Beyond the Campfire

Tony Duckles (CC)

Jon Fox, founder of the Institute for Poetic Medicine, describes how to bring poetry into the world of medicine.

By making us stop for a moment, poetry gives us an opportunity to think about ourselves as human beings on this planet and what we mean to each other.

-Rita Dove, former U.S. Poet Laureate

Jack Coulehan, physician and poet, founder of the Center for Medical Humanities, Compassionate Care and Bioethics, who has done so much to raise awareness of literature related to medical humanities, wrote a poem that takes a risk.

Also read: Heal your body by giving voice to your soul: An interview with John Fox

My Machine

If I had a machine to use

in a case like yours, I'd use it

on the nucleus that makes

my feelings, to deepen them.

I'd take a long time, like a monk

at morning prayer, before I spoke

and turned each word into a sign

of passion.  When I told you,

Yes, the damage is more

than anyone knew, I'd hold you

in my arms, desperately close

like death.  I'd throw off the sham

of working in a reasoned way

to find the answers to your pain.

Instead, I'd use an archaic

neural poem and feel the pull

of healing, skin to skin, instead of

acting neither man nor woman

and doing the decent thing.  The ache

would be a price worth paying.

-- Jack Coulehan, M.D.

The poem projects cool sensibility. It's ironic, absurd. He wants to dispel the chasm between physician and patient. Constrained by medical formulations and technical words, he struggles to find a more visceral language for love and connection. Under the surface, the tension feels volcanic.  He goes way “over the line.” He wants to be human. How can a doctor communicate compassion and genuine concern in a depersonalized medical world?  Especially when death is at our right shoulder?

Jack risks the question: who is it that cares and who is being cared for?  He writes in Academic Medicine:

“The usual formulation of the physician-patient relationship contains a paradox. Medical education encourages an attitude called “detached concern” toward patients. But this term contains a nascent contradiction: if you are truly detached, then how can you be concerned? Caring or concern implies a connection. If physicians care for their patients, they experience them as subjects rather than as objects; in other words, they form an empathic connection with them.”

If we intend to set in motion lasting change and move from sickness care to health care, it is essential we look not only at what we do and how we do it regarding medicine — but ask the question who is served and who offers treatment.

In addition to lowering cost and increasing access, lessening bureaucracy and paperwork, we must do what we can together to create healing environments that empower and cherish a whole person.

A poem, one made of healing words, makes it possible for patients and those dedicated to their care to creatively voice the unique facets of truth that each of them brings along in the journey of healing.

It's people who cherish and empower, not buildings or technology.  When a family member is depressed or a patient is facing a major change in body image because of a medical intervention, it is you and I who care, or not.

John Wright, before he retired as director of medical education at the Swedish Medical Center in Seattle, began to write poetry. In the following poem he wants his psychiatrist to know it was more than pharmacology and biology that helped him out of depression:

Therapy

to Phillip

You attribute my recovery

to nor trip tyline -

its effects on neurotransmitters,

on the a myg dala.

You barely nod towards your worth -

insisting on blood levels,

on a therapeutic dose.

While I credit half our success

to pear trees blossoming white

beyond your left shoulder,

to the wisteria -

its pink flowers hanging

lush and fragrant

over the portico,

to the warmth of your hand.

- John Wright, M.D.

John knows the problem of disconnection a physician can feel.  He wants Phillip to acknowledge and remember his part in the healing process; see the place natural beauty and tenderness have in the art of healing.

Stephen and Ondrea Levine, who do so much to bring our troublesome minds into the caring heart, write:

“It is said we could look the whole world over and never find anyone more deserving of love than our selves.  Medicine Poetry is a poultice capable of drawing poisons out of our forgetfulness. It reminds us.”

It’s been my good fortune for over twenty-four years to show people in hospitals, medical schools, wellness/cancer support centers and hospice care throughout the United States, how they can connect with the evocative and expressive power of words. It’s nothing short of revelation what can happen to a person and a group.  I am often moved in ways where silence, one that honors this sacred sharing, is the only appropriate response. 

An essay I wrote, “Healing the Within,” appeared in The Healing Environment published by The Royal College of Physicians in 2003. In 2004 my work was documented in Healing Words: Poetry & Medicine, a deeply moving film that also features the inspiring Arts-in-Medicine program at Shands Hospital at the University of Florida, Gainesville. “Poetry Therapy: Reclamation of Deep Language” was published in the 3-volume Whole Person Healthcare.  

Can words heal? Can they reveal who we are and help us learn what we mean to each other?  To consider this, after Coulehan and Wright’s poem, I would like you to visit another world, one very different from the world of medicine. Kim Nelson works with incarcerated kids in gangs. She writes to them in There Is No Place Dedicated to Solitude:

It is with words we begin

to know where we are,

the details of existence

reveal our code of connection.

And there’s a light in their eyes

when the silence is burned.

They can see all around themselves

the past, the present, and future.

We all begin to know

Africa, Pajaro, the liquor store,

a basketball court, Grandmother’s house, the park

Watonsville, Antarctica, the rodeo, home

Where we live, and the lives of our minds,

our relationships to trees, animals, and buildings,

to clouds, rivers, and shootings,

to neighbors, and strangers, and war

To loneliness and oranges, to ancestors and the morning.

We learn from our stories

erasing the blind spots

that make myths of our lives

For we depend on each other, like words

saw horse, rocking horse, sea horse

I take meaning from you

near you, around me, at my side—

There’s no place dedicated to solitude.

