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Although the blue sky lured me out

riding around Lyall Bay

I found the long black road shaded

from a low-slung northern sun,

grateful that a passing ute

broke the law on my behalf

to swerve over the double-yellow

lines and give me width.

Out in the flat of Cook Strait

the inter-island ferry snails past

a confident little red tug boat

hauling a stricken ship back

into harbour, past jagged black rocks

in shore, snow topping the backdrop range.

Kia tūpato is twice signed at Moa Point

where little blue penguins may cross,

just as my Nana Mae

would warn to take care,

her serene smooth face

forever denying the shame

of death by drowning,

a young troubled husband

lost overboard crossing

this beguiling strait

on his way to Hanmer Springs.

Farewell to an old patient

The police phoned me at home one weekend. Could I complete a medical certificate of cause of death? My patient, Ian, had been found by a neighbour, dead on his lawn beside a motor-mower that was still running.

I could make a pretty good guess as to the most likely medical event. Although Ian was only 60, his risk factors for coronary heart disease lined up against him like witnesses for the prosecution. We had discussed the chances of a life cut short on several occasions.

Yet a jolt of sadness and loss went through me when the officer named the person who had died. Ian was a jovial and entertaining character, and we had known each other for many years. My efforts to prise him away from a self-destructive lifestyle, came from a genuine concern for this likeable patient.

Ian was for cremation. He had lived with his parents until they each died, and then alone in the family home. He never mentioned having a special or an intimate relationship. His social life revolved around hanging out with his male friends on the golf course and at the club.

Farewell to an old patient

Oh, Ian, so suddenly you’re gone.

These cold purple lips

delivered denial

through our twenty-five years together

kissed the smokes

sank deep the 19th hole with your mates

cheerily asked for the bad news

at every visit, while I kept saying

what doctors are expected to say

repeated quarterly

along with ritual weigh-ins

lab tests and prescriptions

and all that diabetic crap.

Bald, bearded, round

this face under the sheet.

Your iron defence, always jovial

eventually rusted

to an anxious edge

as you borrowed time nearing sixty.

Sure, Ian, you accepted late

the need for needles

and made your peace with pills

but the habits of a single bloke

life-blood and death-trap

were never really on

the negotiating table

were they?

As I drove to the premises of the funeral director to view the body, there was time to reflect on whether I had served him well as his GP. My efforts were based on repeated gentle nudges on the wheel of behaviour change. Gentle nudges, politely blocked. As with many of our patients, Ian found accepting the need for daily medication, even when that escalated to include insulin injections, easier than giving up the cherished habits central to his social life. What he lived for, eventually killed him.

… the habits of a single bloke

life-blood and death-trap…

So, I asked myself, how much does an abrupt death at age 60 in a man with no family, no dependents, represent failure? Are we overly concerned with how long one lives, rather than how well life is lived?

Suppose I had persuaded Ian that his only hope lay in removing himself from his circle of friends and the habits they shared, and he had complied, living perhaps to the age of 65 but in social isolation. Is that what medical success looks like?

In an earlier column, I introduced William Carlos Williams, often considered the most influential 20th century American poet. Williams was also a GP. His great skill was in observing detail and describing a simple scene in plain language with impact.

The Poor

By constantly tormenting them

with reminders of the lice in

their children’s hair, the

School Physician first

brought their hatred down on him.

But by this familiarity

they grew used to him, and so,

at last,

took him for their friend and adviser.

Williams hooks our attention and curiosity in the first line of this brief poem, with the words, tormenting them, which suggests tension and conflict to follow. Conflict is a powerful bait in any work of creative writing, whether poem or novel, play or film. We wonder how the players will react and whether the tension will be resolved.

Yet we find this is only a doctor tormenting the poor parents of children with persistent head lice. Does he mean to torment them, or is that the unintended consequence of repeated reminders? Who says they are feeling tormented – from whose point of view is this being told?

Knowing that the poet here is a doctor may lead us to assume it is being told from the point of view of the School Physician, but I interpret this poem as speaking from the parents’ perspective. The doctor is likely to have repeated his message about addressing the head lice, much as we find ourselves repeating our advice about making healthy food choices and the benefits of regular exercise, and these parents, like our patients, feel tormented by the repetition. Some of that sense of torment may arise from feelings of guilt or failure in not having adequately dealt with the problem the first time.

The next strike comes in the fifth line, brought their hatred down on him. Poetry often uses imagery such as metaphor to give it colour and force, but in this little poem there is no imagery, just a couple of words carefully selected for their impact. There may have been resentment from these parents, whom Williams calls The Poor in the title, toward the relative affluence of the doctor who is hassling them to take better care of their kids. From today’s perspective, I find the title of this poem rather patronising and judgemental. Perhaps that attitude tainted communication from this doctor.

Over time, however, this School Physician becomes seen as their friend and adviser, through familiarity and the development of trust. Rapport can be built on common ground, the mutual concern for the wellbeing of the children. We all know that telling the truth is not always appreciated initially, but we can think of patients who have come around after initially prickly interactions.

Finally, note the very loose structure of this poem, written a century ago when rhyme and regular metre were the norm. Rhyme and rhythm can make a poem, like the lyrics of many songs, easier to recall and recite, but they can also constrain the choice of words to those that fit the pattern being followed.

By employing a free-flowing structure, Williams is able to create a sharp little line, at last, with commas before and after, to slow the reading and produce a sense of trust emerging over time. If the reader is scanning the poem on the page with the eyes only, this device is easily missed, which is one reason why poetry is best read aloud.

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