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The Poetry in Geriatric Medicine

2018; Elsevier BV; Volume: 19; Issue: 5 Linguagem: Inglês

10.1016/j.carage.2018.04.009

2377-066X

Jerald Winakur,

Empathy and Medical Education

For the last 30 years I have been writing about my work in geriatric medicine. It is in the poetry where one most clearly hears the human voices — my own and in those to whom I have ministered. The writing has provided me with valuable insights into why I chose medicine, specifically geriatrics, as my life’s work. I believe that the act of writing these poems, of highlighting, of memorializing these experiences, has kept me centered. I have also realized that the work of reflecting on my day in and day out doctoring life — whether these experiences be banal, or upsetting, or sublime — has nurtured my empathic responsiveness and made me a better physician and a better person. This poem arose after rounding on one of my long-term care patients many years ago — long before AMDA existed. I could not help thinking about — perhaps a bit too optimistically — how I might feel if were I him. When will my eyes Letting It Go Tied into that chair he’s come full circle sits outside the nurses station watching his world in shift rotations likeable old gent but he can’t hear our exhortations it’s that smile he gets just before he lets it go part relief part wicked anticipation the nurses know ask me year after year in consternation Can’t we just put in a catheter? and I always say No! without hesitation lecture on infections then pat him on the shoulder as if to say: Well done! And one day when I lie in my own pool of self-reflection I will savor that warmth tickling the remains of my erection patiently await their arid ministrations and with that my own powdery resurrection Here is a poem that came to me after a routine office visit with a couple whom I had been caring for over many years. The Whistler They come every four months He smiles, drools, sits quietly always says yes, only says yes at her turn she bitches and sighs bemoans and cries: he’s getting worse he’s only getting worse She can’t take it anymore and neither can I. Have you considered a Home? I ask my stethoscope on her chest trying to discern what’s inside, looking into her mascara-caked eyes now red and ruined beyond relief when she shyly says, Doctor I’ve gotten so fat but do you know he still whistles when I take off my clothes And he sits there smiling smiling, grinning, nodding Yes, he says. Yes. Those of us who care for the oldest and sickest in our technologically-based, end-of-life conveyor belt of “do everything you can” have witnessed the scenario described in the next poem all too often. Side Show Come one come all see what awaits you amazing death-defying acts by octogenarians and even older the barker in white coat stands center station flipping his instrument see the Pretzled Woman living on green drool grass-snaked through her nose all the way to her gullet and over here we have Vacant Man–watch his chest rise and fall in perfect syncopation with the mechanical sighs of loved ones who said do everything you can... you be the judge then thrill as poisons pummel Mister Neoplasia a race to the finish see what’s eating his hairless hopeless carcass then gasp at grandma’s wire act heart stopping spells of fatal fibrillation deftly thwarted by a thin strand threaded through amazed arteries into a heartsick ventricle shocked and dazzled by joules pulsed along its length death defying death denying how long can this go on? Step right up — don’t be the last in line. I will never forget my involvement with these two people, the oldest, old mother and her aging, doting son, both my patients. All of us trying so hard. The Tyranny of Aging She’ll soon be ninety-five, struggling to stay alive after that last stroke left one-half paralyzed. More encouragement is what she needs I tell her worried old son as I leave the daily shift by shift progress of this tortured recuperative process: the fatigue, the frailty, the torn rice paper skin the thick syllables, the bottom reddening. Yet she understands every word, tries, tries puts up with our constant entreaties: Yes, that’s it, that’s it we say, see there’s movement coming back, keep pushing, work every moment, you don’t live to be your age by giving up. Wake up, pull up, sit up, cough that junk up…. And, you know, she’s improving: the feeding tube is out, she’s talking more, drinking Ensure, the therapist has her bearing weight on the good leg. I’m planning a discharge date okay, to a nursing home, but a good one. She’ll have visitors — her “boy” — flowers, the sun. She just needs to keep up the hard work push a little more say the aides and clerks Now today I’m in the stairwell hushed, head spinning heart pounding, mind-weary from all this rounding I have to go to her now–doctor-calm, manner mild– to say I just closed the lids on her last living child. In the poem Sherbet (see box), I remember how it felt to come as a visitor to my friend and former patient now in palliative care. Someone with whom I had struggled so mightily to save during a protracted hospital siege — before I convinced myself and her family that it was finally time to let go. Dr. Winakur practiced internal and geriatric medicine for 36 years. His latest book is Human Voices Wake Us (Kent State University Press, 2017).