I couldn’t recall something exactly, or the name of a place or person. My mother, father and brother have helped me fill in the gaps where needed, but it is also noticeable that they do not remember everything as I do. Charles Fernyhough writes:

“The idea that the past is a story that we tell ourselves, whose vividness can be no guarantee of its authenticity, highlights our reliance on language for social acts of remembering. If our autobiographical memory system serves to create a coherent narrative of our own past, it is a system that can frequently fool us into believing stories that are not true, as evidenced by the fact that many of us ‘remember’ events that we no longer believe actually happened.”

This was the concept that I was fascinated to read about in Judith Schalansky’s beautifully realised Atlas of Remote Islands: Fifty Islands I have not visited and never will. Christy Ducker recommended this book (it’s really very beautiful, brilliant and unique) and the preface particularly intrigued me:

“The absurdity of reality is lost on the large land masses, but here on the islands, it is writ large. An island offers a stage: everything that happens on it is practically forced to turn into a story, into a chamber piece in the middle of nowhere, into the stuff of literature. What is unique about these tales is that fact and fiction can no longer be separated: fact is fictionalised and fiction is turned into fact.”

I think everything I write tends to start out as an exploration of autobiographical memory that I then run with, to a greater or lesser degree. Christy Ducker invited us to think of a place that we were experts on, then asked us to put someone into that environment who had no knowledge of it. This was the inspiration for My Mother Visits the Dissection Room, a blend of factual information in terms of place (the dissection room I remember from medical school and that I have lately re-visited) and my knowledge of my maternal relationship that ended up as a poem about an imagined scenario that incorporated all of these elements.

 

My Mother Visits the Dissection Room

by Eliot North

 

She said she wanted to go there.

So I pulled some strings,

read her the rules.

“Sensible shoes?” she said.

“Yes Mother. Plus clothes

you don’t mind ruined.

Fixers, they don’t wash out.

The smell will get you,

but not of death. More chemicals

like wax and rubber.”

But my mother, being my mother

didn’t seem to mind.

Walked right up to the

plastic head,

stuck her hand inside.

“You won’t even know

I’m here,” she said.

Pulled on a dark-blue lab coat.

Watched closely

as I unzipped the body bag,

revealed cavities and cages.

Stood on tiptoes to peer inside,

scribbled in her notebook.

So I placed a stool

three feet away;

her territory and mine.

When the students filed in

they looked at her,

the older woman with colourful shoes.

Whilst I quizzed the students,

she daubed her paints.

At the end they crowded round her.

Admired her line and

brave use of colour

whilst I put the organs back.

As the students left

she called out to them.

“Call me Poppy!” she cried.

They waved from the door.

“Weren’t they interesting?

What a wonderful body,

all those nooks and crannies.”

I slung the heart in a plastic bag.

Looked at my watch

before herding her out.

Then as we went to the door

she turned round and said,

“Shall we say the same time next week?”

 

Published by Ink, Sweat and Tears on 30/08/2016 http://www.inksweatandtears.co.uk/pages/?p=11697

 

These two concepts, the unreliability of memory and the way in which we narrate our lives using a blend of fact and fiction to best suit ourselves at the time of telling, is endlessly fascinating to me. I’ve struggled at times to differentiate between what I think actually happened and what I have imagined when recalling the past. The poems I write are often a conscious blending of fact and fiction, something termed in memory research as imagination inflation (what a great term!) I don’t like to pin down my writing necessarily as creative non-fiction. I would prefer to think of my poems as fictionalised truths. In this my drive towards a cohesive narrative wins each time; I will bend the facts to meet the needs of the story I am writing. Who hasn’t done that after all?

 

Acknowledgments

This essay draws on the poetry, prose and script suggested by tutors Bill Herbert, Christy Ducker, Fiona Evans, Helen Limon and William Fiennes, as well as the following books, performances and readings:

Fernyhough, Charles, 2013, Pieces of Light: The New Science of Memory, London: Profile Books Ltd. (quoted passages p 3, p 20, p 54.)

Ishiguro, Kazuo, 1995, The Unconsoled, London: Faber and Faber Ltd.

Lively, Penelope, 2013, Ammonites and Leaping Fish: A Life in Time, London: Penguin Books Ltd. Extract read by the author at NCLA Reading: ‘Penelope Lively in conversation with William Fiennes,’ on 1/5/14.

Payne, Nick, 2014, Incognito, London: Faber and Faber Ltd. (Script) and Performance at Live Theatre, Newcastle, 30/4/1/4 followed by post-show discussion with the author, neuroscientists and clinicians working with memory disorders.

Schalansky, Judith, 2010, Atlas of Remote Islands: Fifty Islands I have not visited and never will, London: Penguin Books Ltd. (quoted passage pp. 19 – 20)

Henig, Robin Marantz, The Reminiscence Bump: People looking back on life remember their twenties best. Psychology Today, Posted October 24, 2012. Cited https://www.psychologytoday.com/blog/cusp/201210/the-reminiscence-bump 2/8/16

Reclaiming Reflection: Creative Writing and the Medical Humanities (2)

15 Sep, 16 | by cquigley

 

Creative Non-Fiction: imagination and the nature of truth

by Eleanor Holmes

 

A copy of Primo Levi’s The Periodic Table lay on my bookshelf for years, a gift from my father, one of his favourite texts. The fact that I’d not actually read it until my creative writing tutor at Newcastle University, the author William Fiennes, re-introduced me to the collection, specifically the final story Carbon, reveals how I had for most of my life considered non-fiction to be less worthy of my time than fiction.

Why had I drawn such a distinction?

