It would make an interesting calculation for some graduate student in English literature to figure out, since the introduction of the written word, how many poems have been written about death. Even without a definitive answer to this question, it is obvious that poetry and death have a long history together. Perhaps it is because, when nothing else is left us, when we have run out of remedies and medicines and interventions, we still have words. They offer only an imperfect resistance to the inevitability of our own annihilation, but since they are all we have, we wield them as best we may.

I came to writing poetry in middle age, or perhaps it is more accurate to say that I came back to it. I had compulsively scribbled poems since childhood only to abandon this pastime in college, when what I conceived to be real life overtook me. But when various illnesses beset my children and parents and my body gave its first twinges of the aches and pains common to midlife, I turned again to the written word for clarity of understanding and also for comfort. I wrote about my own illness episodes, and those of my family. When my best friend died of breast and ovarian cancer, I wrote about that too.

After I discovered for myself the healing properties of creative writing (how you can be miserable and in pain, write a poem about that pain, and afterwards still have exactly the same amount of pain but feel surprisingly better), and found these verified to some extent by the research literature (1, 2), I began to introduce such writing into my own professional work with medical students. Building on existing models of reflective and point-of-view writing in medical school (3, 4), I encouraged my medical students to write about their patients, in poetry as well as in prose. I thought that writing poetry might help students understand their patients — and themselves — from an entirely different perspective, through metaphor, image, symbolism, rhythm, allusion, and indirection (5), as well as liberate them from more conventional narrative forms of self-expression. On the whole, students responded enthusiastically, and wrote movingly about their patients and their own lives. Surrounded daily by illness, death, and dying, it was not surprising that one topic that preoccupied their writing is death.

Medical students are mostly annoyingly healthy, energetic, smart, caring, and capable young adults who like order, structure, and control. Death and dying tend to violate all of these positivist constructs about the nature of reality, and therefore often appear in student writing as unruly, transgressive phenomena that do not fit their neat formulation of health and disease. In both poetry and prose, they conceptualize death as the ultimate enemy, the foe they hope to defeat many times before at last yielding the field. Yet medical students also realize that somehow they must learn to become the facilitators and midwives of the dying process. In their writing, they wonder what death demands from them as physicians-in-training. They gaze hungrily at their dying patients, hoping that in their moment of transition they will reveal what is needed. What these students seek is a way to affirm that, although they are fast on their way to becoming objective professionals, apparently incapable of shock or fear, they are still compassionate human beings who can grieve the loss of a life (6).

When I was diagnosed with a rare form of uterine cancer, in the time it takes to read a pathology slide, my life was expanded from teacher (and wife, mother, grandmother, daughter, sister, and friend — but that is another tale) to include that of patient. My recuperation from surgery and commencement of treatment was accompanied by an outbreak of generative energy, almost as painful as a case of shingles, because it forced me to attend carefully and unrelentingly to emotions and thoughts which consciously I would much preferred to have avoided. Nevertheless, as artists have complained for centuries, the creative urge cannot be denied. In my case, it eventually took the form of a series of poems about cancer and death. These poems imagined me from the perspective of the grave (with a nod to Emily Dickinson); they cast death as an unwanted but omnipresent companion in every aspect of my life; and they tried to wriggle out from under the fear of death, if not death itself. Many of these poems emerged during an elective medical student creative writing group for which I served as faculty advisor that serendipitously started up upon my return to work.

In my poems, I am still a teacher even as I became a patient. My poems are written in equal parts pain and hope. I write them partly to begin to connect with other people experiencing the same unwanted acquaintance with death that I am developing; and partly to stay connected with my students whom I know are also often frightened, uncertain, and overwhelmed in the presence of mortality. Although they seek a guide, someone to show them the relevant landmarks along the journey, all I can be is a fellow traveler. In my writing, I want to strip myself bare, to become as transparent as water, so that the line between patient and doctor, between professor and student blurs, until their doubts and ambivalence are reflected in me, and mine in theirs. I want to say only, we are all suffering mortals. Let us help each other move toward this final mystery with grace, dignity, and courage.

Of all of the people who have written about death, none has ever discovered a way to use language to evade its grasp. No one has postponed the grim reaper's arrival by dedicating a sonnet to him. Yet in writing about death, from differing and shared perspectives, my students and I have moved closer to dying. Death remains inscrutable, but through writing poetry that names it, we have in some indefinable way befriended it; or if not that, then at least have familiarized ourselves with its many guises and come to recognize its varied approaches. In this strange intimacy, achieved word by painfully crafted word, there may be found resolution, and beyond that, even consolation.

Here Is My Body
By Johanna Shapiro, Ph.D.

Here is my body
I know its wounded places
Here a scarred remnant
Here an imperfect healing
Fissures and canyons of pain
Flowers of suffering
In steps now uncertain
The body still stumbles
Forward. It is ready
I am ready
Here I am.

References

1. Smyth, J.M., Stone, A.A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. JAMA, 281, 1304-1309.
2. Pennebaker, J.W. (2000). Telling stories; the health benefits of narrative. Literature and Medicine, 19, 3-18.
3. Branch, W.T., Pololi, L., Frankel, R.M., Coulehan, J.L., & Williams, P.C. (2001). Small-group teaching emphasizing reflection can positively influence medical students' values. Academic Medicine, 76, 1171-2.
4. Charon, R. (2000). Reading, writing, and doctoring: literature and medicine. American Journal of Medical Science, 319, 285-91.
5. Campo, R. (2003). The healing art: a doctor's black bag of poetry. New York: W.W. Norton.
6. Henderson, S.W. (2002). Medical student elegies: the poetics of caring. Journal of Medical Humanities, 23, 119-132.