25 September 2010


I was having a discussion with some physicians the other day about Dante. (rather, they were discussing, and I was somewhat on the fringes of the fire, I, the student trying to dry the clothes she was wearing as she’d forgotten to bring extra pants on the trip to swim in a mountain river…) But as often-enough happens, there was a trigger point for me in the conversation and I jumped in.

I do believe that essentially everyone is more learned than I am (the people with whom I generally surround myself, at any rate. I like to be around people I can learn from. Then again, everyone can school someone else on something).

I’m a dilettante, professionally (perhaps euphemistically aspiring to be a renaissance woman…). Even title-above-and-description-wise. Could be a better physician(in training), could be a better writer, but – can’t pick one – and therefore can aspire to be kinda good or okay, maybe, at both. And I’m in general wholly impressed and overwhelmed by the general culture and knowledge of the physicians I know and have the privilege of spending time with (though these are, also, those who have chosen to remain in academic medicine and spend a good deal of their time teaching).

 However. This particular group started discussing Paradise Lost and then The Inferno. One started going on and on about how Dante was so ahead of his time in writing about/describing heaven and hell in that way, etc, that that was the big thing about the work, and I’m thinking (and soon saying) ahh…no. Two things. Writing in Italian. And politics. Big, big politics. Just as political as Machiavelli, in some ways, but a prettier and much more interesting and complex story. (no need to expound. again, amongst people (I’m sure) who know this better than I do.

so...sometimes I know things.

Everyone’s a poet. Poetry is natural, poetry is breathing, it’s a way of being quiet and looking at the world. People translate that – or feel impelled to translate, transcend that into another form. Or they don’t, and it’s still poetry – the moment is, still, poetry. Anything exquisite. Anything that makes you catch your breath, or stop, or see or listen or feel in a slightly different, slightly new or nuanced way.

But people are afraid of poetry, think it’s esoteric, complex, overly intellectual, overly analyzed, and – frankly – pointless, perhaps a historical footnote. “I don’t understand poetry,” they say. I hate that. I hate that it seems – or makes itself seem – so inaccessible. There are so many different ways to read. If you read something and you like it, that’s good enough. If you see a painting, hear music, and you like it, that’s good enough. That’s appreciating. There are other ways and more and more things to delve into and appreciate and fall in love in other ways… but it shouldn’t be inaccessible. Art should be – is – for everyone. Enjoyment, expression. It’s all about communicating and translating, bringing across experience, which is not unique to the artist, at all. At all. (There are what, two stories in human experience? In literature? If that?)
To me, anyway, art is something about a collective unconscious, to get slightly Jungian.

I took a class called “Art for the People.” And bridging science and art, as I did and still try to do, flailing-ly, I see people have the same-same fears and feelings of inadequacy vis-à-vis science and art. Science makes itself out to be intimidating. Medicine speaks an entirely different language – not just in medical terminology. Medicine turns English, commonplace words upside down.
“How is the patient mentating?” (thinking. are we judging? yes. cognition. alertness and orientation. but also judging… the patient’s relationship to the world, as if we know how to govern that).
“Please ambulate the patient.” (‘order’ to nurses. help/make sure the patient gets up and walks).
“Is the patient’s sensorium intact?” (ie. hearing voices/seeing things? feeling things that “aren’t there?”)
Medicine  auscultates heart, lungs, carotids, abdomen, rather than listen.
Rather than sortof sad, someone is probably dysthymic, and if they’re just feeling normal, they’re euthymic.
Patients “complain of.” (did you know that’s what you were doing when you went to see a doctor for a particular reason?)
Patients “deny” symptoms (did you know that’s what you were doing when you said you didn’t have whatever the doctor asked you about?)
There is too much to digress upon here.

Poetry used to be communication transmitted across towns, countries (by modern definitions), across time. The poets were idolized. (in some countries, they still are. In France, streets are named for poets, philosophers, composers. In the US…presidents…some generals, maybe…)
Plato banned poets from the Republic because they were too influential, and because they made mirages, in some sense. Turned things upside down. Forms are supposed to be pure, organic.
Words are powerful.
Words can destroy.
It’s a dangerous thing, to wield a pen. It could get you exiled, incarcerated, killed.
Still does.

That is poetry. That is writing. That is being a writer.
A good friend once told me that all you need to do to be a writer is to write. It’s a heady thing, to call yourself a writer.
To be a writer, you just have to write.

I’m intimidated in the same way by writing poetry that rhymes and by drawing or painting in color. I feel like, with both, you have to do it really, really well – really skillfully, artfully, delicately, and deliberately – or it comes off as heavy-handed and trite. And overbearing.
So I almost never write things that rhyme.
And I prefer to draw in charcoal.
By the same token, I love writing, and I love drawing in black and shades of grey (I supposed I don’t actually draw “in” white, except for the pieces that are pages shaded full of charcoal then erased to create shapes and shadows.

For poetry. Rafael Campo, a personal hero who I am honored to call mentor (and, as he said once, future colleague), often writes formal sonnets. Many of his poems – entire books – are composed of formal sonnets (the Shakespearean, not (or sometimes?) Petrarchan kind – ie, 3 stanzas of four lines each plus an ending couplet, ABAB CDCD EFEF GG. Iambic pentameter. End-rhymed. You’d think something like that would be pretty damn obvious.
And yet I didn’t notice for awhile. I’m slow, perhaps. I don’t notice things. All true. But it wasn’t until a second, third, reading, and perhaps reading the poem aloud, that I realized the lines rhymed.