I had read numerous books at medical school by Oliver Sacks, such as The Man Who Mistook His Wife for a Hat and more recently Hallucinations. These books, it turned out, definitely fell under the banner of creative non-fiction. On the one hand they could be considered factual science writing, but Oliver Sacks as an author seemed to be doing so much more than that. This realisation made me re-think what this genre was or indeed could be. Since taking William Fiennes’ module in 2013, my consumption of creative non-fiction has dramatically increased and shows no signs of abating.

Creative non-fiction, as I now understand it, is writing based in truth that uses literary techniques more commonly associated with poetry, prose and script. The attention to character, voice, style, shape, structure and form mark out this genre from journalism and reporting; the facts of a piece not necessarily being as important as the way in which it is written. For me, the words ‘not necessarily’ are crucial here.

The suggested reading list provided by William Fiennes surprised me in its breadth and scope: memoir, reportage, nature writing, science writing, portraits, travel writing, case studies and essays. Unwittingly, I had read more than I had expected but it had never occurred to me to ask, “What kind of book is this?”

In favouring fiction, particularly the novel, I’d often sought to escape reality and move away from my own experiences as a child, growing up, going to medical school and latterly working as a doctor. I soon noticed that in writing creative non-fiction, whether telling your own story or that of another person, the writer can leave themselves very exposed. There is something that appeals to readers when an author states ‘this happened’ – to them or to someone else. It creates a stamp of authenticity that can be quite interesting to unpick.

The criticism Jon Krakauer received after publishing Into Thin Air is a reminder of this. In telling his own story, he was also telling the story of those who had died on Everest. His book reads like a thriller, the tension created by the narrative pace is palpable, but the story was never going to be easy to write or to be without its controversies. The moral and ethical debate surrounding consent and sensitivity when writing creative non-fiction is very interesting to me, particularly as this is something I have wrestled with when I have wanted to write about my own work as a doctor, the truth of my own experiences.

Having researched the science behind memory, I now know that when we recall something, memories are created from scratch using different areas of our brain. In remembering, we create our own unique version of the truth, every single time, which begs the question “what is truth anyway?” The latest scientific research on memory, gleaned from my reading of Charles Fernyhough’s fascinating book Pieces of Light, sits quite neatly alongside the fact that creative non-fiction can often blur what has happened (fact) with things that have been imagined (fiction). This creative license and economy with the truth when telling our own stories is something we are all likely to be familiar with, writers or not. I cannot remember with perfect accuracy conversations I had at the age of ten, but I can use my imagination to fill in the gaps, thereby telling the story I want to tell.

This seemed a minefield to me when I started to write, so much so that I wrote under a pen name and still do. This name is no longer a secret, I have become more comfortable writing about my experiences as time has passed. It now acts as more of a separation of my writer and doctor roles. The professional duties I am bound by I take very seriously; those of anonymity, confidentiality and consent. But these same concerns paralysed me for many years in terms of writing about my life as a doctor and all that medicine has done to shape who I am. The subject of family I find far easier to explore than strangers, colleagues or indeed patient encounters; not that I do not also consider and respect those professional parameters when writing about my family, particularly consent, as my mother will attest to in my latest series of creative non-fiction blog posts entitled Consultations with my mother.

The two poems I’ve written and published about clinical encounters (He Blew Me A Kiss in the previous post and The Milkweed Monarchs here) are two examples of how you can blend medical science and clinical detail within a human narrative, writing from different points of view, using characterisation and voice alongside a narrative arc. Interestingly, I can’t seem to write poetry without some kind of narrative inherent in them, perhaps because I was a prose writer before I started to write poetry. It wasn’t possible to gain consent to write these poems from the persons that inspired them, so providing anonymity was very important when I considered publication; a very deliberate blurring of fact and fiction.

One writer from William Fiennes’ reading list particularly stood out for me, and that was Jo Ann Beard. We read her story Werner, and the dramatic tension she created and her poetic prose style mesmerised me. This was a piece of writing based in truth, but it was someone else’s story, that of a man called Werner who the author had read about and contacted. The way she got inside his head, however, and the use of flash backs was so effective at creating this man’s inner world as well as re-enacting the outer facts of his extraordinary escape from a burning building, that you felt you were experiencing what happened as if you were Werner himself.

What particularly struck me after reading this was “how did she achieve this?” I have since researched Jo Ann Beard and found her writing described as ‘dramatic re-enactments.’ I went on to source another essay called Undertaker, Please Drive Slow which was published in Tin House after The New Yorker declined to run it as creative non-fiction. She wrote this forward to the piece:

In December 1997, Cheri Tremble committed suicide with the assistance of Dr. Jack Kevorkian. What follows is a merging of fact with fiction: the external details of Cheri’s life and illness are as accurate as possible, gleaned from interviews with her friends and family, while the internal details – her thoughts, her memories, and what occurred after her loved ones saw her for the last time – are imagined.”

In Undertaker, Please Drive Slow she utilises flash backs to Cheri Tremble’s past and childhood, flickering memories that mark her decline from a healthy, working woman and mother through her diagnosis of breast cancer, the treatment she endures, then her terminal decline. The images she uses to convey the final circumstances of her death are free of cloying sentiment and all the more powerful for it.

This writing is however right on the edge, clearly controversial because of the subject matter and the question of ownership as well as truth, whatever we mean by this. It does however shed light on a subject that is so rarely spoken about, that of death and dying. Clearly we cannot ask the person who has died to tell us about their experience of dying, but in this extraordinary essay I feel Jo Ann Beard comes as close as possible to doing that. There is a kind of alchemy at work here, the way she pushes creative non-fiction as a genre to its very limits to explore an emotional truth that I believe would not have been possible if this had been written as fiction.

