Poetry & Communication in the Medical World

‘In the din of medicine, what are the voices of our patients, what are our voices, that they become so hard to hear?’ (1)

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Last week I spent a truly enlightening day at Manchester University’s Medical School. I was there to contribute to a day of seminars on the topic of Significant Illness, run by Dr. Sarah Collins. Brilliant and inspiring, Sarah is course director for the MSc Medical Humanities and Senior Lecturer in Communication. Students come to Significant Illness sessions to hear former/current patients talk about their experiences of living with a ‘significant illness’. Two women came to speak about being diagnosed and treated for cancer. I was there to discuss patient/carer/doctor dialogue and palliative care, but also, as the first poet to visit the centre, to run poetry workshops exploring poems about the body.

The day was all about communication. It was set in the Consultation Skills Learning Centre, where Sarah teaches Clinical Communication. She aims to encourage a relaxed and informal atmosphere. There was lots of food and drink provided, to sustain us throughout the day, and we needed it. The talks are frank and can be distressing, but Sarah provided a safe place for everyone, including the students, to talk openly about their views. We started with a discussion in small groups about what ‘palliative’ means. I admitted to the students that I have always interpreted ‘palliative’ as a hopeless word. Its connotations for me are negative and desperate. The medical students however, saw its meaning change, and adopt different levels of significance depending upon the age of the patient. If the word was attributed to a child, they understood my interpretation, but when applied to an elderly person, then the word became more positive. ‘Palliative’ became about making people ‘comfortable’, about enhancing the quality of a life, however limited, not a failure to save one.

In workshops that followed we discussed poems about diagnosis by Raymond Carver, Sharon Olds, Jon Glover. I had to remind myself I was not working with creative writing students, so acute was their understanding of the texts, so engaged were their responses.

One thing that really struck me is how much I assumed the students inherently understood the patient experience.  I was surprised how much they welcomed not only the poems but also Debbie’s story, about her diagnosis and treatment for breast cancer. I began to realise she was telling them something ‘new’, when she explained the impact of diagnosis, on her and her husband. I expected a medical student to already appreciate the range of emotional reactions, or to foresee what oncologist Samir Guglani, Director of Medicine Unboxed has described as the ‘charged world of the medical encounter’ (2) This is not a negative observation.  I’m beginning to understand, that just because it’s happened a lot in my family, not everyone has experienced ‘death’ and ‘dying’.  For some medics, the world of hospitals may be their first encounter with serious illness and bereavement.

Poet and editor Jon Glover, has written about living with Multiple Sclerosis in his collection Magnetic Resource Imaging. He and I have talked about the ‘alien world’ of the hospital, and people’s behaviour within it.

He says: ‘I am always amazed that they (medics) can seem interested, calm, helpful, sympathetic, gracious when they have just said something that changes one’s life. And they have said it to five people that morning and five more that afternoon, no doubt. And then they go home to tea.’

The poems led to an interesting discussion about how to communicate ‘bad news’. How acceptable is it for doctors to reveal their ‘human’ side? With that come questions of vulnerability, professionalism and respect. In a telephone call with Samir Guglani, I told him about the consultant who came to see my husband and I within an hour of our daughter’s death. She had been part of the team trying to save her, or rather prolong the little life Ella had left, at what was a very traumatic time in intensive care. Whilst talking to us, she began to cry, but abruptly stopped herself. She said she was being unprofessional. I wanted her to cry. We had looked to doctors all through Ella’s life for advice and help and knowledge. For them to cry, surely that would prove to my husband and I, that what had happened was terrible? We shouldn’t have to accept it. I felt cross that she chose to censor her response. When explaining this to Samir, he asked me to consider what right did she have, to intrude on our grief in that way? Could it be be detrimental if she was to place her own sadness upon us?

On sharing this with the students, they agreed that ‘getting it right’ was challenging in the complex world of communication within hospitals.  They were keen to overcome it, find an answer. In the end, we decided that time was an important factor. Although time is the most difficult thing to claim more of, we agreed it was needed for initial reactions to be understood, not misunderstood, between doctor and patient. Time spent in a room with a clinician is almost suspended in some way, it doesn’t feel real, especially at that moment of explaining bad news. There is almost a freezing of time, when the patients’ senses become extremely heightened. Glover’s poem ‘Back to the Diagnosis’ ends with him leaving the room, after an appointment with his consultant, and going ‘out to the corridor/and the waiting room and the files and the right time.’

After a writing workshop in the afternoon, where students read poems about all kinds of bodies by Jo Shapcott, Jean Sprackland, Neil Rollinson and Clare Best, they then began to write their own ‘body poems’. The day ended with a reading from Her Birth. I read to medical students and clinicians, writers and writing students from the city, actors who are ‘simulated patients’ at the hospital, as well as music and art therapists from hospitals in Manchester.  The setting was the most unusual I’ve read in so far: mock consultation rooms, where the students learn and practice. Nothing like a full-size skeleton as backdrop.

