Words on the borders of the body
2015; Elsevier BV; Volume: 386; Issue: 10006 Linguagem: Inglês
10.1016/s0140-6736(15)00771-0
ISSN1474-547X
Autores Tópico(s)Empathy and Medical Education
ResumoWe are sitting around the edges of the situation—hushed and watchful visitors, torn between feeling necessary and a hindrance. “We” are family members coming in by shifts, and my notebook and I. Yes, I'm there at my father's bedside in the hospital ward marked High Care, feeling everything you feel for somebody you love as you watch them sinking deeper into the damage of their body, sinking maybe out of sight.At the same time, I'm the writer, if not physically with notebook in hand then with a note-taking mind absorbing just those details that later (yes, I know this, consciously) might be what animates a poem on the page. Is this a guilty confession—the splinter of ice that Graham Greene describes in the ruthless writer's heart? A confession, maybe, but not guiltily. It seems to me natural that one of the things in attendance at the bedside should be poetry. I need to explain, or to try to explain, how I dare to feel so sure of that.Last year, I was one of the judges for the Medicine Unboxed Creative Prize—a prize for any form of artistic expression that addressed medical issues, with judges drawn from all branches of the arts. The rich range of entries took in anything from operas to art installations, from novels to electronic brain-music machines. But I was struck by the fact that more than half of the entries in our shortlist were poetry collections or at least projects that gave a leading role to poetry. What was it about poetry, this most low-tech, low-budget, and arguably modest form of creativity, that seemed so well adapted to stand at the edge of the world of medicine, and of illness itself?Remembering those days at my father's bedside, with the quiet attentive visitors, suggests an answer. The poems in the Medicine Unboxed Creative Prize competition varied widely in style but they shared one quality—that of listening to their subjects giftedly.Plenty has been said, and still needs to be said, about the role of poetry in helping people speak out. For people who find themselves cast as patients, as “sufferers”, there can be a desperate need to make one's experience heard. For mental health service users, the sense of being unheard, misheard, can be particularly sharp, and there is, I believe, a good therapeutic case to be made for making one's inner experience articulate—to be heard by the world outside, one's family, workmates, friends, not to mention one's doctors, and, at last and crucially, to be heard by oneself. This need to be heard can be as true in physical suffering as the psychological kind. The winner of the prize on this occasion, Tiffany Atkinson, in her collection Dolorimeter, wrote poems that showed language almost at its wits' end with the challenge of articulating pain.But the emphasis on poetry as self-expression overlooks its equal-and-opposite gift, that of listening. More than any other form of writing, poetry gains power from the words' relationship with silence. Silence tends to have a bad name in the world of self-expression, but there are as many kinds of silence as there are of speech.The silence I mean here is not the silence of the silenced; it is a silence in attendance, a resonant silence, silence listening. If it was a therapist, it would subscribe to the school that offers no opinions, just a clarifying echo of the other's words now and then. It offers a space in which the other's words mean more.On the poetry page, the silence of listening is visible. It is the white space where the end of each line hangs, a moment—the end of a stanza even more so. The space around the edges does more than contain the words; it gives them whatever form, fluid or formal, they need.Sometimes I look at a poem forming on my notebook page and I want to reverse the sentence I have just written. The words are there to shape a silence the situation demands.But back at my father's bedside, I am both present and a step or two outside. Look, there's me, I notice, playing that part; there's him, my father, playing his, in this not at all unusual human drama. A tweak of the cast list, we could swap; the play goes on. Or we could be the family at the next bed, or the medical staff, or the porters, all moving with that particular blend of urgency and calm that characterise the inhabitants of this island called hospital, a world apart from but also somehow contained in the everyday world.Of all forms of writing, poetry is the one that most alertly attends to itself—not self-indulgently, we trust, but responsibly, in the way a good therapist knows that she needs supervision. It takes nothing for granted about language, and tries to be self-aware of what it is doing, what liberties it is taking (yes, there are ethics involved in this, as well as care and love) when it speaks. It is aware of boundaries. During those long days in High Care, there was no mistaking that we were sitting close to the boundary of life and death—in fact that father would already have been over it without that high-tech care. That proximity made us tinglingly aware of boundaries between people. The person in the bed whose hand you could physically hold might be already in a place beyond your reach.Boundaries and borderlines had long been a fact of my father's life. He was a refugee from the Baltic state of Estonia, invaded and occupied by Russia, by Germany, and by Russia again during the course of World War 2. His survival had depended on the porousness of borders—dangerous ones, policed—but he had made it through. That history furnished my family with metaphors for the final months of his life. At the difficult end, I would be willing him to slip beneath the wire, the cruelly barbed wire, it had come to seem…and away. But that was