Primo Levi notes in Carbon his final essay of The Periodic Table:

The reader, at this point, will have realised for some time now that this is not a chemical treatise: my presumption does not reach so far… Nor is it an autobiography, save in the partial and symbolic limits in which every piece of writing is autobiographical, indeed every human work; but it is in some fashion a history.”

I have now finished reading The Periodic Table, a book that defies easy classification, something I now realise is a positive draw for me and that I seek to explore in my own writing. The blend of short stories, memoir and science writing, woven together by Primo Levi’s love of chemistry, his training and work in this field, his survival of Auschwitz and the horrors of the Holocaust, and his undoubted genius with words is such a moving and life-affirming whole.

BBC Radio 4 have just dramatised The Periodic Table for radio, the different chapters named after single elements from the periodic table broadcast in episodes, ranging from fifteen minutes to an hour. This provides a perfect entry point to Primo Levi’s work as well as a way in to explore this rich and endlessly rewarding genre of creative non-fiction. If you read or listen to no other essay of Primo Levi’s make it Carbon, the story of a single atom of carbon as it journeys from limestone crag to the author’s brain cell as he writes. As William Fiennes said to me it is perfection in writing, the perfect full stop.

BBC Radio 4 iPlayer: Primo Levi’s The Periodic Table, available now: www.bbc.co.uk/programmes/p040d1vz/members

 

The Milkweed Monarchs

by Eliot North

 

I was riding my favourite bike. The Chopper

with the red flag and the silver streamers on the handlebars.

Minding my own business, cruising down Beach Road

to school at Kaikoura Flat. Happened right outside the

Whale Watch Office. “Idiot tourists,” Dad said,

“never bloody look where they’re going.”

 

Don’t remember much after that. Just the pain

in my belly, the voming and that funny shaped

bruise that crept like a shadow across my skin.

“Handlebars mashed his Pancreas,” the guy said to Mum

after they airlifted me to Christchurch. Wish I could

remember the ride. They’d given me the needle by then.

 

Couldn’t understand a word when I came to; most of

the docs were from England. Got my own room

on the kids ward though, was pretty stoked at first.

Turns out nine weeks in one room can really turn you off

a place. Kept telling me I couldn’t eat and put a stupid tube

in my chest, for that pseudo-food to drip in overnight.

 

Would’ve gone mad if it weren’t for the Monarchs.

Mum and Dad bought them in from the farm,

loads of tiny ones on bunches of Milkweed. Boy were

they hungry, just ate and ate whilst I couldn’t. Got fatter

and fatter, the black and yellow stripes growing further

and further apart. They were more interested in them than me.

 

Didn’t mind though, those ugly critters. Gave most of them

names. Watched how they crawled around my room before

they tucked their tails under like upside-down question marks.

Mum said I was daft, but I knew the Monarchs would save me.

As soon as they slipped into those bright green overcoats

and changed for good, with their precious crowns of gold.

 

“Coincidence,” the docs said. I don’t reckon. My pancreas

would’ve been stuffed if it weren’t for them. When the cocoons

turned black and then transparent, I could see the orange

wings inside.  First one came out all small and wet with

a loud POP!  Like the noise my brother makes when

people kiss on TV. I knew it was my time too.

 

Just pressed the buzzer and the nurses came flying.

Pulled out the drips, blood spurting over the sheets

but I was free. Stretched my arms wide and stuffed a

Chocolate Fish in my mouth before they got near my room.

You should’ve heard the shouting but I didn’t care;

there weren’t no Pseudocyst in me no more.

 

Commended in the Hippocrates Poetry Prize NHS category 2014

http://hippocrates-poetry.org/hippocrates-prize/2014-hippocrates-prize-open/2014-hippocrates-commended.html

Published in the accompanying anthology

 

Acknowledgements

This essay draws on the suggested reading list provided by William Fiennes for his Creative Non-Fiction course at Newcastle University and the following books, periodicals and podcasts:

Beard, Jo Ann, 2002, Undertaker, Please Drive Slow, Tin House Magazine, Portland: McCormack Communications. Vol. 3, No. 4, pp 27 – 59.

Levi, Primo, 2000, The Periodic Table, Penguin Books, London. Translated from the Italian by Raymond Rosenthal.

Fernyhough, Charles, 2012, Pieces of Light: The New Science of Memory, London: Profile Books Ltd.

Cusk, Rachel, 2013, New Writing: Memoir, Newcastle: Mslexia Publications Ltd. pp 30 – 42.

Radiolab podcast: Season 3, Episode 4, 2007, Memory and Forgetting, New York: accessed 1/3/13 at www.radiolab.org.

N+1 podcast: Episode 3, 31st August 2011, Both Fish and Fowl – Jo Ann Beard, New York: accessed 16/3/13 at www.nplusonemag.com.

Reclaiming Reflection: Creative Writing and the Medical Humanities (1)

14 Sep, 16 | by cquigley

 

Poetry and Reflection: a powerful tool for learning

This post is part of a series over the next three days on the theme of Creative Writing and Medical Humanities by Dr Eleanor Holmes (pen name Eliot North).

 

 As a GP Tutor I’ve delivered seminars on the patient centred medicine (PCM) component of Newcastle University’s Medical Undergraduate (MBBS) course to 1st and 2nd year students, for the past three years. Professional reflective practice is taught and assessed across all five years of the curriculum.

The ability to reflect and learn from clinical encounters is central to medical education and continuing professional development. Delivered within a creative context, I believe written reflection can also be an important tool to foster wellbeing and resilience in healthcare students and professionals.

