on “Medical Poetry”: Primary Care, an anthology of poems by physicians (Univ of Iowa Press)

Yesterday at a business meeting, I met a board member of the Joslin Diabetes Center in Boston. “Doctors aren’t having fun anymore,” he said. “They’re saying the profession is becoming as standardized and routine as practicing law. The insurance companies want the MD to spend just fifteen minutes with a patient. That’s all he or she gets compensated for. So if the MD decides to spend more time, he’s got to cheat somewhere else to make up for it. We’re trying to run the Joslin so a doctor can spend on average forty-five minutes with a patient. But it isn’t easy.”

Last week, I attended the annual dinner for the Kenneth Schwartz Center of Massachusetts General Hospital. The center’s mission is to “educate, train and support caregivers in the art of compassionate health care.” They sponsor tutorials in hospitals, convincing physicians that the ability to empathize with patients is an asset (!). I spotted the urologist who treated my father-in-law for prostate cancer in the late 1990s. This was the doctor who bluntly told my wife with no preamble, “Your father will be dead in six months.” Her father lived five more years, and as he neared death, we called this doctor to request additional pain medication. “Why are you calling me?” was the doctor’s response.

This literary website isn’t the place to dissect America’s healthcare system, though it’s simply a fact that the United States has the least universal and most costly healthcare system in the industrialized world. Over 40 million people here don’t have insurance. In 2002, Medicare covered only 43% of the healthcare costs of the elderly. While all of this occurs, doctors are disgruntled due to the administrative burdens and compromises in care – and because they’re not making as much money as they thought they would.

primary.jpgMeantime, Yale University researchers have found that medical residents who completed a creative writing workshop “felt the experience helped them better view the patients as people, and not just medical cases.” It was reported in the Journal of General Internal Medicine that “focusing on the craft of writing provides a means of increasing one’s powers of observation and improving one’s understanding of both self and others.” The editors of Primary Care, More Poems by Physicians would most likely endorse this finding, since they have been tracking the “poetry movement in medicine.” They say, “Many physicians attempt to build into their lives opportunities for reflection and self-awareness. It is in this context that medical poetry has blossomed.”

But writing poetry isn’t primarily an opportunity for self-awareness. It’s an opportunity to make an effective poem for someone else’s awareness. (Yet we also insist that the poet discovers as he/she writes. What is discovered? Mainly the shape and sound of a world.) The editors of this anthology want it both ways – writing as prescriptive therapeutic and as polished, liberated art. “If asked why they write, the poets represented in this anthology would likely give reasons similar to those of other writers,” they say. “To them it feels natural to make poems … This would have been the case had they become attorneys, business executives, or forest rangers.”

Some very selfish people become very good poets. Some very inhumane doctors make very accurate diagnoses. When inhumane doctors treat patients with sensitivity, the sick heal more rapidly and the dying die more calmly. (Our ex-urologist is still said to be a great practitioner with no “people skills.” Astute, he shows up for the dinner anyway.) But if there were a Schwartz Center dedicated to inculcating kinder habits in selfish poets, the quality of their writing would degrade and some would stop writing altogether.

The satisfaction in writing is the discovery that you can make something artful out of the materials of the life you actually lead. This anthology can’t make up its mind if it wants to valorize the materials or the artful outcome. Fortunately, there is so much solid work in this book that the editors have more than enough evidence to make both cases.

This is Peter Pereira’s “Labyrinthitis”:

Five months ago, the telephone
rang: a voice saying his father
was dead – a ruptured aneurysm
early Sunday morning
while he was in the garden
clipping roses.

Now there’s a ringing
in his ears, the room spinning
when he turns, and he’s beginning
to wonder if he’s not becoming
his old man.

He fidgets on the exam table,
kneading palms, as I narrate
the inner ear’s anatomy, how rhinovirus
upsets our bearings.

We went boating the week before,
the man says, and he was fine.

I silence myself to listen
to whatever he has to say, and imagine
how for five months the words father dead
must have looped inside him.

How they entered his ears like a pair of ravens
and flapped against his tympanums, began
a rippling inside each fluid spiral
and funneled deeper, deeper. No longer as words,
but as shadows of words, a hush
left for him to unravel.

Some of us believe that when a shock enters the body, it jolts up the spine, ripples throughout the nervous system. Sorrow enters the body; it’s a physical thing. Much of the poetry here, including Pereira’s moving poem, manages to do something both artful and humane, namely to voice empathy without reflecting credit on itself. Sorrow enters these poems; the poets observe and absorb the greater sorrow of the world. It must be the overwhelming presence of this sorrow that turns some doctors into unreceptive horrors. The healthcare system itself is an engine of sorrow. Enlightened MDs today perceive they are not only treating patients, but also the patients' caregivers and family.

What doctor-poets have that teacher-poets don’t is a job in which communication has an instant effect on the well-being of others. Thus, their poetry, as evidenced by this selection, is quite straightforward, demotic, based in story. These doctor-poets seem to make the transit from job to art with a fluidity that suggests they see little difference between the two. There is an absence of subterfuge, a great deal of faith in language itself, and the mature force of intentionality.

This is Serena Fox’s “Another Drive-By”:

Drive-by-birth. This mother snares a cab,
Shoots up, delivers, leaves her baggage
Backseat to the world. Boy born. Tab
Unpaid. The driver hasn’t disengaged
The gears. Paramedics cut the cord.
The taxi twitches, swears, then disappears.
Sirens swaddle them and us in sordid
City night. Small body in arrears
For drugs. Drugs lace a smile across a face
Devoid of motherhood, numb to need.
She nearly rolls onto him, take his place.
We take her in to detox, warm, to feed
A son. Withdrawal fuels a newborn thirst.
Milky, dawn suckles day by dying first.

[Primary Care: More Poems by Physicians, edited by Angela Belli and Jack Coulehan, University of Iowa Press, 2006, 152 pages, $19.95 paper]