later. Now, the High Care ward seemed to be filled with other kinds of borders, ones that challenged my understanding and my feelings even as I sat there. Was he, or in what sense was he, there with us at all?The previous few years of my father's life had called some fundamentals into question. As he lost the use and gradually the understanding of language to a deepening aphasia, as his memories of himself fell away, and then as dream-like figments of a traumatic past began to harden into something real enough for him to see them standing at the end of his bed, everyone who knew and loved him had to ask: where are you now? Where would any of us be, once we are not in our language or our memories? Was some essence of him still there, whole but inaccessible, beyond the rubble? Or was he dispersing already, as bodies disperse into their elements after our deaths?All of these questions could be abstractions—in the bad sense, academic—except that during my father's illness they became questions made flesh. Beyond the point where he could physically say anything, or even think it, my father was asking the most searching questions about language, about what it means to be a self, and yes, about poetry.I had previously written a collection of poems, Deep Field, in pursuit of those questions, but this was one step closer to the edge. That day, in High Care, words were out of the question, apart from those words on the medical notes, and the numbers on the monitors around him, all beyond me. But the blurring of boundaries was in front of my eyes, the most physical and technological of facts. What else could poetry do, from a hard chair at the bedside, but attend?In High Care,a high-sided bed contains you… notentirely: these tubes and wires are a part of you too;that shivery trace, you, on the monitor,the numbers that tot up the oxygen freight in your blood.The shrink-crumpled black- reddish bag of onetransfusion, another of amber like sap from the pine,not to mention the saline, a clear life-tisane—all you, also hospital property: the conduits and nervesof its rhythmical-jittery self. (Bleeps everywhere,continual not-quite-always-false alarms.) I lean in;I'm within the gradual devolution of this body,even less sure than you seem (as you scratch, in a vaguediscontent, half-sleeping, where sticky-pads itch;a mosquito has settled, steel proboscis in a vein;you swat at it)—less sure, as I take your handto stay it, just at what point you begin or end.Philip Gross's new poetry collection, Love Songs of Carbon, was published by Bloodaxe in September, 2015; he won the T S Eliot Prize with The Water Table in 2009. Philip Gross, “In High Care” from Later (Bloodaxe Books, 2013) is reproduced with permission of Bloodaxe Books (www.bloodaxebooks.com) on behalf of the author. We are sitting around the edges of the situation—hushed and watchful visitors, torn between feeling necessary and a hindrance. “We” are family members coming in by shifts, and my notebook and I. Yes, I'm there at my father's bedside in the hospital ward marked High Care, feeling everything you feel for somebody you love as you watch them sinking deeper into the damage of their body, sinking maybe out of sight. At the same time, I'm the writer, if not physically with notebook in hand then with a note-taking mind absorbing just those details that later (yes, I know this, consciously) might be what animates a poem on the page. Is this a guilty confession—the splinter of ice that Graham Greene describes in the ruthless writer's heart? A confession, maybe, but not guiltily. It seems to me natural that one of the things in attendance at the bedside should be poetry. I need to explain, or to try to explain, how I dare to feel so sure of that. Last year, I was one of the judges for the Medicine Unboxed Creative Prize—a prize for any form of artistic expression that addressed medical issues, with judges drawn from all branches of the arts. The rich range of entries took in anything from operas to art installations, from novels to electronic brain-music machines. But I was struck by the fact that more than half of the entries in our shortlist were poetry collections or at least projects that gave a leading role to poetry. What was it about poetry, this most low-tech, low-budget, and arguably modest form of creativity, that seemed so well adapted to stand at the edge of the world of medicine, and of illness itself? Remembering those days at my father's bedside, with the quiet attentive visitors, suggests an answer. The poems in the Medicine Unboxed Creative Prize competition varied widely in style but they shared one quality—that of listening to their subjects giftedly. Plenty has been said, and still needs to be said, about the role of poetry in helping people speak out. For people who find themselves cast as patients, as “sufferers”, there can be a desperate need to make one's experience heard. For mental health service users, the sense of being unheard, misheard, can be particularly sharp, and there is, I believe, a good therapeutic case to be made for making one's inner experience articulate—to be heard by the world outside, one's family, workmates, friends, not to mention one's doctors, and, at last and crucially, to be heard by oneself. This need to be heard can be as true in physical suffering as the psychological kind. The winner of the prize on this occasion, Tiffany Atkinson, in her collection Dolorimeter, wrote poems that showed language almost at its wits' end with the challenge of articulating pain. But the emphasis on poetry as self-expression overlooks its equal-and-opposite gift, that of listening. More than any other form of writing, poetry gains power from the words' relationship with silence. Silence tends to have a bad name in the world of self-expression, but there are as many kinds of silence as there are of speech. The silence I mean here is not the silence