Words that heal

Blessed are they that mourn, for they shall be comforted.

There once was a physician who had twin daughters. One grew up to become a psychiatrist. The other developed schizophrenia as an undergraduate. She poured out her anguish through words with pen on paper. Eventually, she became a published poet. Of the two daughters, which one was the healer?

In order to diagnose, a psychiatrist must learn to listen to the patient. Now there are many practicing psychiatrists who base their pharmacological treatments on symptoms alone. Medication regimens are adjusted based upon the patient’s response to the drug. Sometimes the dose is increased to enhance the effect of the drug; other times the drug is discontinued because of untoward side effects. Much of pharmacological treatment comes down to trial and error. Many times medication can help, but in the end a pill cannot heal a soul.

Freud, regarded by many as the father of psychiatry, once wrote: “Wherever I go, I find a poet has been there first.”

Throughout the centuries poets have pursued the art of crying out, of putting pen to paper (or stylus to papyrus), crafting words as conduits to transmit their anguish, their deepest longings, their joys, their sorrows. Many have written in part to help themselves to heal. When we read their words, we enter in to their anguish, their longings, their joy and their sorrow; and when we do, we ourselves may experience some degree of healing as well.

It doesn’t take a college degree to become a poet. One must only open oneself up to the suffering of the soul, to face one’s demons, to record the emotional truth of the spiritual state, to capture the passion (and in this instance I refer to the root meaning of that word: to suffer) in a few brief lines which may, if one is lucky, last for an eternity.

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Readjusting to medical practice in America

I write these words in a bit of a mental fog. Lying in my own bed in the early morning stillness, I unable to say with any degree of certainty whether our recent 16-day medical mission to Africa was a conjurer’s dream, or if this American life with its mundane worries and cares might actually be the illusion.

Yesterday, belatedly I flipped the page of the calendar that hangs on my bedroom closet door. The month of August bears a reproduction of Gauguin’s “Dog Before Straw-Covered Huts, 1892.” Although Gauguin painted in Tahiti, this scene could well be African; the colors certainly are. In any case the Gauguin print offers a magical window to the events of the past two weeks.

I am still on Nigerian time, five hours ahead of schedule. I become sleepy at 4 o’clock in the afternoon. Last night I forced myself to stay awake until 9:00 PM, then slept soundly until 2:30 AM. Shortly, I drifted back to sleep until 4:00 AM, when agitated, I arose, unable to endure the confines of the bed any longer.

Yesterday at the office I saw 18 patients, a mere pittance compared to the usual daily roster of 75 to 90 in Obudu and Ogoja. Yesterday my American patients came to me with their slates of worries and anxieties, for which I silently forgave each one of them on the spot, because they had no understanding, really no concept of what it means to face suffering truly every day without hope.

The one exception was the father whose young son failed his routine vision screening in the right eye. Instead of the usual red reflex, a grayish white pupil greeted my light. Over the course of the past two years this man’s wife had been diagnosed with breast cancer and his daughter developed insulin-dependent diabetes. I referred the boy to an ophthalmologist for further evaluation. This family has suffered much, and there will be more suffering to come; but at the very least there will be treatment available and the means to access it.

As yet I have not left Nigeria in my mind. I am still haunted by the faces of the suffering children I saw, children for whom I could do little from a medical standpoint. As a clinician practicing in the African bush, I could not cure dislocated hips, disfiguring keloid scars, congenital hernias the size of eggplants, hemolytic anemias, and scarred corneas. Moreover, my Nigerian patients didn’t have the resources to travel 5 hours to the nearest university hospital, let alone bear the cost of care. (In Nigeria, medical care must be paid for out-of-pocket prior to treatment.)

Although I have left Nigeria, Nigeria has not left me. She is like a child crying in the night, waiting to be comforted; rooting for a mother’s breast nowhere to be found.

Great performances, poor players

Medicine is a learned profession, but clinical practice is above all a matter of performance, in the best and deepest sense of the word. —Frank Davidoff, M.D.

Years ago I recall watching a television documentary on Arthur Fiedler, the conductor of the Boston Pops orchestra.

The camera caught Fiedler backstage, stooped and shuffling slowly about as he struggled with his tux in preparation for the evening performance at Symphony Hall. He looked like the old man he had become—tired, fatigued, worn out. But then, as he stepped out onto the stage, a miracle happened. Fiedler’s frame straightened, his head lifted squarely onto his shoulders, a big smile flashed across his face. Proudly, he assumed his position at the head of the orchestra, pumped up by the thunderous applause.

We are what we are; we become what circumstances require of us.

Fiedler’s transition occasionally flashes through my mind as I step across the threshold into an exam room to meet a patient. Almost always I offer a big smile and extend a hand in greeting. I attempt to hold my composure throughout the interview, adjusting my demeanor to reflect the emotional state of the patient. I become, as it were, a player on stage where the art of medicine is performed countless times in daily rounds.

I might move from an encounter with a new mother, freshly primed by a healthy, thriving infant to a silent teenager, subdued in the throes of a depression. In each case I’m cast as best supporting actor, called to muster my emotive repertoire at a moment’s notice.

Sometimes I don’t feel up to the task; I’m drained, exhausted, spent. Sometimes I want to turn tail and run as fast and as far as possible to distance myself from the suffering I witness daily. I want to cover my ears, shut out the woes, the aches and complaints, for I have more than enough of my own.

None of this is permissible, of course. The patient has come seeking expertise, care and compassion—what does it matter how I, the clinician, might feel?

Here Osler’s wise words of comfort seep into my mind:

Dealing as we do with poor suffering humanity, we see the man unmasked, exposed to all the frailties and weaknesses, and you have to keep your heart soft and tender lest you have too great a contempt for your fellow creatures…

Even I, a poor player who daily struts and frets his hours upon the stage of clinical medicine, am not one to wallow in self-pity. Ultimately, I can not run from the responsibility I have for those entrusted to my care.

I call to mind the image of Fiedler stepping out on stage. Once more I buck myself up, rap quickly on the exam room door and step into the limelight for my next performance.

It will be the best I have to offer.