04 July 2012

"Weird it up."

My first semester workshop. And coming back to poetry after 6 years out of school for it, 8 years out of long-term, rigorous workshops (+ 1 week at Naropa a year before). I listen. To our brilliant, young, poetry prof (National Book Award finalist at 26, professor in creative writing 4? 5? years later, just published his first novel to critical acclaim...)
"Weird it up."

(Along those lines, another piece of poetry advice from that prof that I don't plan to do in medicine - "keep going with this until you fail. There's a project for winter break - write a book. And fail.")

Also: "I try 100, 500 lines until I get the right one."

So, I'm not right yet. But some poems do have 40 drafts. Average is 10, 12, for me.

I can't find the John Ashbery line I've heard quoted often enough, about how he knows something is done if he just keeps moving a comma.
Me: with current manuscript, still changing punctuation. And spacing. Right margin? Left margin? Middle? ...and does the fact that I put two periods at the end of one poem, rather than my ever-present and over-used ellipsis, look like a mistake, or something a poet might have done on purpose? Perhaps it should be one, then. Perhaps three. But two is so much more of what I wanted to convey, that incompleteness and hesitation and where on earth am I going with this line.(..). 

I'm on the AIDS consult service/clinics this month.

Things I can't do:
- draft patient notes 40 times. Let alone 10-12. Let alone 2.
- "weird up" my patient notes. Or make them rhyme.
- "weird up" the physical exam. Disease does that all on its own.

Things I can do:
- I have no idea what's going to happen when I go into work, every day. I'm always behind in reading, at least one day. And you can tell by looking -
- Except you can't tell anything by looking. Some of my current patients, if they walked in, you'd never think to test them for HIV. Ever. (Often enough, that's a cause for delay of diagnosis).

‘Weird it up." There's House. There are glass boards for dry erase markers (I want one). There's Occam's razor - the simplest explanation, tying together all the symptoms, is the most likely. In medicine, it’s the mantra of “if you hear hoofbeats, think horses, not zebras.” But there are some zebras. And there are a lot of patients who do have two rare diseases. Or three. (and a lot who don't). You still have to know all of them. The body weirds it up.  Or disease does. Or we do.

Often enough, "atypical" might just mean "unlike the population originally studied." An easy one is heart attacks - myocardial infarctions (MI). (Is it like a newspaper headline..."Heart ATTACKS!" or more like "attacks to the heart" ?)
"Typical" symptoms. Tested in middle-aged white men. It turns out that populations other than middle-aged-white-men actually present with different symptoms. So that becomes "atypical." Even if "typical"/"average"/"within normal limits" in whatever peer group you're talking about.

One pathology. One pathway to disease, one thing happening in cells that are essentially identical in different people. But the visceral-to-somatic, the unconscious-to-conscious translation is different.
The body, the mind, the whatever it is (something about XX vs XY? Does this make any sense?) weirds up the process on its way to being verbalized (in the body sense).

It's an elephant (sitting on my chest). There aren't wild elephants in the US. In Cameroon, they're much smaller than the East African ones, and they eat plantains and mess up fields. Damn elephants. So is it then a giraffe? A gorilla? Are we going for large and docile, or lots of weight and inertia? Affable, aggravating, innocuous, plodding? Bus, crane, helicopter, hippopotamus? (Referred pain perhaps, or a panic attack, or an aortic dissection, or an esophageal rupture, or esophageal spasm should be referred to as 'a snuffleupagus sitting on my chest.' The sensation is the same. But it's a completely different animal. And why not one that is, technically perhaps, "imaginary"? So is the proverbial elephant).

"Weirding it up," the very analytical, poetic term, deserves a lot more exploration. It's not about making the reader work for an image. It's not about obfuscating for the sake of obfuscating, making poetry illegible to all but other poets (and even then), it's not just about pushing your mind beyond where it naturally might go. An expected image, after all, isn't really an image; depending on how much it hews to convention, it might be more like clip art. 

A patient presentation - the art of the 3-minute presentation, the ultimate art of the one-liner - is about conciseness and absolute precision. The team should have an idea of the patient before walking into the room (and a somewhat extended view of the patient-as-person in the longer presentation and note). It's about your interaction; you were there, you know and can distinguish this patient from anyone else in the hospital or in your clinic at that moment. But the language we can use is...both limited an incredibly specific, ridiculously separate from life, and unbelieveably close and beautiful. On surgery service at the VA, sometimes I'd get confused about which patient was which (awful). The why, though - most were 60-something-yr-old male Vietnam era vets, with approximately similar medical problems, and I might have seen/talked to them for ten minutes before they were completely draped in the OR. The image evoked, then, was completely generic - I didn't know them. Or remember enough names.

A patient was talking to me about his primary care provider of the past 9 years, whom he thinks is wonderful. "I've been working with __...." He laughed. "I mean, I've been her patient since 2003." I uncorrected him. "You were right the first time. That's the way it should be - patient-provider relationship, working together."

It's the interaction that keeps it interesting. Who wants to work with clip art all day? Who wants to have generic patients?

A real image - the "weirded-up" one, but the one that's a vortex, too, that's closer to something exact - is an interaction, too.  It's not flat. It's a conversation without beginning or end.

The next time I get a comment/look about the (both in-progress) MD/MFA thing (daily to weekly), new response. Had to weird it up.


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