Poetry in Healthcare

By Diane Kaufman

I am a poet and a child psychiatrist. Beginning in childhood and all the way through my now senior years, I have found poetry to be a life saver. It is a paradox that poetry written in words can help convey that which feels beyond mere words to express. Poetry is like magic. It casts its spell by using language in unique ways through a concentration of resonating elements such as but not limited to sound, rhythm, structure, imagery, energy, and intention.

When a teenage patient of mine tragically turned to suicide to relieve her pain, I found myself thinking of her (she remained always close in my thoughts), when given the exercise to write a “poetic progress note” during an online course about creativity. That is how the poem, “What Makes Us” was born into the world. It is a poem about suicide that aims to prevent suicide. The poem was written on Memorial Day 2016. How appropriate. The meaning we give to our memories or perhaps our memories give to us, and how we use our life experiences, no matter what the pain, to grow ourselves further in healing ways, can be a gift of poetry.

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A Life Far Distant from My Own

By Lisa Goren

A Letter

On behalf of the Social Security Administration’s Cleveland Office of Disability Adjudication and Review, please accept our condolences on the loss of your brother and our colleague, Dr. Hershel Goren.

I speak for everyone when I say that our thoughts are with you and your family.

I hope that you find solace at this time, as you learn of the difference which he made in lives far distant from your own.

Respectfully,

XXXX

U.S. Administrative Law Judge

Hearing Office Chief

That’s the letter my dad received in early 2013 two weeks after his older brother’s death.

The Unimportant Details

At 9:30 p.m. on a Friday night in late December, my dad called me.

“Hi.”

“Hi.”

“Uncle Hershel died.”

“Um, what? How? Where? Of what? Can you tell me more information?”

Pause.

Pause.

“Not really. They found him in his apartment. They don’t know when it happened.”

They didn’t know when it happened because he lived alone. He lived in the same one-bedroom apartment in the Shaker Heights neighborhood of Cleveland for 40 years. The only way they knew something was wrong was because of the deal he struck with the building super (I picture him like Schneider a la “One Day at a Time,” but only because Pat Harrington fills in a lot of blank face Every Men in my imagination). The deal was if there were two newspapers outside his door, Schneider should further explore. A neighbor alerted Schneider of the two papers and he promptly retrieved the apartment keys. I can only imagine the feeling he must have had when he put the key in the lock. I know I’m projecting when I imagine my own knotted stomach and shaky hand, while conjuring an image of what awaited on the other side of the door.

The details of what Schneider found are unimportant, as there was nothing horrifying, or tragic (despite the obvious) and only the most certain indication that my uncle died immediately of causes that will always remain unknown, but decidedly natural.

This happened during the weekend before the new year, so arranging a Jewish funeral in Michigan when the body was in Cleveland and ensuring the burial and Shiva could all happen in good time, was a bit challenging, but as is usually the case, things fall into place. At the funeral, I sat between my dad and my aunt, staring at the simple pine box hovering over a six foot deep hole, thinking about how little I knew about the occupant of said box.

The Man

Dr. Hershel Goren completed his residency at the Mayo Clinic, served in Vietnam, spent most of his career as a neurologist at the Cleveland Clinic and in retirement became an expert witness for the Social Security Administration. He was awarded a full ride to Michigan State University and as a debt of his gratitude, started the Hershel Goren Scholarship. A similar opportunity exists for medical students at Wayne State University.

He graduated from medical school and went straight to Vietnam, an experience captured in only a handful of slides, a short diary, neatly pressed uniforms and a prayer shawl Jewish soldiers were told to bring with them to the war in case they never made it home. Members of my family divided up the small number of possessions we found personally valuable, including the reflex hammer neurologists use, which sits on my parent’s mantle.

Hershel never married, never moved, rarely took a new route to work and stopped traveling after 9/11. His Saturday could not be disrupted by family visits because he had a regular trip to the fish market to complete and cookbooks to adhere to in alphabetical order, no less. We imagine those endless weeks of consuming chicken to be the most dreary.

When one lists the details of my uncle’s life, it seems confusing, or sad or monastic or unfulfilled. However, my dad made what is likely the most accurate statement: “His internal life was fulfilled.” While the rest of us are busy amassing large quantities of stuff—bigger houses, nicer cars, iPads, iPhones, full DVRs, children and food, my uncle lived no differently than he did during his four years of residency.

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Storytelling in the Exam Room

By Patricia Kullberg

Mrs. Truong is tired inside, dizzy behind her eyes, and her sleep is no good. There is a buzzing in her chest. The left side of her body feels swollen, her left arm hurts and doesn’t work right. The pain, she says through the interpreter, is very deep. Perhaps worst of all, her bones are cold. Impossible, I think to myself. Yet, how miserable it must be to suffer a chill in such a deep and inaccessible place. She is middle-aged, a refugee from Vietnam and has come to consult me, as her primary care doctor, about her medical problems. She wishes to know what is wrong with her and she wants a remedy. Like all patients, she expects me to re-construct her story in medical terms, to make clinical sense of it in a way that will produce an effective therapy and relieve her suffering.

Her physical examination is normal and diagnostic testing reveals nothing but the minor findings of a well-controlled thyroid condition. She appears, however, indescribably sad. I know what is wrong with her. I see it already at the first visit. In that same moment I suffer the premonition that I will not be able to help her. Mrs. Truong has lost nearly everything dear to her: her husband, most of her family, her community, her cultural surrounds, and her homeland. She’s been cast adrift in urban America, isolated and lonely, with precious little to occupy her time. She is, as most anyone would be in her circumstance, depressed.

Over months of encounters I try to read her as one would read a book, drawing on information from her daughter and the interpreter and my own perspectives on the Vietnam War. I read between the lines of her story, rich with unintentional metaphor and striking for what neither she nor her daughter can or will tell me. I construct a narrative that takes into account the social, psychological, political, and moral dimensions of her illness. What’s the point? My hope is that a more complete and comprehensive assessment will deepen our therapeutic alliance and help me tailor my therapeutic approach to her values, desires, understandings, and circumstance.

But clinical encounters are constrained in so many ways that can sabotage this process. In Mrs. Truong’s case, our respective stories about her illness are embedded in two irreconcilable understandings of disease and disorder. We are unable to breach this gap. The idea of mental illness is too problematic. Her rejection of my story spirals into unnecessary investigations and leads to a therapeutic impasse. I am not, as I had feared, able to help her feel better.

As a speaker for the Northwest Narrative Medicine Project, I will discuss the role of storytelling in the exam room, drawing on narratives from my book, On the Ragged Edge of Medicine: Doctoring Among the Dispossessed, to explore various factors that impinge on the power of storytelling to enhance the clinical encounter. The stories I will tell speak to both sides of the stethoscope, the patient and the practitioner. I expect that participants will have their own stories and perspectives to share. I will pose problems for discussion. I won’t have the answers. But good answers always start with good questions.

Patricia Kullberg, MD MPH, will speak on Tuesday, March 14, 7:00-8:30 pm, in the second floor auditorium of the Collaborative Life Sciences Building at 2730 SW Moody.