Working in an increasingly overstretched and under resourced system such as the NHS, in which clinician burnout and mental health problems are on the rise, the question of how we reflect on the difficult and complex nature of care is becoming ever more important to address.

Stating that the answer might be found outwith Medicine may seem heretical, but it is my belief that we need to look outwards to move forwards. The Arts and Humanities, like Health and Medicine, explore and reflect upon the human condition. What therefore can we learn from each other?

My last seminar with my first year group was entitled ‘Professional Reflective Practice 2.’ After a year of working together trust, an essential element of clinical reflection, had been built within the group. I used my own writing, a poem called He Blew Me a Kiss, as a launch point for discussion, which was published under my pen name Eliot North.

 

            He Blew Me a Kiss

 

She liked Frank, they connected

despite his expressionless face. Behind the wound-up limbs and tremor

a gentle man shone out from the mask.

 

When she visited they would share a cuppa,

chat about this and that. Do the ‘medication shuffle’;

a two-step dance they both knew well.

 

She’d heard about stem cell research.

How they’d taken swabs from patients’ skin. Growing stem cells

from skin cells in dishes, right there in the lab up the road.

 

These stem cells would then become brain cells.

Models of Parkinson’s just like Frank’s. For testing newer and better

medications and perhaps one day even a cure.

 

The last time she saw Frank it was snowing

but he insisted on accompanying her out. Standing by the gate like a sentinel

he’d wave her off that one last time.

 

Later she’d think of stem cells like kisses

blown on the winter air. The moment captured in her rear-view mirror;

A hand lifted slowly, toward a frozen face.

 

Published by EuroStemCell ‘Tales from Within: Imaginative Non-Fiction on Stem Cells,’ 2013. (Frank is a pseudonym)

http://www.eurostemcell.org/he-blew-me-kiss-eliot-north

 

I have found that reading a poem aloud, that I’ve written myself, is an extremely powerful learning tool. There are obvious medical elements I can draw out regarding Parkinson’s Disease and stem cell research, but more than that the poem makes an important statement about connectedness, communication, the complex and varied role of a doctor as well as the limitations of medical science. It speaks to students about the importance of getting to know patients and continuity of care; how embracing the humanity in an encounter can be both powerful and revelatory.

The moment captured in the poem will live with me until the day I die, reading it always chokes me up; I choose to show this emotion to my students. We as clinicians who teach, whether in seminars or on the wards and in clinics, are hugely powerful role models. By stating and showing that this encounter moved me I am by example saying, “It’s OK to show emotion.” This leads to discussions about professionalism, boundaries and clinician wellbeing linked to the evidence base that demonstrates better patient outcomes when doctors show that they are emotionally affected when breaking bad news.

I wrote this poem many years after the event, it was something that sat in my brain waiting to come out. I wish that I’d been able to share it with the man who inspired the poem but he died some years before I got it down on paper. It was a EuroStemCell competition, partnered with the Centre for Regenerative Medicine in Edinburgh that spurred me to write it.

The challenge to submit an ‘imaginative non-fiction’ poem that incorporated stem cell research brought this encounter immediately to mind, the link between stem cells and Parkinson’s a way to explore how I felt about this patient. Discussing the creative process and the fact that I write under a pen name and changed the patient’s name forms a nice link to the importance of anonymity, confidentiality and consent, as well as patient and doctor voice.

With my students I then facilitated a creative guided writing exercise on a memorable clinical encounter followed by small group work, drawing and writing Haiku. The seminar culminated in poster presentations delivered by the students to the group. The results were insightful, empathetic and moving; their use of metaphor and close observation giving authenticity to the explorations they had made of encounters with patients and carers struggling to cope with dementia, a potential diagnosis of cancer and the communication difficulties witnessed for a patient with learning disabilities, linking this to issues of capacity and consent.

As someone who uses creative outlets as a way of coping with the stresses of practicing medicine, it amazes me that the word ‘creative’ can strike fear in to the hearts of medical students and healthcare professionals alike. I believe that by embracing creativity and essentially our inner child, written reflection can be much more than a required component of assessment and appraisal. All humans have the capacity to be creative, no matter how much they protest to the contrary. The skill lies in being able to coax it out of them.

 

Acknowledgements

All of the work I’m currently doing in this area is in collaboration with Sue Spencer with whom I wrote the guided writing framework I used above with my students, influenced by reading the books and on-line resources below. We are delivering a ‘Reflection of Clinical Encounters’ workshop using creative writing methodologies in November 2016 for the Staff Development Programme, School of Medical Education, Newcastle University.

Writing Poems by Peter Sansom, Bloodaxe 1994

The Poetry Toolkit – The Poetry Trust 2010, available as a free PDF download http://www.thepoetrytrust.org/images/uploads/pdfs/Toolkit%20for%20Teachers.pdf

 

Related reading

S E Gull, R O’Flynn, J Y L Hunter. Creative writing workshops for medical education: learning from a pilot study with hospital staff. Med Humanities 2002;28:2 102104

Khaled KarkabiOrit Cohen Castel. Teaching reflective competence in medical education using paintings. Med Humanities 2011;37:1 5859

T J Collett, J C McLachlan. Evaluating a poetry workshop in medical education. Med Humanities 2006;32:1 5964

Poetry Book Review – Cancer Poetry

10 Sep, 16 | by cquigley

 

Ian Twiddy, Cancer Poetry. Palgrave Macmillan, 2015

Reviewed by Sue Spencer

 

Cancer remains one of the most feared of diseases. It evokes dread in the general public and stimulates startling headlines about its insidious and destructive nature. Even as knowledge increases and cancer detection rates improve, this remains the case, despite the fact that cancer is now more treatable and curable than ever. Given this shift in experience of cancer, I had hoped that Cancer Poetry might provide an insight into how poets and poetry have helped humankind navigate this tricky terrain – a big ask I realise, but I do believe that poetry has the potential to achieve this.