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The students seemed keen for more days like this, where they are given the opportunity to learn from ‘the voices of our patients’ and express themselves creatively.  I spent the day with intelligent young people, who absorb a vast amount of knowledge daily.  They learn intensely, but many of them miss literature. There is ‘no time’ for it in their studies and yet they feel they could learn so much from it. It was wonderful to see the students responding so vibrantly to the poems they read and heard that day.  I am very grateful to Sarah for inviting me to the centre, and for letting me devise workshops for the day. It was a day of learning for everyone involved, myself included and it felt so positive to be using poetry in this way.  It was a privilege to spend time with the students. I will leave you with some of their revealing thoughts about the day.

“As a former literature and languages student, it was really refreshing to dip back into that world an indeed learn more about the bridge between art and medicine. I feel that my arts degree has truly enriched my view of our world and of people and of ‘the human condition’ – and as such has added so much to my study of medicine – coming to the reading has enabled me to reconnect with this.” (Olivia George, Year 2 Medical Student)

“It was really nice to have something involving literature as this is an interest of mine that it is hard to explore while doing a medical degree.” (Sam Button, Year 2 Medical student)

“I believe that introducing the power of poetry into medical education can make a difference in the way medical students approach their patients….Coming to the session really helped me consider how we as medical professionals can make a difference to families affected by bereavement – empathy is fundamental for healthcare workers and this form of poetry really helped me revisit its importance. The role of poetry is hugely underestimated in medicine and medical communication – needs to be promoted and encouraged!” (Sargam Vohra, Year 3 medical student)

“I really enjoyed attending the workshop. It was very comforting to listen to poetry about medical conditions. Being a medic means I think about medicine for a long time, so it can sometimes get overwhelming. But looking at medicine through poetry is healing and restoring. I think poetry gives medicine a more humane perspective. The workshop gave me an opportunity to think deeply and philosophically. I would love to attend more workshops like this.” (Zarat Queen, year 2 medical student)

“An interesting session……relevant to our studies but also cathartic and helpful personally. A useful reminder of why we are going into medicine! Something different, enriching our experience of the course.” (Bethany Butcher, Year 2 medical student)

“We were taken through a whirlwind tour of real patient experiences of hospital life and treatment at the same time as considering the ethical, emotional and philosophical aspects to debilitating illness, death and bereavement. As well as being fantastically enjoyable throughout, it was a brilliant way to introduce second year students to the lay person views and the importance and significance of understanding death and the roller-coaster ride involved for patients.” (Matthew May, 5th year medical student)

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Dr Sarah Collins and I during the post-reading Q&A

Dr Sarah Collins and I during the post-reading Q&A

Notes:  Quotes (1) & (2) from ‘The Art Of Medicine: Medicine’s Human Voices’ by Samir Guglani, The Lancet, Vol 384, Sept, 2014

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14 thoughts on “Poetry & Communication in the Medical World

  1. Thank you for your interesting article. I’m also keen on the connection between poetry and medical science and there are a few poetical works that I think might be of interest to you, both by doctors. The first is “The Diagnosis of the Acute Abdomen in Rhyme” by Zachary Cope alias Zeta. This is an extraordinary work of poetry as it was written by an expert in acute abdominal surgery and contains a lot of factual information which would benefit medical students. I think it is also interesting as it also contains the authors own observances of the changing practice of medicine in his era. I believe it is still in copyright and is pretty hard to get a hold of but is worth reading even if the poetry itself is a bit clunky.
    The other one is “The Botanic Garden” by Erasmus Darwin which is easy to view online and also contains a vast amount of scientific information presented in a Dryden-esque epic poetic form. The notes are at least as extensive as the poem itself which mostly relate to contemporary science across many disciplines. Medicine doesn’t actually feature much but Erasmus Darwin (grandfather of Charles) was a well respected physician of his time.

    • Thank you Drew, for sharing this information. I will seek out what you suggest. I agree, creative writing by doctors/medics is a valuable source. The work of Dannie Abse and Denise Bundred has often moved me.

  2. Hi Rebecca – I heard you read at the Wordsworth Trust – remarkable, moving poems. I read your blog above – also fascinating and beautifully written. My daughter is a doctor in intensive care and we have discussions around these topics all the time. Quite often she’ll phone me or email when a day has been particularly bad. She didn’t deliberately write this as a poem, although she is interested in poetry. I’m not making any great claims for it, but it illustrates the way tragedies live in the minds of doctors, and although it’s really simply stated, it’s filled with sadness. She calls me ‘Poppy’, hence the opening line.

