It Is Nothing Like That

Though most days are an easy routine, people who spend their lives in operating rooms know that something awful is only one burst blood vessel, one uncontrolled infection, one random biological reversal away from ending a perfectly contented life. Our biochemistry makes sure things work well most of the time. But then, what are the possibilities for any two strands of DNA to become entwined? The lurking of chance that gives one person a ruptured aneurysm at twenty-five while permitting another to develop comfortable habits and drop dead at eighty-nine is what makes the poetics of doctoring.

When chance seized the teacher, football player, poet—and my patient—Richard Blessing, he was a lot like me: early forties, athletic, a reader, in love with his life. And then one day as he forced a graduate student to go to his left on the basketball court, a convulsion dropped Professor Blessing to the hardwood. Boom. A successful, happy life had turned into a sad one. Difficult, painful, short.

After eighteen months of his illness, Dick paid very close attention to words. CT scan, MRI, tumor, biopsy, radiation, and chemo are the vocabulary of the sick; because of his nature, the words circulated around the tumor in Dick's brain and came out as poems. What I said to him rattled around in there too. I was out of town when he suddenly got worse. "Is it now?" he asked. "Maybe," I told him from that other coast. "Probably." When I got back to Seattle two days later he was comatose, rolled up on his side facing a wall, eyes closed. He stayed that way for a week.

Then he woke up and lived another year.

His collection, A Closed Book, includes a short poem entitled "Directions for Dying." This title wasn't rhetorical, of course. I couldn't save him, a man of my own age and habits. Was I useless? Was there no justice? Well, no. Much of biology is chance, and cannot be altered or avoided even by the acceptance of some infinite force outside of space and time. Medicine only alters the course of things slightly. Doctors have wonderfully exact therapies to influence some diseases, but not all. We don't treat many cancers very well, or genetic diseases, or age. And treatment, of course, isn't the same as cure. Sometimes the best treatments are nothing but advice and comfort.

While my reading of prose has helped me understand much that I didn't know, poetry is a way to better see the things I might know deep down but cannot (or will not) say. Poems create empathy. The person with the knife in hand requires a better understanding of "maybe" than the training provides. While contemporary people, and perhaps surgeons in particular, tend to believe that they are in charge of their destiny and the fate of others, in truth we are adrift in a universe only partially visible to us, and we insist on guessing about the rest of it. Camus said that physicists were reduced to poetry—and that was before string theory. Denise Levertov called our handle on life in the universe "this great unknowing." In her late poem, "Primary Wonder," she writes about the mystery that there is anything, anything at all—let alone everything.

It is this everything that poetry helps reveal in our operating rooms and clinics. One task of medicine is to predict the direction of chance, to help patients prepare for what will probably happen. But that's so small a part of why people consult doctors. What about what could happen, or should happen, or might not? What about the ambush of the least likely? Isaac Babel wrote that the essence of art is unexpectedness, and it is in these side channels of life where poetry is a better guide than a textbook.

Forty years ago, when I was in medical school, I believed in this work as science. But clinical medicine has become a business of technology, not science. The latter is a way of looking at the universe. The former is method functioning within established statistical rules. And method may be industrialized. It is very difficult to jam into the same mind an industrial worldview and a humanistic one, which is why many medical schools now have formed departments of Humanities in Medicine. It really is love and work that define our communal life: medical students and residents must learn that. Young people learning to be doctors require poets. It is poetry that shows them, as Dick Blessing wrote of his own approaching death:

It is not like entering a mirror nor like closing a
door
Nor like going to sleep in a hammock of bones.
You may expect what you like. It is nothing like
that.