Poetry and Medicine XIV: Rachel McAlpine

As if it was simple!

New Zealand poet, Rachel McAlpine, recalls her childhood to capture a scene of fresh innocence, of joy and simplicity within the security of a loving family, with her vicar father carefully and earnestly drying his six young daughters after their bath.

After the Fall

After the bath with ragged towels

my Dad

would dry us very carefully;

six little wriggly girls,

each with foamy pigtails,

two rainy legs,

the invisible back we couldn’t reach,

a small wet heart and toes, ten each.

He dried us all

the way he gave the parish

Morning Prayer:

as if it was important,

as if God was fair,

as if it was really simple

if you would just be still

and bare.

Rachel McAlpine

The poem is in free form with irregular line length, but there is rhyme here to be discovered in unpredictable patterns. ‘Towels’, ‘girls’ and ‘pigtails’, followed by ‘reach’ rhyming with ‘each’ in the first stanza; ‘prayer’, ‘fair’ and ‘bare,’ and ‘simple’ paired with ‘still’ in the second stanza. But note that these lines that rhyme with each other are not consistently positioned within the poem, but they seem to wriggle around and end up in different places, like the girls. A more tightly structured and predictable format would be less well suited to the theme of this poem.

The picture the poem creates in our minds is delightfully cute, with wriggly girls and their foamy pigtails, but there is more depth to this poem than just cuteness.

The poem’s title refers to the creation story of Eve and Adam, where those first people were innocently unaware of their nakedness until disobedience and sin were said to enter the world, sometimes referred to as ‘the fall’ in Christian tradition.

When I read this poem I see us GPs in the girls’ father, as he tries to do his job very carefully, as if it is important and as if the world is fair.

The towels he is using are ragged, like many of the tools we use and the systems we work within.

He attends to the invisible backs, the areas of need our patients may not be aware of or able to reach themselves.

‘As if God was fair;’ speaks to me of the inequities in society, the unfairness of disparities in health outcomes.

‘If you would just be still…’ – surely it would be easier if the patient was more cooperative!

‘…and bare.’ Being bare suggests being open and transparent. It would make our jobs easier if every patient gave a straightforward history, telling it as it is, disclosing the abuse when asked, admitting when they’ve stopped using insulin.

Yes, our jobs could be so much simpler, yet I bet this vicar loved the task of drying his wriggly girls, as we still love caring for those patients who make our day more challenging.

Poetry and Medicine XIII : Unknown

Metaphors for Resilience

I learnt this short poem at school, and although I can still recite it from memory, I have no idea of its title or who wrote it. If anyone can tell me more about it, I would be delighted to know, as the poem has occupied a nook in my mind all my life, contributing to my early appreciation of poetry and my concept of resilience.

I see it as a statement of defiance in the face of forces which wear down, demoralise and destroy.

O do not let the restless sea

The rub and scrub of the wave,

Scour me out and cover me

With sand in a shallow grave.

But may my image like a rock

Scornful of the tide’s attack,

Shift no inch at the green shock

And glisten as the wave springs back.

The even line length, regular rhythm and predictable rhyme pattern make this type of poem, like the lyrics of a song, easier to remember.

Read it aloud, and note the even flow of alternating stressed and unstressed syllables. Yet in the second-to-last line this rhythm is suddenly disrupted, as though something has struck. Reading aloud also helps the reader to appreciate the repetition of sounds – the hissing of ‘s’s at the end of the first line suggesting the sound of waves, the rhyming within a line of ‘rub’ and ‘scrub,’ the repeated ‘m’s in the fifth line and the ‘sh’ sounds in the seventh line.

The words ‘let’ and ‘may’ in the first lines of each stanza are very similar in meaning, but using ‘let’ sounds better alongside ‘restless,’ whereas ‘may’ in the second stanza is phonetically more compatible with ‘my image’ which follows. When a poet selects words which sound as though they belong together, the result is more musical and aesthetically pleasing, like colours that blend well together in a painting.

The main strength in this poem lies in the metaphors. The scouring effect of a restless sea can be seen as a metaphor for anything that steadily grinds us down, such as the constant burden of endless patient need, and working in a health system badly in need of reform. When we talk of burnout in our workforce, we are using a different metaphor, or figure of speech, for the same thing. Becoming slowly buried in sand, and the image of a shallow grave, convey a sense of being terminally overwhelmed.

But the second stanza is far more positive. The narrator is drawn to the image or metaphor of a rock, standing unmoved as the force of each wave’s assault is absorbed, confidently glistening as it springs back.

Poetry and Medicine XI : Julia Darling

Illness as transformative experience

We rate states of poor health or disability differently, depending on whether we’re in that state or imagining what it might be like. According to a Perspectives article on illness as transformative experience in The Lancet, people with serious health conditions consistently rate their wellbeing higher than healthy controls who were asked to imagine what living in a particular health state would be like.

So, sighted people think that living with blindness would be worse than blind people think it is. Going through chemotherapy is usually unpleasant, often ghastly, but those in good health assume it would be even worse than people who experience it for themselves tend to rate it.

Julia Darling was an English novelist and poet. She wrote this poem from her own experience.

Chemotherapy

I did not imagine being bald

at forty-four. I didn’t have a plan.

Perhaps a scar or two from growing old,

hot flushes. I’d sit fluttering a fan.

But I am bald, and hardly ever walk

by day, I’m the invalid of these rooms,

stirring soups, awake in the half dark,

not answering the phone when it rings.

I never thought that life could get this small,

that I could care so much about a cup,

the taste of tea, the texture of a shawl,

and whether or not I should get up.

I’m not unhappy, I have learnt to drift

and sip. The smallest things are gifts.

This is a very personal poem, in which Julia Darling shares with her readers an album of pictures that convey insight into what her daily life has become. Losing her hair, hot flushes, hardly ever walking by day, lying awake in the half dark – good poetry frequently relies on concrete images like these to do the work. Abstract expressions, such as unpleasant and ghastly, as I used in my opening sentences, become generic and miss the impact of individual experience.

Poetry aligns well with patient-centred medicine, exploring the way a particular patient experiences illness rather than the broad umbrella of a diagnostic label.

There is a pivot midway through this poem, where the narrator begins to share how important the taste of tea and the texture of a shawl have become, ushering in the final couplet with its surprising declaration that she is not unhappy. These small things are now appreciated as gifts.

Showing interest and taking the time to listen to how a patient is really experiencing their illness journey, may uncover a more nuanced weave of negative and positive than we often assume.

Reference: Carel, Kidd and Pettigrew. The Lancet, vol 388, 17 September 2016.