    Oh, Poppy,
    shocking night shift
    cardiac arrest on a four week old
    resuscitation led by me,
    for over an hour…
    we couldn’t get him back…

    • Thank you Pauline, for your honest and moving email. Your daughter’s words make a ‘found poem’ don’t they? It’s so simply put, but so accurate, and how powerful the line: ‘for over an hour’, proving the physical exertion, as well as the emotional exhaustion that took place that night. Thank you for posting it here. I’m in admiration of what your daughter does. Do hope our poetry paths cross again.

  3. This is inspiring and moving. I wondered if you knew about the Tools of the Trade, Poems for New Doctors? http://www.scottishpoetrylibrary.org.uk/poetry/poems/tools-trade which puts poems in the pockets of doctors who wouldn’t usually read poetry. I’m fascinated by the potential for narrative forms to bring a wide range of perspectives and ways of critically thinking about how medicine is a moral, inter-subjective, interpretive practice (or practices) rather than a science (or for that matter an art). The skills required to understand people and to view our own perspective with humility aren’t very well taught in medical education, and we desperately need better ways of teaching them. Whatever ways we choose need to capture the attention and imagination of all healthcare professionals, not just the nascent poets – there lies the challenge (I think). A few of my thoughts are here: https://abetternhs.wordpress.com/2015/01/22/everyday-ethics-2/ though most of my blogs are about this in one way or another,
    Jonathon

    • Yes, I do know about Tools of the Trade, a brilliant idea. I was heartened by your response to my post today Jonathon, thank you. Just as I was heartened by the students’ positive responses to the poetry at Manchester. I know very little about ‘medical education’ but I do believe that poetry has a valid place on any medical curriculum – helping future doctors and clinicians to understand humility like you say, and empathy and the skills needed to talk about ‘difficult things’. My day at Manchester reinforced that belief. I shall look at your blog with interest, thank you.

  4. Rebecca, Thank you so very much for coming to spend time with us at Manchester Medical School. It truly was an inspirational day and we are immensely grateful to you. Thank you for reading your poems, for the insights you have given us into Ella’s life and her illness, and for contributing to our medical education project, through which we aim to provide space for creative thinking, self-expression, and individual response to personal experience.

    I’ve loved reading everyone’s comments so far – fascinating and really helpful for me.

    Rebecca’s visit was 10 days ago, and since then we’ve had another 7 of our Significant Illness sessions (a further 84 students), in each of which we have read and discussed three of Rebecca’s poems (‘Toast’, ‘Room in a Hospital’, ‘Palliative’) together with our visitors (who, as well as those talking about their own illness, have included psychotherapists, specialist nurses, palliative care consultants, and Macmillan volunteers). I’ve also taken the poems to ‘Breaking Bad News’ sessions with our 4th year students. And in the closing plenary of our Manchester Communication Conference this Wednesday 11 March, a number of our students performed their own compositions – their responses to significant illness – brilliantly cast in poetry, drama, and music.

    In our medical school curriculum, poems are one kind of stimulus for conversation and communication about personal experience. (I am collecting examples of the multiple ways poetry is referenced in our curriculum and the learning it generates, and would be happy to share these.)

    It doesn’t much matter whether or not the students are nascent poets (or musicians, short story writers, or actors . . .). To quote a student from this week, “I thoroughly enjoyed the session yesterday, I loved how intimate it was and I think that helped the contributions. I’ve always been anti poetry but I thought it really helped better understand a patient’s views”. What does matter is that the education we design and deliver allows intimacy, and creative space for students to be themselves, just as we desire that same space for a patient’s self-expression and unique experience in a consultation.

  5. Sarah, my thanks for this eloquent, warm response. I couldn’t agree more with your final statement. I’m happy knowing that poetry, ‘Her Birth’ and my experiences can be used in this way with your students. I do hope we can work together again.

  6. Thank you Rebecca and Sarah for an excellent day. Us medical students spend hours and hours on a sort of “other side” to patients (and often we are literally sat opposite to them!)- we learn how to “be” medical students and then how to “be” doctors. We come into hospitals from a very different angle and with a very different purpose to patients- the hospital is our classroom.
    Many of us are lucky enough not learn what it is like to be a patient, or the loved one of a patient in our personal lives and therefore we only really see things from this medical other side, the doctor/student side. Days like this allow us some important insight into a patients experience, an insight which can be difficult to gain when we are approaching patients as medical students rather than simply as humans.
    Thank you both 🙂 Rhi

    • Hello Rhi,

      It’s great to have your response to the day, thank you for taking the time to write, and for being so candid. It’s good to know you found the day so helpful. As did I. It’s just as important for ‘us patients’ to understand the complexities of patient/doctor interaction, from the doctor’s point of view too. Good luck with the rest of your studies at Manchester. It was a pleasure to meet you and your fellow students.

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