of the silenced; it is a silence in attendance, a resonant silence, silence listening. If it was a therapist, it would subscribe to the school that offers no opinions, just a clarifying echo of the other's words now and then. It offers a space in which the other's words mean more. On the poetry page, the silence of listening is visible. It is the white space where the end of each line hangs, a moment—the end of a stanza even more so. The space around the edges does more than contain the words; it gives them whatever form, fluid or formal, they need. Sometimes I look at a poem forming on my notebook page and I want to reverse the sentence I have just written. The words are there to shape a silence the situation demands. But back at my father's bedside, I am both present and a step or two outside. Look, there's me, I notice, playing that part; there's him, my father, playing his, in this not at all unusual human drama. A tweak of the cast list, we could swap; the play goes on. Or we could be the family at the next bed, or the medical staff, or the porters, all moving with that particular blend of urgency and calm that characterise the inhabitants of this island called hospital, a world apart from but also somehow contained in the everyday world. Of all forms of writing, poetry is the one that most alertly attends to itself—not self-indulgently, we trust, but responsibly, in the way a good therapist knows that she needs supervision. It takes nothing for granted about language, and tries to be self-aware of what it is doing, what liberties it is taking (yes, there are ethics involved in this, as well as care and love) when it speaks. It is aware of boundaries. During those long days in High Care, there was no mistaking that we were sitting close to the boundary of life and death—in fact that father would already have been over it without that high-tech care. That proximity made us tinglingly aware of boundaries between people. The person in the bed whose hand you could physically hold might be already in a place beyond your reach. Boundaries and borderlines had long been a fact of my father's life. He was a refugee from the Baltic state of Estonia, invaded and occupied by Russia, by Germany, and by Russia again during the course of World War 2. His survival had depended on the porousness of borders—dangerous ones, policed—but he had made it through. That history furnished my family with metaphors for the final months of his life. At the difficult end, I would be willing him to slip beneath the wire, the cruelly barbed wire, it had come to seem…and away. But that was later. Now, the High Care ward seemed to be filled with other kinds of borders, ones that challenged my understanding and my feelings even as I sat there. Was he, or in what sense was he, there with us at all? The previous few years of my father's life had called some fundamentals into question. As he lost the use and gradually the understanding of language to a deepening aphasia, as his memories of himself fell away, and then as dream-like figments of a traumatic past began to harden into something real enough for him to see them standing at the end of his bed, everyone who knew and loved him had to ask: where are you now? Where would any of us be, once we are not in our language or our memories? Was some essence of him still there, whole but inaccessible, beyond the rubble? Or was he dispersing already, as bodies disperse into their elements after our deaths? All of these questions could be abstractions—in the bad sense, academic—except that during my father's illness they became questions made flesh. Beyond the point where he could physically say anything, or even think it, my father was asking the most searching questions about language, about what it means to be a self, and yes, about poetry. I had previously written a collection of poems, Deep Field, in pursuit of those questions, but this was one step closer to the edge. That day, in High Care, words were out of the question, apart from those words on the medical notes, and the numbers on the monitors around him, all beyond me. But the blurring of boundaries was in front of my eyes, the most physical and technological of facts. What else could poetry do, from a hard chair at the bedside, but attend? In High Care,a high-sided bed contains you… notentirely: these tubes and wires are a part of you too;that shivery trace, you, on the monitor,the numbers that tot up the oxygen freight in your blood.The shrink-crumpled black- reddish bag of onetransfusion, another of amber like sap from the pine,not to mention the saline, a clear life-tisane—all you, also hospital property: the conduits and nervesof its rhythmical-jittery self. (Bleeps everywhere,continual not-quite-always-false alarms.) I lean in;I'm within the gradual devolution of this body,even less sure than you seem (as you scratch, in a vaguediscontent, half-sleeping, where sticky-pads itch;a mosquito has settled, steel proboscis in a vein;you swat at it)—less sure, as I take your handto stay it, just at what point you begin or end. Philip Gross's new poetry collection, Love Songs of Carbon, was published by Bloodaxe in September, 2015; he won the T S Eliot Prize with The Water Table in 2009. Philip Gross, “In High Care” from Later (Bloodaxe Books, 2013) is reproduced with permission of Bloodaxe Books (www.bloodaxebooks.com) on behalf of the author. Medicine Unboxed: frontiers and mortalityDebate and cultural change in medicine are at the heart of Medicine Unboxed. Since 2009 we have invited health professionals and the public to engage in dialogue about how medicine encounters society. At our annual events, patients, physicians, writers, philosophers, politicians, performers, and artists discuss medicine's goals and society's values, often seen through the prism of the medical humanities. 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