Poetry and Medicine XII: Seamus Heaney

The mystique of the medicine man

What do kids make of us doctors? What magic do they ascribe to our tools of the trade? What do they imagine we can see when we peer into their ears, with our special torches that they are not permitted to play with, or that we can hear with those tubes we hold in our own ears as we move the cold piece over their chests?

When I was a young GP, a local primary school teacher invited me to visit her class and bring my house-call bag, full of props for a show and tell. The kids loved the reflex hammer.

Seamus Heaney was an Irishman, and a 20th Century poet laureate and Nobel prize winner in literature. Here are some sections lifted from his long poem, Out of the Bag.

All of us came in Doctor Kerlin’s bag.

He’d arrive with it, disappear to the room

And by the time he’d reappear to wash

Those nosy, rosy, big soft hands of his

In the scullery basin, its lined insides

(The colour of a spaniel’s inside lug)

Were empty for all to see, the trap-sprung mouth

Unsnibbed and gaping wide. Then like a hypnotist

Unwinding us, he’d wind the instruments

Back into their lining…

… and leave

With the bag in his hand…

Until the next time came and in he’d come…

And go stooping up to the room again, a whiff

Of disinfectant, a Dutch interior gleam

Of waistcoat satin and highlights on the forceps.

…

The room I came from and the rest of us all came from

Stays pure reality where I stand alone,

Standing the passage of time, and she’s asleep

…

Me at the bedside…

…appearing to her as she closes

And opens her eyes, then lapses back

Into a faraway smile whose precinct of vision

I would enter every time, to assist and be asked

In that hoarsened whisper of triumph,

‘And what do you think

Of the new wee baby the doctor brought for us all

When I was asleep?’

Perhaps nothing is as magical as childbirth, and no aspect of life obfuscated over centuries with so much bullshit. As though children don’t deserve simple but truthful answers to natural questions. Today, it is common practice for a young child to remain in the room to watch the birth of a baby sibling, and I welcome this. Cries of pain and joy, blood and placenta – this is life, to be witnessed and talked about. Or is an instrumental delivery in the home, presumably assisted by ether or chloroform in this case, a gruesome step too far?

Of course, misconceptions can be entertaining, as in this poem, Out of the Bag. Death is the other great life event where myths and bizarre miscommunication abound, but that’s for another poem.

Poetry and Medicine XI: Julia Darling

Illness as transformative experience

Apparently, 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, the narrator sharing how important the taste of tea and the texture of a shawl have become, ushering in the final couplet with its perhaps 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.

The poem leads

The door swung hard shut

and with the day a blank sheet

I let my feet take me just

where, which was up at first

to climb above the cold shade

finding snaking Salamanca

infused with fumes of buses

and bustles of students

so I left the road and strode

across campus, feigning familiarity

with this strange university

then through to Kelburn

and the Upland Road.

Striding easy, I had planned

to return via Aro Valley

but instead surrendered

to the pull of the bush gully

down my right, quiet but

for an unseen stream

and the sweet creaks and gongs

of an unhinged tūī.

Following damp gravel tracks

around the contours of deep shade

I lost the arc in my mind

and suddenly stumbling into light

was perplexed to find

where the wilful poem had led.