Kim insists her kids write about details of their lives, to learn where they are and learn who they are. She says bluntly, “The alternative for them is to murder people.”   

Nearly everything she reflects upon is something that could help to create a more healing environment in hospitals. For caregiver and patient, what silence needs to be burned?  Why not use our words to see all around?  Use words to see the details of our existence, to say where we are, tell our stories, erase blind spots, depend on one another? 

We don’t need a new expensive machine for this, only paper and a pen. (For someone who can’t write, I scribe poems while they speak.) 

Again Stephen and Ondrea Levine:

Poetry is a short-cut to the subconscious.  It can in a few words turn the mind away from its forgetfulness.  Erupt in the heart with the shamanic-like power of the “hidden word” an unimaginable acceptance of healing.

People who have never written poetry in their life (or not since 4th grade!) write things that emerge raw and authentic. Even sometimes, with only a few words, much is said. They release pain on the page.  They uncover “hidden words.” They touch one another. 

You led me to a place where my own 6 lines of poetry would take me to, on the profound journey to my lost friend. For that I will forever be grateful.

- Tom Roberts, Clearwater, Fl

During the workshop, I felt something stir within that has been silent for many years and am anxious and committed to begin writing poetry again. Yes, we were few in number, but nevertheless, words touched each other.

- Shirley Gerecke, Cleveland, Ohio

When illness shakes up our lives, writing can give us the courage to listen deeply to what we don’t know.  

How Poetry Comes to Me

It comes blundering over the

Boulders at night, it stays

Frightened outside the

Range of my campfire

I go to meet it at the

Edge of the light.

- Gary Snyder

I met Sydney Long while offering a writing program at The Wellness Community in Columbus, Ohio. Sydney, writing in what turned out to be the latter stages of breast cancer, went out, as Snyder recommends, to the “edge of the light.”  She turned away from the campfire, to be with herself and her world, with the unknown that is blundering over the boulders.

Here is a fragment from a longer poem that reflects upon chemotherapy:

After a long day I felt pulverized

Like plaster dust-fine and desiccated.

Scattering on the wind preferred.

Dispersing care and burden.

Poems became a way to put one’s attention on what the poet William Carlos Williams called “the thing itself.” They enable a person to “give birth to their images” which Rainer Maria Rilke said are “the future waiting to be born.”  

Those images are where Sydney takes refuge:

The dark is palpable and soft.

It hugs me.

Sanctuary

The Darkness-that-knows holds me

Like a mother comforting her babe,

Like a cave wintering a bear.

Outside my body is wracked with

Procedures:

Surgery, transfusions, needle pricks,

Ice blankets, respirators, code-blue

Until all crises pass and

I'm ejected from haven to

Join matter once more,

To mold spirit with body in the

Long, slow journey of recovery.

Dark indigo only a memory

And a deep longing for home.

Sydney makes a place in her poem -- and within herself -- for wild and deep rest. She makes a place for the cave wintering a bear and in that breathing wildness, a deep longing for home awakened.  Is that an awakening beyond the body?  As a woman living through breast cancer, she imagines the tender mercy of a mother holding a baby. 

These are words that heal. They help her remember her true nature.

When I was eighteen, studying creative writing at Boston University, I was faced with a heavy decision I carried during the course of my freshman year. It had crept up on me since I was four. After years of surgeries, the gradual disintegration of my lower right leg, because of a bone and nerve disorder, made the amputation of the leg inevitable. 

This experience was the blundering frightened creature outside the range of my campfire. I held out as long as I could and finally I edged out to meet it.

It was during this time I found I wanted to look beyond the literary enterprise of writing. What I had to wrestle with during this time in my life set me on the path of poetry and healing. Perhaps that’s why, after so many medical interventions to save my leg, I understand and remain startled by those lines by Jack Coulehan, “Yes the damage is more/than anyone knew….”

I’ve not shared this many times: in the early morning hours before the amputation, a nurse, or perhaps it was a nurse’s aide, appeared at my bedside. It was dark. Her blue-sweatered arms, white nurses uniform, long brown hair, her compassionate face. There was no campfire. She had stepped beyond its range to find me. I was frightened. She let down the railing, laid down in the hospital bed, and held me.

Citations/Permissions:

“My Machine” by Jack Coulehan, Academic Medicine. 2006; 81 (1): 48.  Reprinted by permission of the author.

“Therapy” by John Wright  The Beginning of Love (Bluestone Books 2005) © 2005.  Reprinted by permission of the author.

Quotes by Stephen and Ondrea Levine from the website, Warm Rock Tapes, www.warmrocktapes.com

“There is No Place Dedicated to Solitude” by Kimberley Nelson appeared in Finding What You Didn’t Lose by John Fox (Tarcher, 1995) © 1995.  Reprinted by permission of Kim Nelson.

“How Poetry Comes to Me” by Gary Snyder. No Nature: New and Selected Poems (Pantheon Books, 1992)  © 1992.

“pulverized…”  “The dark is palpable and soft…” by Sydney Long,

© 2008. Published with permission of Ross Long, husband and executor of Sydney Long’s estate.

John Fox is a poet and certified poetry therapist. He is the author of Finding What You Didn't Lose: Expressing Your Truth and Creativity through Poem-Making and Poetic Medicine: The Healing Art of Poem-Making. He founded the Institute for Poetic Medicine in 2005. He is an adjunct faculty member of the California Institute of Integral Studies, John F. Kennedy University, Institute of Transpersonal Psychology, the University of California, Santa Cruz and Holy Names University.