When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don't make it into textbooks. It's important because it teaches creative thinking -- something of immense value to doctors.
|Danielle Ofri (photo by Joon Park)
It's important because interpreting metaphors is a critical clinical skill in diagnosis; patients' symptoms often present in metaphorical manners and we doctors need to know how to interpret our patients' metaphors. Last but not least, there is a therapeutic value to introducing beauty into a situation that is not commonly associated with aesthetics.
I've been giving poetry to my medical team for a few years now, but each time I always hesitate before handing out the poem. I hesitate because I'm never sure if this is wanted, or even tolerated. My students and residents never voice opposition, of course, but that's probably because they are decent and polite people (though I wouldn't discount that it's because they know that I am grading them at the end of the month).
A poem is universally met with dead silence. That silence is the worst part of it -- the dreaded muck of passive-aggression, boredom, resentment, and rumbling stomachs. The silence might also encompass awe, satisfaction and epiphany, but I'll never know. It all sounds the same.
I've always wanted to give poetry to my patients. Unfortunately, English is not the first language for most of the patients in my hospital, so this has been challenging.
But there is one set of patients that seems to consistently speak English -- the alcoholics. The Bowery-type alcoholics aren't necessarily the favorite patients of the interns. These patients are frequent fliers, they are clinically "uninteresting," they are often malodorous, and their illness is perceived as self-inflicted. But they do speak English.
So one morning on rounds, our team went to examine a new alcohol-withdrawal admission. His condition was standard: alcohol-on-breath, speech slurred, fingers trembling, hair and beard disheveled, body odor a mix of unwashed socks and cheap beer. He was cranky, and impatient with the detailed questions we asked.
As the team was finishing up, I whipped out some papers from my pocket -- Jack Coulehan's poem "I'm Gonna Slap Those Doctors." I gave a copy to the patient and distributed the rest to the resident, interns, and medical students. Asking their forbearance for this slight divergence from medical protocol, I plowed onward and read the poem aloud.
I'm Gonna Slap Those Doctors
Because the rosy condition
makes my nose bumpy and big,
and I give them the crap they deserve,
they write me off as a boozer
and snow me with drugs. Like I'm gonna
go wild and green bugs are gonna
crawl on me and I'm gonna tear out
their goddamn precious IV.
I haven't had a drink in a year
but those slick bastards cross their arms
and talk about sodium. They come
with their noses crunched up like my room
is purgatory and they're the
goddamn angels doing a bit
of social work. Listen, I might not
have much of a body left,
but I've got good arms -- the polio
left me that -- and the skin on my hands
is about an inch thick. And when I used
to drink I could hit with the best
in Braddock. Listen, one more shot
of the crap that makes my tongue stop
and they'll have something on their hands
they didn't know existed. They'll have time
on their hands. They'll be spinning around
drunk as skunks, heads screwed on backwards,
and then Doctor Big Nose is gonna smell
their breaths, wrinkle his forehead, and spin
down the hall in his wheelchair
on the way to the goddamn heavenly choir.
(from Medicine Stone, Fithian Press 2002. © Jack Coulehan, reprinted with permission)
As I read the poem, I could feel the atmosphere in the room changing, ever so slightly. The focus shifted from the patient to the poem, and everyone was an equal neophyte with this particular poem.
When I finished reading, some of the medical team looked uncomfortable, but the patient was smiling broadly. "This is great," he said. "I love it!" With his pronouncements, everyone relaxed a bit.
"You know," the patient continued, seemingly happy to have an audience, " I used to read some books, back in the day." He sat up in bed, more animated now. "I like history stuff -- ancient Greeks, ancient Romans. Real characters, those guys."
We ended up having a conversation about his childhood in small-town New Jersey, how he cut classes in high school to putter around on the beach.
We left the room feeling awkward but also somehow lighter. Suddenly our patient wasn't just another alcoholic drying out on the ward. He was a real person, someone who stood out in our minds.
The poem certainly didn't change the course of his devastating disease of alcoholism. It didn't offer him the epiphany to suddenly quit drinking or to reconnect with his estranged family. His liver enzymes didn't miraculously normalize. His platelets didn't bound back to health. But it gave all of us a sense of human connection.
Throughout his four-day stay in the hospital, the patient was much more pleasant to the team. I noticed that the students and interns wandered in more frequently to say hello. We all felt just a bit more connected.
Whenever I experience hesitation about handing out poetry, I try to recall this episode. Poetry is always a risky endeavor, in any setting. A hospital shouldn't be any better or worse than a literary salon. You saddle up your metaphors, grab your couplets, and take your chances. And hopefully you'll recover.
To learn more about Danielle Ofri's work: