by Danielle Ofri
Toxic sock syndrome. That’s the first thing we noticed when we entered the hospital room. For those gentle readers who are not familiar with such sensory assault, toxic sock syndrome is the clinical term for the rank odor that accompanies damp, fetid feet that have seen more street time than shower time. The patient in front of us displayed all the cardinal signs of a chronic Bellevue Hospital alcoholic: cantankerous mood, matted, stringy hair, stirring halitosis, a W.C. Fields nose, and bone-rattling tremors of the fingers and tongue. He was not especially happy to see our group—one attending physician, two residents, four interns, and six medical students—bunched around his bed, all attired in crisp white coats and equally crisp attitudes.
After the usual line of questioning about blackouts, seizures, cirrhosis, ulcers, and other maladies of the bottle, I pulled a tattered photocopy out of my pocket. “Sir,” I said, “would you mind if I shared a poem with you?”
“Sure,” I said, trying to sound casual. While I’d subjected interns and students to poetry, I hadn’t yet tried reading poems with patients, mainly because most of our patients don’t speak English. But I’d been carrying a copy of Jack Coulehan’s poem “I’m Gonna Slap Those Doctors” in my pocket for several weeks now, waiting for just the right English-speaking alcoholic who might be amenable.
Because the rosy condition
makes my nose bumpy and big
and I give them the crap they deserve
they write me off as a boozer
and snow me with drugs. Like I’m gonna
go wild and green bugs are gonna
crawl on me and I’m gonna tear out
their goddamn precious IV.
I haven’t had a drink in a year
but those slick bastards cross their arms
and talk about sodium. They come with
their noses crunched up like my room
is purgatory and they’re the
goddamn angels doing a bit
of social work . . .
Gradually the patient’s face changed. He was no longer surly. He was attentive, amused. When I finished he said, “You know, Doc, you got it right. So many docs treat you like you’re something the cat dragged in. But we’re all the same peons here on this earth.” He pulled himself a little higher in his bed. “You know, I used to like to read. Books and all. Back in grade school I liked English the best. Stories, poems, all that shit. My favorite subject.”
I wondered if my medical team would’ve thought about this malodorous patient as a person who’d once had a favorite subject at school. For the duration of his stay at the hospital, I noticed the medical team treated him much more like a “citizen” and less like an annoyance.
In my years as an attending physician at Bellevue Hospital, one thing I’ve noticed about the interns, residents, and medical students I supervise is that they tend to be starved. Famished. They will stuff comestibles of all sorts into their mouths whenever the opportunity arises. At first I offered chips or pretzels to help them stave off starvation, but I quickly realized that it had been weeks, in some cases months, since any of them had consumed fresh produce, so I stopped at the fruit stand on the way to work each morning to stock up on bananas, grapes, strawberries, and mini-carrots. Within minutes of my depositing this bounty at the doctors’ station, only a few lonely grapes would be left.
These physicians-in-training weren’t only starved for fresh food. On the first day of their month’s rotation, I asked them to introduce themselves and tell the group about the most recent book they’d read (Harrison’s Principles of Internal Medicine did not count). Usually the blood drained from their faces.
It was obvious I needed to attend to the full spectrum of their nutritional needs. From then on, each day’s repository of fruit was accompanied by 20 copies of a poem. The sign taped to the table read (with arrows usually but not always pointing in the appropriate direction): “Fruit of the Day; Poem of the Day; Please Take One of Each.”
Thus began our tradition of Post-call Poetry, sometimes nicknamed Literary Rounds. Poetry is not the easiest sell on the medical wards. Even after years of offering poetry to my residents, I still experience a momentary lapse of confidence every time. Will they think I am certifiable? Will they deign to cut me one iota of slack, understanding the calculus that every minute “wasted” translates directly to one minute less of sleep? Will I be branded one of “those” attendings, the kind not sporting quite enough clinical tomatoes in their cerebral salad?
Nevertheless, I soldier on. “Okay, guys, poem of the day.” I press the daily verse into hands already burdened with charts, X rays, clipboards, stool samples, and EKGs. “Any volunteers to read?” If you ever need to silence a crowd, this is surely the way to do it. And so I read the poem aloud, flicking my eyes over the page every line or two to catch any surreptitious glances at lab reports or scut lists.