I looked forward to reviewing this book. As a nurse, an educator and a writer, I am committed to improving patient experience of health care. I believe that creative approaches can be very powerful in terms of bridging the gap between patients and professionals in the clinical encounter. I am committed to Julia Darling’s project of promoting poetry within this arena. Julia’s introduction to The Poetry Cure, where she shared her own experiences of writing poetry whilst being treated for breast cancer herself, exhorts the benefits of poetry in health and illness:

 “I believe that poetry can help you make you better. Poetry is essential, not a frill or a nicety” (1)

Knowing Julia, I also know that she did not see poetry as an elitist enterprise. She created spaces where wonderful poetry could be responded to in an accessible and enabling way. However, the poetry world does have a problem with being perceived as elitist, with discussions around poetry sometimes viewed as alienating and “other worldly”. Many people I encounter do not often see the relevance of poetry to clinical practice until they actually experience its alchemy and find out for themselves how metaphor, metonym, rhythm, patterns of speech and language itself can shed light on the everyday, particularly in the context of health care practice.

I have to confess to finding Cancer Poetry a difficult read, and found myself skipping significant chunks where it did not engage me. I found the author’s sweeping generalisations and unsubstantiated comments particularly irritating. There are no references to psychological and sociological literature that might illuminate what might be “going on” in a poet’s work.

My first question relates to the inspiration behind this book. Why it was written? Was there an intellectual or emotional impetus to analyse this subject? My personal feeling is that Cancer Poetry reads as an intellectual exploration, in contrast to work such as that of Julia Darling, which, by encouraging us to confront raw emotions and to deal with contested realities, establishes the potential for poetry to help patients and professionals during demanding treatment regimes. Cancer Poetry is a dense book, with an undoubtedly rich content, but I struggled to grasp its potential within the context of improving the experiences of people living with cancer and its treatment.

The opening chapter attempts to chart the terrain, but seems to end up being more of a celebration of Paul Muldoon and his work. There appears to be an ambivalence about whether cancer should be written about and a reluctance to state a position as to whether it is a worthy subject and whether “good” poetry results. There is also a limited review of the foray of other disciplines into this subject – for example, the role of linguistic scholars and the pervasiveness of the war metaphors used to present people’s experiences of living with cancer. I disagree with the author when he states that a similar language is not used in the discourse around other conditions – we hear of ‘wars’ on obesity, people ‘battling’ neurological degeneration etc.

The opening chapter discusses high profile survivors and battlers of cancer, for example Jane Tomlinson and Lance Armstrong, but all of this misses the point that these “celebrity” patients are not typical or representative of most people’s experiences.

The chapters that follow are categorised around specific themes and this is where I found more traction and some engagement in relation to the discussion. However, I would have liked to have known why the author chose the poets that he did. After all, there is a huge body of poetry written about cancer experiences from a range of perspectives and the analysis in this book seems partial and limited. There is also little discussion of the poems in the context of the poets’ other works. It can be very narrow to discuss poems solely on the subject they explore rather than within the landscape of a poet’s other work or within a historical or cultural context. People’s experiences of cancer are often shaped by their health care encounters, cancer treatments and their side effects, relationships with health care professionals, and ongoing uncertainties around choice and prognosis. All of this must inform poetry written on this subject, yet I found myself not being able to grasp the arguments presented in Cancer Poetry.

This book represents all that I find difficult and challenging in the world of medical humanities. For me, Cancer Poetry is not an example of a melding of knowledge and theory. It is a book of literary criticism on poems written about cancer. I may be wrong, but if we want to engage health care practitioners in the merits of the humanities, to enhance their practice we need to focus less on intellectual silos and more on making connections, sharing insights, creating synergy and stimulating new thinking. I wish this book had done that.

 

Reference

  1. The Poetry Cure edited by Julia darling and Cynthia Fuller 2005 BloodAxe Books http://www.bloodaxebooks.com/

Poetry Book Review: The Wound Dresser

7 Sep, 16 | by cquigley

Two poetry book reviews will be featured this week. The second review will appear on Friday.

 

WoundDresser

 

Jack Coulehan, The Wound Dresser (Albuquerque: JB Stillwater, 2016)

Finalist for the 2016 Dorset Poetry Prize, selected by Robert Pinsky (Poet Laureate of the United States from 1997 to 2000).

Reviewed by Barbara Salas

 

The Wound Dresser by Jack Coulehan is a collection of 77 poems that explore the reality of being a physician, reflect on health and illness, and delve into the experience of suffering from different angles. In the following lines I will share how Coulehan’s poetry has made me reflect on diverse aspects of life, disease and on the art of medicine.

The book is the author’s sixth collection of poems, and its title alludes to a composition by Walt Whitman (whose photo appears on the book’s cover): verses that speak about the care of wounded soldiers during the Civil War, and to which Coulehan dedicates his very first piece of the collection. This theme of looking after the sick is central to the author’s poetry.

The order of the poems, though not clearly stated, seems to reveal the passage of time: from the “The Secret of the Care”, which opens the first section exploring the feelings of a junior doctor, to the very last poem of the series, “Retrospective”, which is a reflection on forty years of medical practice. This subtle timeline is structured into four parts, each one orbiting around common themes.

