For a change of pace, a poem I workshopped tonight (still very much a work in progress) at the HMS Writers’ Group:
Maple Leaves: A Responsive Prayer
October 3, 2007
The week we got the diagnosis,
we heard from all over – Texas and Canada.
Cancer… it was a big word.
My husband’s whole family said prayers
and lit candles.
Like a big shrine,
as wide as the spread of my arms.
They are very Catholic.
(I can see the candles shining.)
That was three years ago, and now it is October.
In Boston, it is still summer-warm,
but we know the frost is coming,
and the paper snowflakes in the windows.
(Your husband stays, sitting quietly behind me.)
More than anything, I am tired.
The medicine makes my skin itch and peel.
My stomach is sick,
my head aches,
my mouth is full of sores.
But I am so proud that I made it through twelve times,
and now thirteen,
and tonight will be fourteen.
(I hope you get to go home soon.)
No, not too soon,
because I want to get more treatments.
And I hope that I will be back in a few months
to go through it all again,
because that will mean it is working.
Cross your fingers for me.
(I will.)
It affects my brain too.
Neurotox-… I can never think of the word.
(Dreams, your husband says, then falls silent again.)
Yes, vivid dreams.
And once
I saw maple leaves falling.
They were everywhere.
Maple leaves falling, and behind them everything was gray.
(What has been helping you get through this?)
Oh, I’m not religious, but I’m spiritual.
And I’ve got God right here with me,
everywhere I go.
(Amen.)
I started out intending to write a little background and it turned into a lengthy reflective essay. So be it, I’m writing-starved.
This poem is based on my interview with a mid-50s patient with metastatic renal cell carcinoma. The neurotoxicity from her interleukin-2 therapy had in fact once caused her to have the hallucination of falling maple leaves, and I was struck by the beauty of the image and by her bravery and confident spirituality in the face of her devastating illness.
I wrote the poem more or less as a creative reworking of our verbatim interview, and it was only afterwards that I recognized its resemblance to the form of Christian responsive prayer, and changed the title accordingly. We sometimes use responsive prayers or litanies at First Parish, and admittedly I don’t like them much – they tend to be too scripted and impersonal to meet my spiritual needs and they feel too “high church” (yet simultaneously lacking in the mystery and comfort of high church ritual). But when the form of this poem emerged, it showed me the similarities between the medical interview and the responsive prayer in a way that has made me appreciate both forms more.
First, the parts in the medical interview are largely scripted: there is always room for adapting the questions to the patient, but in general there are certain ways that certain questions are always asked, wordings that we are taught from the very beginning of our clinical skills curriculum. The introductory question “what brought you into the hospital today?” is simple on the surface, but is actually carefully scripted to elicit the so-called chief complaint while avoiding launching prematurely into the history of present illness and the past medical history (which one might get if one asked a very slightly different question like “what is your medical problem?”). Yes, there are some patients who respond “an ambulance brought me, obviously!” but other than that it is a very effective question.
This scripted quality of the medical interview, in which theoretically the doctor knows exactly what information they need and what to ask to get it and the patient knows the role he or she plays in response to the doctor, can be off-putting for some people and yet simultaneously comforting… like, for me, responsive prayer. I bristle at it because I have trouble setting aside my own ego, identity, and agenda, spiritual or otherwise – I think “My concerns aren’t being addressed” or “I would have phrased this differently.” I’m sure patients often feel the same way, and it’s a huge issue for otherwise caring physicians who sometimes need to get just the facts, ma’am, in a very constrained period of time. But if I were able to let go of clinging to my ego (this is where Buddhism interjects briefly into the conversation) and accept that responsive prayer is not about me as an individual but about voicing the nature and needs of the religious community and my participation in it, I might find responsive prayer – as many people do – to be comforting precisely because it is so scripted and ritualistic, while simultaneously potentially very powerful. Similarly, if patients otherwise are happy with their care and feel that their concerns are being addressed (which is definitely possible within the interview script, something I proudly feel I achieved in today’s Patient-Doctor II interview), then the script can become a reassuring part of the “therapeutic environment” I wrote about in a previous post.
I have to acknowledge two failings in the analogy between medical interviewing and responsive prayer. First, it goes without saying that the purposes are very different. I have tried to focus my comments here in true writers’ workshop fashion on form rather than content, although when it comes to poetry (like architecture), form and function are closely intertwined. The analogy also breaks down in that the response portions of responsive prayers are typically voiced by the community as the community (using “we” rather than “I”, or even speaking for all of humanity) whereas medical interviewing is much more one-on-one. That being said, especially with the presence of the husband in the room in this patient’s case and in the future the knowledge that I will be asking the interview questions on behalf of my entire team and everyone else who will be involved in this patient’s care and have access to her medical record with my writeup, the sense of community should never go away. It is a strange sort of intimacy, to speak so deeply with another person sometimes, but to be doing so on behalf of so many.
That’s enough overanalyzing of this poor poem (you know you’re in post-college literary criticism withdrawal when you overanalyze your own works). I very much welcome comments and feedback on the poem itself and on what I’ve written afterwards.
The HMS Writers’ Group is a small group of students, faculty, and other HMS affiliates who meet every few weeks to share and workshop our work, read the work of other writers both medical and non-medical alike, do writing exercises, and generally “live the writer’s life on the side,” as our poet-teacher-guru Sophie Wadsworth put it tonight. It has been a real blessing to have this group exist, even though I can’t always attend or contribute, because it reminds me of my longstanding love for writing and provides a community of kindred spirits who also confront the harsh and sublime realities of medicine through words.
I love readership, but this poem is copyrighted and may not be copied or reused in any form without my permission. Please leave your contact information in a comment if you would like me to get in touch with you about its use.