I was floored.

Knocked over, stunned, gasped. Floored.
(this is what poetry does to me).

It takes a subtle, delicate, absolutely %$*&#*& brilliant writer to pen lines that ‘happen’ to rhyme, where the words are completely organic and belong there, each in their own right. You would never question any of them, or see them there only to serve a purpose. It’s completely fluid.

And, in my mind, next to impossible to do. (for mere mortals like myself).
Formal poetry has a place both in history and in vivid, living memory and practice. There are those who say, probably, that contemporary poetry is too…anything…not rigorous in the same way it used to be. Or something. Forms are a fantastic exercise to use (and for those who are absolute masters, a natural vehicle in which to write). As an exercise, I wrote a sestina (if you want to talk about ridiculously complicated forms… suffice it to say, 6 stanzas of 6 lines each plus an ending tercet. There are six words, through the poem, that end lines. That’s it. And the alternate in a particular pattern through the stanzas. And they rhyme. My six words were: alive, body, line, words, hypochondria, worry. These are sometimes slightly altered – “live” for “alive”, “align/realign” for line, “wary” for worry, once. But still. Imagine a poem in which “hypochondria” appears 7 times….)

But you can’t do this if you can’t do it well. I say. And writing something that “happens” to rhyme is unbelievably difficult. You can’t choose a word because it’s close enough/approximate enough to what you mean, and rhymes with the word you want it to. They both have to be exactly, absolutely right. Standing alone. And then they have to rhyme.

Art is similar for me. I can stand/sit/stare at paintings for time that doesn’t seem to pass. There isn’t thought. There’s something…visceral, zen, implicit. Indescribable. Each large city with which I am familiar has a few paintings like this for me. And when I’m there, I have to visit. It’s like going to see friends. You don’t * not* see some people when you’re in a certain place.

Dear gods, I digress. In writing and in live conversation.

Drawing. Art. Mine. Anything I do in color feels garish. I have to really mean it. It can’t be incidental, it has to be exactly right, or it feels out of place and like artifice. Pencil. Charcoal. Black ink wash. I hesitate to use color. I hesitate to use rhyme.

When flute players first learn to do vibrato (really a ‘coming of age’ moment for that instrument)…we want to use it all the time (or, I did). Showing off? Yes. Does it sound good? No. Vibrato is, in my mind, one of the most unique and beautiful things about the flute. It is an instrument that feels organic – not quite the hollow bamboo of yore (though some still are) – but – in essence – the music is from a column of air pulled up from my body, directed across and into this hollow cylinder by the force and delicate shaping of my lips, and I, in the same way, control the octave and the tone itself. Nothing fancy. No reeds. Nothing. You can play a range of beautiful notes on a headjoint, without any keys or fancy trappings.
And the separations in the air, the notes, are merely small, deliberate interruptions of the air by my tongue. Breathing marks phrases. This, too, is visceral.

But back to vibrato. It’s a decorative element, it’s a way to add emphasis, to add color or mood or shading. And at first – WE FIGURED IT OUT!!! – it’s all the time, and the flute section melodies (cause we always have the melodies) sound wobbly, slightly off key, and annoying as hell as the wobbles are all happening at different frequencies from the vibrating throats of the young arrogant flautists*….
Until we learn.
Delicate. Deliberate. Only when it means something. And then, dear gods, it can be stunning.

* okay there * may * have been a similar phenomenon when I learned to do the back-of-throat clicks in Cameroon. There are just some things you do have to respond to that way, though. And that here I keep trying to (still!) because, really, why say “uh-huh” or “I hear you” or nod or make non-specific murmurs of assent when you can do this. Which took a lot of assiduous practice to figure out the mechanics thereof.

I did learn to use vibrato sparingly. Somehow, that hasn’t been true yet of rhyme or of color. If it is the same thing.

Patient today.
“Are you going to be my regular doctor?”
“Yes, for now.”
“What does that mean?”
“Well…I’m not here forever (why do I hesitate to say – only for a few more months?). There are other people who will be here longer than me, that you’ll see later.”
“Will they be like you?”
Step back. “…what do you mean?”
“Will they have your personality?”
“Ahh…well they’re all very good doctors…”
The patient’s friend looks at me. “She likes you. She hates most doctors.”

Masquerading in a short white coat. Trying to get people to call me by first name. Never introducing myself as doctor. And yet – and yet. Everything I say, can say, can think or figure out to do in medicine feels pretty black-and-white, simple. I don’t have the nuanced colors yet. And if I try to use them, I’m generally – wrong. Anything fancy, any shortcuts. There’s a hell of a lot of color in the body. New language to learn. It’s easier for me, sometimes, with patients because I don’t have enough of the language or the knowledge, I am a lot closer to their level of understanding. My physical exam – black, white, subtle shadings of grey that are emerging. “Within normal limits” or not. (and even that…) “murmur” or not (aka ‘I didn’t auscultate one). Or “I think there’s something there…but I’m not sure what it is.”
Easy to start to feel fancy and knowledgeable and…real… when you’re (sortof) dressing the part, all the right toys are arranged in your pockets, the sign on the exam room door has your name written, the MAs call you doctor, the patients call you doctor (though they see your attending coming in to ‘visit’ and talk, probably exam them as well, every time..). Somehow, somewhere, there will be the time and the will to learn, to remember that none of this is “real” and it has to be made real, really earned – if I can find both.


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