Poems for June 2012

Raymond Carver
(1938-1988)

What the Doctor Said

He said it doesn’t look good
he said it looks bad in fact real bad
he said I counted thirty-two of them on one lung before
I quit counting them
I said I’m glad I wouldn’t want to know
about any more being there than that
he said are you a religious man do you kneel down
in forest groves and let yourself ask for help
when you come to a waterfall
mist blowing against your face and arms
do you stop and ask for understanding at those moments
I said not yet but I intend to start today
he said I’m real sorry he said
I wish I had some other kind of news to give you
I said Amen and he said something else
I didn’t catch and not knowing what else to do
and not wanting him to have to repeat it
and me to have to fully digest it
I just looked at him
for a minute and he looked back it was then
I jumped up and shook hands with this man who’d just given me
something no one else on earth had ever given me
I may have even thanked him habit being so strong

“What the Doctor Said” by Raymond Carver from A New Path to the Waterfall. © Atlantic Monthly Press, 1989.

–

Dana Gioia
(1950 – )

Finding a Box of Family Letters

The dead say little in their letters
they haven’t said before.
We find no secrets, and yet
how different every sentence sounds
heard across the years.

My father breaks my heart
simply by being so young and handsome.
He’s half my age, with jet-black hair.
Look at him in his navy uniform
grinning beside his dive-bomber.

Come back, Dad! I want to shout.
He says he misses all of us
(though I haven’t yet been born).
He writes from places I never knew he saw,
and everyone he mentions now is dead.

There is a large, long photograph
curled like a diploma—a banquet sixty years ago.
My parents sit uncomfortably
among tables of dark-suited strangers.
The mildewed paper reeks of regret.

I wonder what song the band was playing,
just out of frame, as the photographer
arranged your smiles. A waltz? A foxtrot?
Get out there on the floor and dance!
You don’t have forever.

What does it cost to send a postcard
to the underworld? I’ll buy
a penny stamp from World War II
and mail it downtown at the old post office
just as the courthouse clock strikes twelve.

Surely the ghost of some postal worker
still makes his nightly rounds, his routine
too tedious for him to notice when it ended.
He works so slowly he moves back in time
carrying our dead letters to their lost addresses.

It’s silly to get sentimental.
The dead have moved on. So should we.
But isn’t it equally simpleminded to miss
the special expertise of the departed
in clarifying our long-term plans?

They never let us forget that the line
between them and us is only temporary.
Get out there and dance! the letters shout
adding, Love always. Can’t wait to get home!
And soon we will be. See you there.

“Finding a Box of Family Letters” by Dana Gioia, from Pity the Beautiful. © Graywolf Press, 2012. Reprinted with permission. (buy now)

Poems for January 2011

Kim Addonizio
(1954 – )

New Year’s Day

The rain this morning falls
on the last of the snow

and will wash it away. I can smell
the grass again, and the torn leaves

being eased down into the mud.
The few loves I’ve been allowed

to keep are still sleeping
on the West Coast. Here in Virginia

I walk across the fields with only
a few young cows for company.

Big-boned and shy,
they are like girls I remember

from junior high, who never
spoke, who kept their heads

lowered and their arms crossed against
their new breasts. Those girls

are nearly forty now. Like me,
they must sometimes stand

at a window late at night, looking out
on a silent backyard, at one

rusting lawn chair and the sheer walls
of other people’s houses.

They must lie down some afternoons
and cry hard for whoever used

to make them happiest,
and wonder how their lives

have carried them
this far without ever once

explaining anything. I don’t know
why I’m walking out here

with my coat darkening
and my boots sinking in, coming up

with a mild sucking sound
I like to hear. I don’t care

where those girls are now.
Whatever they’ve made of it

they can have. Today I want
to resolve nothing.

I only want to walk
a little longer in the cold

blessing of the rain,
and lift my face to it.

–

Sharon Olds
(1942 – )

His Stillness

The doctor said to my father, “You asked me
to tell you when nothing more could be done.
That’s what I’m telling you now.” My father
sat quite still, as he always did,
especially not moving his eyes. I had thought
he would rave if he understood he would die,
wave his arms and cry out. He sat up,
thin, and clean, in his clean gown,
like a holy man. The doctor said,
“There are things we can do which might give you time,
but we cannot cure you.” My father said,
“Thank you.” And he sat, motionless, alone,
with the dignity of a foreign leader.
I sat beside him. This was my father.
He had known he was mortal. I had feared they would have to
tie him down. I had not remembered
he had always held still and kept quiet to bear things,
the liquor a way to keep still. I had not
known him. My father had dignity. At the
end of his life his life began
to wake in me.

Poems for September 2010

Sharon Olds (1942 – )

Diagnosis

By the time I was six months old, she knew something
was wrong with me. I got looks on my face
she had not seen on any child
in the family, or the extended family,
or the neighborhood. My mother took me in
to the pediatrician with the kind hands,
a doctor with a name like a suit size for a wheel:
Hub Long. My mom did not tell him
what she thought in truth, that I was Possessed.
It was just these strange looks on my face—
he held me, and conversed with me,
chatting as one does with a baby, and my mother
said, She’s doing it now! Look!
She’s doing it now! and the doctor said,
What your daughter has
is called a sense
of humor. Ohhh, she said, and took me
back to the house where that sense would be tested
and found to be incurable.

