Martin Dyar on the Intersections of Poetry and Medicine

When I teach poetry and creative writing to medical students, their idealism and their diverse talents are always apparent. Generally speaking, students in the early years of a medical degree have a passionate vision of what it will mean to dedicate their lives to alleviating the suffering of others.

And most if not all of them are capable of levels of articulacy and creativity which can make the development of that vision a natural thing. A poetry writing class for poetry’s sake, as a meaningful escape from science, and as a way of diving into a broadly defined conversation about their future patients, seems to be an enticing prospect for many trainee doctors.

There can be pleasure and interest on both sides. Poets teaching creative writing in the realm of medicine find themselves at a fascinating vanguard, with an audience of apprentices that is often willing to take the art form seriously. Undergraduate medicine is by definition a place of intense vocation and intense commitment. The pulse of the medical student body contains a beat of anticipation. They are asking themselves always: When will I be ready?

In the work of making doctors, a great deal of imagination is marshaled. Patients, who rarely appear in medical schools, are solemnly invoked, and they can seem to haunt the mind of the curriculum. In their absence, the encounter between the doctor and the patient is earnestly visualized, and the possibilities of success and failure, authenticity and awkwardness in that pivotal relationship are endlessly dreamt about.

This anticipation among medical students can manifest as a special responsiveness to poems that represent aspects of illness and healthcare. In their reading and discussions, they desire to prove that they have what it takes (the vocabulary, the insight, the poise, the empathic substance) to excel in that strange destination known as clinical responsibility.

With respect to their own artistic ability, the culture of anticipation can grant to the medical student a measure of poetry on tap. Because of where they’re coming from, but perhaps most of all because of where they believe they are going, they have something to say. Something internal is primed for its moment of overflow. And when their creative work is going well, the distinction between the art of poetry and the art of medicine can appear superficial.

It is, however, something of a truism, accepted in medical schools internationally, that student idealism is impacted by the sobering realities of the later phases of medical training. The system has figured out that the system gets in the way. By the time they qualify, the precocious drive to embody patient-centered care, so much in evidence among the younger students I have met, has been altered. In some cases, what is referred to by medical educators, mordantly and at times somewhat mystically, as ethical erosion has no doubt begun to come into play.

This awareness has not led me to think of my students as naïve for their enthusiasm. Neither have I abandoned the idea that their rehearsal of their future roles through the reading and writing of poetry can stand as an example of true compassion. And I continue to see this work as an example of one of poetry’s most relevant powers: namely, its ability to relocate us, however subjectively or fleetingly, so that we are face-to-face with things beyond ourselves, including the lives of other people, and even the totality of life itself.

There is an abundance of poetry from recent decades and across the 20th century that explores the subjects of illness and healing. Many varieties of medical need have been set down, and forms of healthcare and recovery explored, questioned, criticized, and in some cases celebrated. In seeking out and gathering together poems of this kind, as the editor of the anthology Vital Signs: Poems of Illness and Healing, recently published by Poetry Ireland, I have been repeatedly struck by poetry’s ability to play with and deepen the meaning of illness and healing, while remaining in universal territory.

I have also been struck by the predominance of affirmational writing. Suffering is part of the subject matter of Vital Signs, and yet, notwithstanding their clear-sighted candor with respect to the realities of illness, the poets express a consistent refusal of despair, sounding instead notes of hope in the face of adversity.

There is a high-toned affirmation in Patrick Kavanagh’s sonnet “The Hospital,” which begins with the famous ironic claim: “A year ago I fell in love with the functional ward / Of a chest hospital.” Characteristically forgetting the team that diagnosed his cancer and removed his lung in Dublin in 1955, Kavanagh presents a proud picture of solitary acceptance in the face of chronic illness, building a philosophy of sickness that hinges on the values of love and literature, and concluding with a didactic line: “We must record love’s mystery without claptrap, / Snatch out of time the passionate transitory.”

Diane Seuss, in the poem from the celebrated collection frank: sonnets which begins with the line “I saw a little movie of a person stroking a small bird…” renders hope from a good-humored bond between the poet and a dear friend who is dying of AIDS. Their final conversation is something of an isolated world of care. Mortality is worked through slowly and tenderly, until death itself enters the narrative. Negotiating her own wintry realism and her grief, the poet allows herself a stab at spirituality, a counterintuitive ending: “There is no death.”

There’s distinctive affirmation too in Rita Dove’s “The Secret Garden” where love and love-making after a protracted illness pertain to the banishing of difficult memories and to a kind of musical rapprochement with the body’s tendency to break down.

The quiet diary entry voice of “In Your Condition” by Tracy K Smith, which speculates on the vulnerability of expectant motherhood—and navigates fear by the compass of imagination—is another sounding of hope in a time of dependency.

And when in “What the Doctor Said,” Raymond Carver exposes the insufficiency of a doctor’s effort to break the news of an inoperable cancer, the portrait of shock and failure is not without certain images that seek to hold on to a faith in communication, and to the subtle inner resources that might make new meaning possible.

In his poem “The Wound Dresser,” looking back on his volunteer nursing and field hospital work in Washington, D.C. and Virginia during the American Civil War, Walt Whitman conjures a hectic and tragic setting, but one that is mitigated by the poet’s own energetic commitment. That poem makes a spectacle of the poet’s higher instincts: his dedication and his empathy are relentless. When he tells us, “Bearing the bandages, water and sponge, / Straight and swift to my wounded I go,” it is part of a layered and fantastical ideal.

“The Wound Dresser” is a thrilling historic document and a thrilling poem, but it does not provide a realistic model for healthcare professionals in our own time, who of course need to know their limits and should not demand a superhuman emotional capacity of themselves. At the same time, the poem is deeply infused with concern for the suffering of wounded soldiers, whose pain and dignity are irresistible for Whitman. He may be grandiose in his transcendence of himself, but he can be unforgettably selfless too, and he is fixated on the essence of care.

Emily Dickinson is jaunty and serious at once when in her “Surgeons Must be Very Careful” she catches a widely shared queasiness at the thought of what surgeons do; she matches the classic bioethics theme of the patient’s real presence being replaced in the mind of the doctor by the intellectual absorption of diagnosis and treatment.

Surgeons must be very careful
When they take the knife!
Underneath their fine incisions
Stirs the Culprit – Life!

Dickinson was writing at a time when surgeons were relative outsiders to the medical profession, but the poem still resonates in our time with its witty sense of advocacy for the trusting and needy patient who awaits a procedure. Dickinson knows that we need to be cruel to be kind to each other. But the best way to check and balance the necessary harm of medical intervention is to approach one’s clinical role with extra humanity, and to be, in a true sense (to go with the poet’s ingeniously demotic phrasing), “very careful” indeed, and veritably caring.

The long-range sensitivity of Dickinson’s final word choice, her punchline “Life!,” serves to elevate the meaning of the human body. The idea that there is something before our very eyes that is greater than we ordinarily perceive, something living, something planetary, with implications for who and what we are, can be a tool for the cultivation of wonder, humility and care, and a touchstone for a world where such things are too often in short supply. It is not a new idea, but its transformational impact on the words we use, and on the worlds of writing we have at our fingertips, has yet to be realized.

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Vital Signs: Poetry at the Frontlines of Illness and Healing, edited by Martin Dyar, is available from Poetry Ireland.