The first section comprises poems that generally reflect on the doctor-patient relationship. A recurrent element of these compositions is the idea of the physician as the one who witnesses the inner secrets of the patient. In “Take Off Your Clothes” we are invited to think about the physical examination: the patient exposed and vulnerable, and the doctor as the one with access to the “narrative in [the patient’s] flesh” (p. 23). Physician and patient are “intimate companions” in a journey through the intricacies of the body, in which we appreciate compassion and loving care from the doctor, but also patent fear from the patient: a topic often conveyed in Coulehan’s poetry (e.g. “The Rule of Thirds”, pp. 26-7).

However, the relationship established between doctor and patient, though close, appears to be at the same time “detached”, perhaps because the access to those secrets does not necessary grant intimacy. In fact, it sometimes seems to signify the opposite, something like a “cold distance”. The four poems “A Lesson in Diagnosis” (pp.5-8) convey to me this tension between “union” and “separation”. The closeness is transmitted through the acknowledgement of the patient’s vulnerability during the clinical exam (“During the discussion/ she keeps trying without success/ to cover her nakedness with a sheet.” p. 7), but the distance is present in the detachment that the doctors demonstrate both in their use of language as well as in their actions (“He drags us to another case —/ this one, a supraclavicular mass./ No one stoops to pick up her glasses.” p. 6). It is clear that while the patient is embedded in pain and anguish, the doctor sees and identifies the problem from afar, without being part of it or experiencing it.

Some poems reflect on the process of learning to practice medicine, and the feelings and thoughts that the clinical encounter trigger in the physician. The need to pretend to be competent (“I palpated/ their abdomens, balloted their livers,/ and listened to respiratory crackles,/ while disguising the depth of my doubt/ with a kindly, but serious look.” p. 3), or the difficulty in interacting with some patients (“I was surprised to find/ how much I disliked some of the patients” p. 3) is present in “The Secret of the Care”, the first poem of the collection. This made me ponder on the physician as the one who has two identities that sometimes stand in tension: on the one hand, the “professional” side that actively cares for the patient; and on the other, his inner world full of thoughts, worries and prejudices that are often hidden in the consultation yet present in his mind.

Finally, the contrast between the patient’s inner life and the painful reality of being ill captured my attention in this section. “The Silk Robe” (pp. 16-7), offers a glimpse of the patient’s life beyond the clinical setting by underlying details like her “blue silk robe”, her “scent” or her “delicate gold chain”. What those details evoke sharply contrast with the reality of her medical condition: the “cultures”, the “catheter”, and the “bed rest” reminds us that she is sick. While reading this poem I thought about the clinical encounter, during which sometimes doctors interact with patients as if their whole being were only their disease. Those doctors sadly forget that the patient is first and foremost an individual; a human being with an inner life that has to be acknowledged and respected. These two dimensions (the person as patient and as individual) are beautifully captured in Coulehan’s literary work.

The second section conveys, through reflections on historical figures or events and mythical accounts, how medicine has changed through time. It also reflects on how human elements like prejudices, fears or beliefs can shape the interaction between doctors and patients, both in the past and today. “To the Heart of Lazar Riverius, Galenist Physician” (p. 40) presents the contrast between the current medical practice (one that operates without “faith” and in a somewhat “mechanical” fashion) and the medicine of the past, which used to embrace the spiritual dimension of the person more openly (“Today the surgeons shut you down,/ open, patch you, put in plastic —/ and not a single Sign of the Cross!”).

In “McGonigle’s Foot” (pp. 42-3) we see how a century and a half ago (1862) prejudices on identity and nationality shaped the medical practice: since the patient is “a foreigner, a drunk, and loud” [emphasis original] there is no need to anesthetize him. (In the notes [pp. 99ff.] we learn that the poem was based on the idea that surgeons back then only gave opiates and alcohol “selectively”). Although we could be tempted to think that this speaks of something that only occurred in the past, the poem reminded me of recent published research in the US, which proves that today black people are less likely to be prescribed opiates for pain management than their white counterparts.1

The third section is a compilation of reflections on the passage of time, on life, and on death. Those moments occur around the world, in places like Alaska, Alexandria, Kosovo, or Cambodia. There are poems on the horrors of war (“War Remnants Museum, Ho Chi Minh City” p. 56), on the passage of time (“Deliver Us From Evil”, pp. 64-5), and on the contrast between life and death: in “Cesium 137” (p. 68) we are presented with a scene in Brazil where the same substance that uncovers the “loveliness” of the children (“their loveliness aglow at last”) also causes their death. That substance is the radioactive isotope cesium 137, deadly toxic.

The tone of this section is sharp, direct and often painful, particularly for me the poem “Christmas in Kosovo” (p. 57), an account of the result of the war in the Balkans. The verses unfold the horror of the conflict with brutal clarity:

“One of the men was found in the courtyard,

decapitated, and so far his head

remains missing. Many had been shot

at close range, after the solider pricked them

with machetes and brass knuckles. Later,

the women were raped, and in some cases

their bones were broken.”

That strongly contrasts with the moment in which the poet is witnessing those horrors (soon after Christmas): a time of hope for the coming of Christ, to which Coulehan alludes through the reference to Isaiah’s “Prince of Peace” (Isa 9:6 “For a child has been born for us, a son given to us; authority rests upon his shoulders; and he is named Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace”). That strain between hopelessness and belief, so present in the poem, made me reflect on the very same tension that is often present when coping with a diagnosis of a life-threatening illness.

