Poetry and Medicine XIII: Poet 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.

But 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 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.