Given the demands of time, energy, and responsibility on my audience, I am granted only momentary patience. Poems read in these situations need to be short, accessible, and somehow relevant. I don’t always pick poems that relate to medicine, though I do try to highlight poems from the Bellevue Literary Review (BLR) to raise the students’ awareness that literature can be written in a hospital. The Department of Medicine at New York University has published BLR since 2001, providing a forum for poetry, fiction, and nonfiction about health and healing. Despite a burgeoning interest in such literature (the review receives thousands of submissions each year), popular twice-yearly on-site readings, and tireless promotion from our editorial staff, the vast majority of our students and staff remain impressively unaware of the literary efforts afoot in their own medical center. Many are unaware of the existence of literary magazines in general, so I hand out free copies to the medical and nursing staff. Sometimes I feel like I’m competing with the drug reps who stalk the same halls with free pens, mugs, and notepads.
To open the minds of students and staff about the side effects of medication, I usually offer Nikki Moustaki’s BLR poem, “Writing Poems on Antidepressants.” I want to give them a sense that what we value in a medication (doesn’t cause hyperglycemia or urinary retention) may not be what patients value.
Each day offers some little irony or a dream
or a blind albino woman
sitting next to you on the train
with eyelashes like white silk threads
attached like broom-straw to her one closed eye
as she taps her cane against the window
and you, the poet on antidepressants,
thinks: look at that, hmmm, interesting.
Did I buy dog food? Here’s my stop.
Another poem may offer gentle insight into the subtle symptoms of aphasia, as well as to the isolation and loneliness of aphasic patients. Halvard Johnson’s poem “Ambulance,” also from BLR, begins with the epigraph “This restaurant has a fine ambulance.”
What my friend, of course, must have
meant was that this restoration
had a fine ambience, but some of
his words in the rain came unstruck from time to thyme,
as patents from one ward sometimes wonder into an udder,
where they almost flit in, though
God knows no one knows their names,
where their faces seem almost familiar
until looked at closely . . .
When I receive my evaluations at the end of each rotation, I am reminded that rarely is anyone neutral about poetry. Some students and interns are delighted for the change of pace, both in topic and in tone. Others are downright angry over the waste of time. Perhaps this divergence of opinion is triggered by the relative “uselessness” of poetry. After all, in comparison to angioplasty, radiation therapy, and heart-lung machines, poetry can seem a little useless on the hospital ward. Some students find such uselessness liberating, allowing them to flex underused muscles of creativity. Others may find it threatening, since it can be seen as a seditious attack on the empirical nature of science.
At the end of each month, I get up the gumption to present a four-page poem. This requires bribery on a grander scale, so I temporarily relax my insistence on healthy food and present a double-fudge chocolate-mousse cake, studded with die-sized cubes of dark chocolate. I plunge into John Stone’s “Gaudeamus Igitur.” Written for a medical school commencement by a cardiologist-poet, the poem is appropriate for the end of an intense month-long rotation before our group is scattered to the far-flung reaches of the hospital.
Stone borrowed the form of his poem from Jubilate Agno, by the 18th-century poet Christopher Smart, in which each line begins with the word “For” or “Let.” What captures my students’ attention, as they wolf down their cake, is the blend of clinical references (letting them know they are in the know) and pithy lines that perfectly capture their mixed emotions about being doctors.
For this is the day you know too little
against the day when you will know too much.
For you will look smart and feel ignorant
and the patient will not know which day it is for you
and you will pretend to be smart out of ignorance
For you must fear ignorance more than cyanosis . . .
Those lines bring knowing nods and uncomfortable squirms. They have all—we have all—been in this position. The fear of not knowing enough is constant in medicine. I point out the following passage about the arts to remind them that there are critical sources of inspiration beyond the New England Journal of Medicine.
For there will be the arts
and some will call them
whereas in fact they are the hard data
by which our lives are lived
For everyone comes to the arts too late
For you can be trained to listen only for the oboe
out of the whole orchestra
For you may need to strain to hear the voice of the patient
in the thin reed of his crying
For you will learn to see most acutely out of
the corner of your eye
to hear best with your inner ear
I repeat that last line: “For you will learn to see most acutely out of / the corner of your eye / to hear best with your inner ear.” “This is how poets think,” I say. “Here is an example of how physicians can learn from poets.”
And then I end our time together with the passage below. I remind them that medicine (and life) consists of far more than what we learn in medical school. That medicine is fully integrated into the world at large, and that being a physician means engaging all aspects of life to the fullest because, in the end, we doctors are in the same lifeboat as our patients
For this is the end of examinations
For this is the beginning of testing
For Death will give the final examination
and everyone will pass.