Finally, the fourth section comprises family memories and meditations on personal experiences. This change of perspective enables the reader to think about health and illness from different angles, gaining a richer and deeper understanding of topics previously considered in other poems. “Fever of Unknown Origin” (p. 79) speaks about the urge to find explanations to events that are often impossible to account for (“I hold to an old script/ that says calamities have reasons (…) Convenient nonsense,/ but sometimes true.”), and about the need to find a cause to gain control over the disease. With the narrator as the patient, the poem is a reflection on the fear of being seriously ill, and the threat that that constitutes to our somehow perceived “ordered” reality.

The exposure and vulnerability that often patients feel while being examined is a topic extensively covered by Coulehan from the perspective of the doctor, but in “Role Model” (pp. 80-1) this matter is beautifully explored from the view of the patient. The detached and factual discourse of the physician contrasts with the feelings of shame of the patient, who just wants to leave and hide away from the clinician: a need that perhaps we have all felt at some point when being exposed in front of a stranger.

Overall, The Wound Dresser is a fascinating journey that takes us through the complexities of life, illness and death; a journey during which the reader has the opportunity to reflect on the tension between the objectiveness that supports the clinical encounter, the doctor’s inner world, and the patient’s humanity, secrets, fears, needs and contradictions. The presentation of clinical encounters, the use of historical figures or events, the look at scenes around the world, and the account of personal memories that Coulehan brings us facilitate a contemplation of health and illness from interesting and varied perspectives, thus enriching the reader’s world and triggering meaningful meditations on the art of medicine.

 

References

  1. Goodnough A. Finding Good Pain Treatment Is Hard. If You’re Not White, It’s Even Harder. The New York Times [Internet]. 2016 [cited 15 August 2016];. Available from: http://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in-patients-pain-treatment.html?smid=fb-share&_r=0

 

Further Reading

Blackhall, Leslie J., “Cultural Diversity And Palliative Care”, in Chochinov, Harvey Max and William Breitbart (Eds.), Handbook of Psychiatry in Palliative Medicine, 2nd Edition (Oxford: Oxford University Press, 2009), pp. 186-201.

 

 

Poetry Book Review: Thinks Itself a Hawk

22 Jul, 16 | by cquigley

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Review: Thinks Itself A Hawk, Wendy French, The Hippocrates Press, 2016.

by Rebecca Goss

On June 30th this year, I headed to University College London Hospital (UCLH) Macmillan Cancer Centre to listen to Wendy French read from her new poetry collection Thinks Itself A Hawk. As I approached the revolving doors in the middle of the wide glass frontage, a woman was leaving the building via the doors’ slow spin. She was wearing a headscarf, and carrying several plastic bags of what looked like shopping or bundled belongings. She was alone. She looked tired. She looked sad. And she looked ill. I have spent a lot of time in hospitals, but I have never come close to cancer. As the doors ejected us in opposite directions it began to dawn on me where I was going, and what I might see. My naivety overwhelmed me. I thought I was going to a building about cancer, not a building that contained it.

In 2014, Wendy French became UCLH’s first ever poet in residence at the Macmillan Cancer Centre. To quote from the foreword to Thinks Itself a Hawk, French’s resulting book, ‘the residency’s intention was to extend access to poetry and the spoken word and assist with improving patients’ well-being.’ French ran weekly creative writing groups for patients and wrote her own poetry in response to her time spent at the centre.

Throughout the book there are many references to walking and movement and ‘openings’ – the paths our lives take. An early poem in the collection is titled Cancer’s Daily Walk. Cancer itself ‘will walk in the town, in the city,//enter St. Paul’s when doors are open,/will walk……where its feet take it.’ But eventually the cancer enters ‘distracted bodies/whose cells are greedy for change’ and then all routes will lead to those revolving doors. French is there to document the process of arrival as people ‘try to shake off//their fears as they shake/their coats from the rain.’ (The Waiting Game)

Cancer’s impact on daily life and family relationships is all studied here. A poignant stanza in Today’s Appointment shows how family ‘outings’ have been transformed with ‘a wave of a dark wand’. Rather than trips out with picnics the sick now carry ‘bags of medication, nebulisers/in a field of white coats.’

In an environment at times harrowing and bleak, French is able to show us the real people who live with cancer. French sees the blatant effort needed to survive – ‘blood is exchanged like currency’ – yet we can also tell French got extremely close to these people. French respects them, utterly, as do the medical staff, but French is able to give them something not always prescribed. She gives them time. ‘We sit together not talking but dawdling…’ (In the Wood). ‘She tells me that pain is unpredictable/but there’s refuge in books and music.’ (This Girl).

French accepts there is a world inside the centre, and a world outside it. Referring to a tunnelled walkway that connects the Macmillan Centre to the rest of UCLH, French writes ‘down here…time is marked differently…We know we are unique we hold our heads high/and picture the outside.’ (Because)

Illness can cut people off from the ‘real’ world, but French is keen to show that the Macmillan Centre does not just house patients. Behind its doors are patients’ relatives, clinicians, volunteers, ambulance drivers, catering staff, Kingsley the ‘concierge’ – everyone is accounted for, and illness feels less isolating as a result. I remember hearing the broadcaster Andrew Marr in a radio interview about his stroke say that illness is nothing to be ashamed of. French’s poems take the shame away from suffering by scattering light on everyone involved. In Mammogram, a witty but never crass depiction of a medical examination, we focus on a list of apologetic utterings from the clinician: ‘Unfortunately I have to ask you to put your breast here/Unfortunately this may hurt for five seconds/Unfortunately we have to do this five times’. To see the appointment from the medic’s perspective highlights issues of identity in the book. The repetitive use of ‘unfortunately’ hints at the ‘human being’ behind the façade of ‘doctor’.

