Poetry and Medicine V: Rachel McAlpine

New Zealand writer and poet, Rachel McAlpine, recently celebrated her 80th birthday by publishing a book of poems, How to be Old.

Here’s one of my favourites from this collection, reproduced with Rachel’s blessing.

Getting old is not like getting pregnant

Preparing for old age is scary

scarier than getting pregnant

twenty thousand miles from home.

Now my body has to face

the prospect of extreme old age.

What scares me most is the unknown

and so I study hard. But hey

old age is not like pregnancy.

I’m carrying a void

and when I say I’m getting old,

nobody says to me, How lovely!

Congratulations!

Is this your first old age?

When is it due?

Oh no, they tell me,

you’re not old.

You’ll never be old.

It’s all in the mind.

Age is just a number.

Try homeopathy.

Note the sweet-sour flavours here! I love the way the poet has poignantly blended the scariness of ageing with humour.

What scares her most is the unknown. But she is also a keen observer of other people’s responses and comments, including the tendency of others to minimise the reality of her experience, in an attempt to be reassuring. ‘Oh no, they tell me, you’re not old, you’ll never be old…age is just a number.’ Rachel McAlpine is an astute listener, capturing commonly heard expressions, yet she does not feel well heard herself, when she dares to tell people she is getting old, and how scary that can be.

Poems vary tremendously in style and technique. Some make powerful use of metaphor, some produce a musicality from rhythm and repetition of sounds, but this very accessible poem takes strength from using everyday language to bring together two contrasting aspects of the human life cycle – pregnancy and ageing. This is reminiscent of James Baxter’s lines, discussed in a previous article: “Alone we are born/ And die alone.”

I read the last line of this poem, “Try homeopathy”, as an indirect way of stating that there is no cure for growing old, representative of a range of responses from others which are well meaning but futile.

That is where it ends, on an amusing note. It is one of the techniques of poetry to address a heavy theme with sufficient levity to keep the reader engaged, and in this case to leave them pondering their own mortality while demonstrating that it can still be approached with a sense of fun.

This essay was originally published in NZ Doctor, 2022.

Poetry and Medicine III: James K. Baxter

High Country Weather

Alone we are born

And die alone;

Yet see the red-gold cirrus

Over snow mountain shine.

Upon the upland road

Ride easy, stranger:

Surrender to the sky

Your heart of anger.

This is one of my favourite poems by New Zealand poet, James K. Baxter. It is short and compact, selecting a few powerful images for the reader to reflect on, and in doing so it conveys both beauty and truth about the human condition.

At one level, we may want to challenge the statement that alone we are born, and die alone, citing our own examples of these pivotal moments in life being wrapped in a loving family. Yet as a poet, Baxter is stripping away some of the trappings surrounding birth and death in order to highlight in a few words that there is an essential alone-ness in the arrival and departure which book-ends our lives.

Suddenly, the poem switches from this introspective mood to draw us out into a mindful awareness of the beauty in the world around. Instead of talking in prosaic generalisations about mindfulness being an awareness of the present moment as we experience it through our senses in an attitude of non-judgemental acceptance, Baxter presents us with one breath-taking example. We leap from morbid thoughts to a magnificent reminder of how wonderful the natural world can be if we open our eyes to it.

In the second stanza, the poet or the narrator of this poem addresses the reader as a stranger riding an upland road. Describing the road as upland, with mention of a mountain in the previous line, suggests effort is required, yet this stranger is encouraged to ride easy. With another dramatic leap, Baxter urges the reader/rider to surrender to the sky their heart of anger.

Reading this as doctors, we may want a more detailed history, more explanation of the background and context. But ambiguity in poetry creates space for the reader to respond to the written lines in whatever way they resonate. We may acknowledge that anger is a burden we carry that makes the journey harder, or we may identify more closely with other related concepts such as resentment or frustration or finding it difficult to reach forgiveness. Similarly, within the consultation, allowing space for the patient to respond to what has been said creates the opportunity for the patient to relate the generality of the conversation to their particular need and circumstances.

Letting go, no longer fighting, is portrayed in the poem as surrender to the sky, but here the sky may be a metaphor for the natural world, or for a God or other symbol of the faith and values held dear to the reader. Once again, metaphor permits a range of responses in the reader, which encourages a personalised interpretation.

This essay was originally published in NZ Doctor, 2022.

Poetry and Medicine II: William Carlos Williams

William Carlos Williams is considered one of the greatest American poets of the 20th Century. He was also a general medical practitioner. This is how one of his poems begins.

Complaint

They call me and I go.

It is a frozen road

past midnight, a dust

of snow caught

in the rigid wheeltracks.

The door opens.

I smile, enter and

shake off the cold.

Here is a great woman

on her side in the bed.

She is sick,

perhaps vomiting,

perhaps laboring

to give birth to

a tenth child. Joy! Joy!

Each reader will have different responses to a poem, and our interest might be drawn to different details. Before you read my comments, I would ask you to read this poem opening again, slowly, out loud.

The poem is written in free form, without regular line length or rhyming patterns. It is a narrative poem, telling a story in a conversational tone. It is told from the point of view of the doctor, someone who is familiar with the unfolding of a patient’s history. Written almost a century ago, the poem doesn’t fit into the tight structural conventions of the time, but Williams had a huge influence on the shape of modern poetry.

The title he chose puzzles me. My initial response was to anticipate a patient making a complaint. I have had to deal with several patient complaints recently, in my role as a Complaints Officer. We tend to see in a poem, as in life, what we already know.

Decades ago, I was involved in providing GP obstetric care, including a total of eighty home-births. Being called out in the middle of a miserable night to participate in a wondrous event is familiar, but what strikes me here is that Williams has pared the drama down to two actors, his focus being only on the distressed woman and himself. Where were the husband, the other children? Was there a midwife? But a poet has the freedom to pay selective attention to the truth. This is not a documentary, it is creative art, however deeply it may be rooted in real experience. Like parables and mythology, poetry need not be ‘realistic’ to be a potent vehicle for truth.

But perhaps this woman is not in labour. She is sick, we are told, but the next two lines begin with the word ‘perhaps’, bringing a surprising degree of uncertainty into the poem. That may have been his first consideration as Dr Williams entered the room, but for this poem he was not concerned with sharing his diagnostic thinking to resolve uncertainty, instead he abruptly concludes with the following lines –

I pick the hair from her eyes

and watch her misery

with compassion.

Compassion is an abstract term which we are very familiar with in medicine, but for me the most powerful and moving line in this poem is, ‘I pick the hair from her eyes’. The description of that simple gesture conveys in so few words far more than a general lecture on showing compassion.

Williams’ great strength as a poet was his observation of the particular details on which the grand principles of life and medicine hinge. And this is also one of the defining features of general practice – to appreciate and attend to the singularities, the specifics which are of greatest concern for each patient we are with.

This essay was originally published in NZ Doctor, 2022.