—

W.S. Merwin (1927 – )

September Plowing

For seasons the walled meadow
south of the house built of its stone
grows up in shepherd’s purse and thistles
the weeds share April as a secret
finches disguised as summer earth
click the drying seeds
mice run over rags of parchment in August
the hare keeps looking up remembering
a hidden joy fills the songs of the cicadas
two days’ rain wakes the green in the pastures
crows agree and hawks shriek with naked voices
on all sides the dark oak woods leap up and shine
the long stony meadow is plowed at last and lies
all day bare
I consider life after life as treasures
oh it is the autumn light
that brings everything back in one hand
the light again of beginnings
the amber appearing as amber

Steps in the Right Direction

In my penultimate post I introduced a patient with a problem. This 12-year-old boy, gravely injured in the January 12th Haitian earthquake, orphaned of his mother, displaced, relocated, with a spinal cord injury and an orthopedic spinal deformity, without having had an operative intervention.

Another blogger/pre-medical student, and I have been cold emailing surgeons about the case. So far, no dice. Orthopedic surgeons and neurosurgeons have generally said that operative intervention is likely indicated, technically routine with a high likelihood of a good outcome. However, surgeons are only one piece of the puzzle.

It takes a highly skilled team to perform spinal surgery. It takes a pre-operative team, then in the O.R. along with the surgeons, there are the anesthesiologists, nurses, technicians, a Post Anesthesia Care Unit (PACU) team, a Surgical Intensive Care Unit (SICU) team; then there’s the step-down to the regular med-surg unit with all their staff, supporting functions and logistics and the physical plant, all of which implies a hospital. Then, there’s the rehabilitation facilities, associated inter-disciplinary team professionals, supplies and adaptive equipment. There is also always the possibility of complications and extra, unanticipated costs.

So, there are many, expensive, technical resources that have to be mobilized, and well, paid for. So, finding a hospital in the position to take on an involved, international, humanitarian, and thus pro bono case is an extra and pretty tall hurdle.

My department acting-chairman suggested a renown hospital affiliated with a voluntary, benevolent society. That particular one did not pan out. However, that suggestion and a positive association I have from my other life led me to make another contact.

Now, it’s time to reveal my dark side. I, along with my wife, so we, like to go to Women’s Flat Track Roller Derby bouts. The local league is the Boston Derby Dames. It all started in Detroit though with the Detroit Derby Girls. These events are held in big venues to accommodate the track, the teams, the officials, the MCs, a Buffer Zone of Safety, the stands, the refreshments, the facilities, the parking. In Detroit the bouts were held at the Masonic Temple Auditorium.

Here in Boston, they’re held in the Aleppo Shiners Auditorium in Wilmington, MA. Shriners, you know, men in fezes driving little cars in parades, oh, and the Shriners Hospitals for Children. I contacted them on April 19th with information about the case, and moved on.

Today, I received an email from the Shriners Hospitals for Children that a team at the Shriners Hospital in Philadelphia believes that on its face, they can probably help this patient, and that the hospital will accept an application for his care. Plus the Global Medical Relief Fund is offering to assist with travel for this patient.

Even if this does not all work out with this connection, hats off to all these fine folk and their organizations!

This is very preliminary, but very encouraging. So the gratifying part begins as I get the parties together. I believe that the medical and hospital details will go pretty smoothly.

The real challenge, like that of herding cats at a distance, will be negotiating the bureaucratic labyrinth in order for V to leave Haiti and travel to the United States for medical care. The word on the street is that the Haitian government generally errors on the side of not granting exit status to children for medical treatment in the United States. So, I expect that this will become a chapter in its own right of this saga.

Stay tuned for more.

Poems for January 2010

Brian McMichael (1961 – )

Dark Star

The unimaginable mass in his abdomen
Pushes mercilessly through his back
Passes instantly through the hospital bed
And sinks into the center of the earth
Pinning him in position
– a specimen in a collection
a great recumbent termite queen
a distended and humbled, Jabba the Hut

Ballooning
Pregnant like a blister
Without shame or irony
He tells me, “I try to drink a 12-pack a day.”
Do I hide my shock?
An awkward attempt at connection,
Or is it that I’m trying to surprise him
right back in the kisser
By predicting that he no longer gets a buzz
that some people drink like that
just to keep from getting the shakes,
“Yep, and so I won’t hallucinate like I did last Wednesday.”

In Labor –
ed breathing
We deliver him by
Caesarian invasion
crossing the Rubicon into his homeland
by “tapping his belly”

He is polite and grateful
Chatting easily about his
Interesting and lost career

Cause and Effect
Ascites fluid – Clear and golden
Streaming into sterile vacuum bottles
Produces a startlingly nice head,
Usually

We fastidiously capture his
Disturbingly milky elixir
Easy blame slips away

7 liters later
He breathes easier
While at the same moment
The other person in the room,
His dark star child
Begins to grow again
Inside his belly

—

Wallace Stevens (1879-1955)

The Snow Man

One must have a mind of winter
To regard the frost and the boughs
Of the pine-trees crusted with snow;

And have been cold a long time
To behold the junipers shagged with ice,
The spruces rough in the distant glitter

Of the January sun; and not to think
Of any misery in the sound of the wind,
In the sound of a few leaves,

Which is the sound of the land
Full of the same wind
That is blowing in the same bare place

For the listener, who listens in the snow,
And, nothing himself, beholds
Nothing that is not there and the nothing that is.

Engage with Grace 2009

Some conversations are easier than others.

Last year during Thanksgiving weekend, many bloggers participated in the first documented “blog rally” to promote Engage With Grace, a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

The original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide www.engagewithgrace.org now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.

You can join the Engage with Grace group on Facebook.

(This post was written by Alexandra Drane and the Engage With Grace team. )

Stories in the Service of Making a Better Doctor

New York Times
HEALTH | October 24, 2008
Doctor and Patient: Stories in the Service of Making a Better Doctor
By PAULINE W. CHEN, M.D.
Narrative medicine employs short stories, poems and essays to build empathy in young doctors.