The latter section of the book concentrates on the story of Zipora, aged 66 when French first met her, and suffering from aggressive ovarian cancer. Zipora died during French’s residency. Before her death, Zipora shared much about her life as a Jewish woman coming from what the book’s blurb describes as ‘the darkest days of the twentieth century’. It is a very moving sequence, interspersed with letters written by Zipora to her mother. These letters were never sent, but shared with French, and French mirrors each letter with a poetic response.

Guy Noble, Arts Curator at UCLH, writes of French’s work “It touches on the challenges faced by people living with or facing a cancer diagnosis, and reflects upon the “everyday” which perhaps many of us overlook.’ I agree with Guy’s statement, but something we also overlook is that severe illness can define a person. We have to remember that there was a whole life before illness set in. Zipora’s story is a valuable addition to the book, as we learn of such a life. Through both French’s voice, and Zipora’s, we discover a family’s lineage fractured by war, a child orphaned by the age of two and raised in a kibbutz, a marriage not always happy – it’s all survival of a different kind. French’s poems reflecting on Zipora’s story are tender, wise and considerate, and we can only be grateful French was there to record it.

Thinks itself A Hawk is a moving, candid, illuminating and necessary collection. We are drawn to look closely at illness and suffering, the poet never once shying from the awfulness of things. But there is gentleness too. Reading the book is like having French push open a door, beckon us, and with her arm around our shoulders, she tells us to look. And all the time we’re looking, French is there, watching with us. She is the poet, the observer, the chronicler and the guide.

 

 

 

 

 

 

Poetry and Medicine: Prize Winners

20 Jun, 16 | by cquigley

 

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In April I attended the 7th International Symposium on Poetry and Medicine where the 2016 Hippocrates Awards were announced. A fascinating day, the programme included critiques on Philip Larkin’s The Building, Celia de Freine Blood Debts, Mary Kennan Herbert’s Skin Man series, as well as a presentation on Poetry, Psychoanalysis and Ageing, and a discussion around the evidence for the benefits of poetry for patients. Poetry readings of course dominated the proceedings, not just from winning and commended poets, but also sessions from Rafael Campo and Wendy French. A day truly rich in poetry, it left much to reflect on in terms of the potential for the genre to impact on the illness experience.

Winners for the three categories within the Hippocrates Awards are featured below. These and many other poems selected by the judges are available in the 2016 anthology.

Poems very gratefully reproduced by permission of the poets and the Hippocrates Prize.

 

2016 Hippocrates Prize for Poetry and Medicine

 

NHS First Prize

Denise Bundred (Kitchiner)

 

A Cardiologist Seeks Certainty

I spread cold gel on a newborn chest

rest the probe on creamy skin, angle

between ribs, rotate to find a heart

no larger than the tiny fist

pushing me away.

 

Two dimensions defy translation into three

as I locate chambers

amid the maze of vessels.

A millimeter of movement and the image melts

to snowstorm on my screen.

I re-trace arcs of ultrasound to relieve

the twist of doubt.

Adrenalin dries saliva as I strive to decide

whether the aorta arches

to the left or right.

 

The nurse checks the prescription

against an ampoule, initials in black ink

secure in her certainty of drug and dose.

 

The surgeon weighs my words

to determine his incision

shape his operation

as the incubator trundles towards theatre

escorting mother and the nurse.

 

I resolve inconsistencies

into diagnosis, wipe the sweat

from my hands, write my notes;

make my decision.

 

 

Open First Prize

Owen Lewis

 

At Tribeca’s Edge

This evening, I walk to the water where the Hudson opens

itself to the sea, and the sea with its rough cross-currents

is in the air and in the light—the light spectacular, clear,

illuminates the buildings of Newark across the water-way

with gold. The shimmering gold at their backs, they gather

to watch the harbor—the skiffs, prow-high, skip like kids

on a great lawn, a run-away pair braid ribbons of bridal white.

What will I tell my colleagues, gathering in a nearby auditorium?

 

I am thinking of my students, this first evening of Autumn,

young doctors eager with learning, still saddened by the sick.

The best are afraid. They’ve heard their voices tired, darkened

and hoarse. A ferry glides by, its wake spilling the embankment,

so close it seems we must hitch a ride, step in—and the light

between the distant buildings prying free, the sails opening with light.

 

 

Young Poets Prize

Catherine Wang

 

Six pills

Spread out in line like a
formal salute, phrased carefully on
the glass dining table.
Prednisolone coated in
white powder
as
bitter as a serrated edge. Mycophenolate
always stuck to my tongue,
a thick bullet. Then,
Esomeprazole and Hydroxychloroquine
coated my
insides
with chalk. I swallowed Calcium,
Vitamin D, just to ensure
that my thinning bones
would not crumble
like wet
paper.
There is nothing greater than the
drama of the human body,
its desires, indulgences.

 

Fevers and rashes. There was so
much that sixth grade
science could not
account for.
Lupus
was not a model disease, not a
display easily shown on brown
and pink plastic organs.
I embraced the
liberties of
ignorance,
deciphering my disease through its nocturnal
whispers. Pushed by the wind’s
warm muscles, I probed
the orange membranes
of streetlamps.
I
traced the moon’s breath, lingering on
the black glass of the sky.
Six pills spread out in line.
Head tilted back, I was grateful
for the silence,
for the empty taste of air.

 

Copyright  © 2016 the individual poets.

More information, including readings and excerpts from winning and commended poets, can be found here.

 

Check out the poetry and prose pages in the current issue of Medical Humanities

 

 

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