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There’s a good bit of history for the date, May 6th.

For instance, Olga Korbut, Sigmund Freud, and Maximilien Robespierre, among others, were born on this day.   In 1527, Spanish and German troops sacked Rome, signalling the end of the Renaissance.  In 1863, Confederate forces defeated the Army of the Potomac at Chancellorsville.  In 1889, the Eiffel Tower officially welcomed the public.  In 1954, Roger Bannister broke the four minute mile.  In 1994, the Chunnel opened underneath the English Channel, better linking Britain and France.  In 1998, Chicago Cubs pitcher Kerry Wood struck out 20 Houston Astros to tie Roger Clemens’ major league record.  May 6th is also police day in Georgia (U.S.), and International Diet Day.

But for whatever capricious reason, the historical factoid that resonates the most with me today is the admission on May 6th, 1757 of English poet Christopher Smart to St Luke’s Hospital for Lunatics in London.  He had developed a religious mania which compelled him to pray continuously, and apparently wandered the city doing so in public.

Samuel Johnson remarked, “My poor friend Smart shewed the disturbance of his mind, by falling upon his knees, and saying his prayers in the street, or in any other unusual place.” And also, “I did not think he ought to be shut up. His infirmities were not noxious to society. He insisted on people praying with him; and I’d as lief pray with Kit Smart as any one else. Another charge was, that he did not love clean linen; and I have no passion for it.”

Smart himself wrote in his work, Jubilate Agno, composed during the years of his confinement (though not published until 1939):

“For I blessed God in St James’s Park till I routed all the company. For the officers of the peace are at variance with me, and the watchman smites me with his staff.”

In all likelihood, Christopher Smart suffered from bipolar disorder.

He was, if excessively ardent in his devotion, harmless.  Certainly, far worse has been done in the zealous demonstration of faith.

Here is a poem for which he is well known.  One can imagine what effect the loss of freedom and bleak ambiance of the asylum must have had on its author.

For I will consider my Cat Jeoffry (from Jubilate Agno)

For I will consider my Cat Jeoffry.
For he is the servant of the Living God, duly and daily serving him.
For at the first glance of the glory of God in the East he worships in his way.
For is this done by wreathing his body seven times round with elegant quickness.
For then he leaps up to catch the musk, which is the blessing of God upon his prayer.
For he rolls upon prank to work it in.
For having done duty and received blessing he begins to consider himself.
For this he performs in ten degrees.
For first he looks upon his forepaws to see if they are clean.
For secondly he kicks up behind to clear away there.
For thirdly he works it upon stretch with the forepaws extended.
For fourthly he sharpens his paws by wood.
For fifthly he washes himself.
For sixthly he rolls upon wash.
For seventhly he fleas himself, that he may not be interrupted upon the beat.
For eighthly he rubs himself against a post.
For ninthly he looks up for his instructions.
For tenthly he goes in quest of food.
For having considered God and himself he will consider his neighbor.
For if he meets another cat he will kiss her in kindness.
For when he takes his prey he plays with it to give it a chance.
For one mouse in seven escapes by his dallying.
For when his day’s work is done his business more properly begins.
For he keeps the Lord’s watch in the night against the adversary.
For he counteracts the powers of darkness by his electrical skin and glaring eyes.
For he counteracts the Devil, who is death, by brisking about the life.
For in his morning orisons he loves the sun and the sun loves him.
For he is of the tribe of Tiger.
For the Cherub Cat is a term of the Angel Tiger.
For he has the subtlety and hissing of a serpent, which in goodness he suppresses.
For he will not do destruction if he is well-fed, neither will he spit without provocation.
For he purrs in thankfulness when God tells him he’s a good Cat.
For he is an instrument for the children to learn benevolence upon.
For every house is incomplete without him, and a blessing is lacking in the spirit.
For the Lord commanded Moses concerning the cats at the departure of the Children of Israel from Egypt.
For every family had one cat at least in the bag.
For the English Cats are the best in Europe.
For he is the cleanest in the use of his forepaws of any quadruped.
For the dexterity of his defense is an instance of the love of God to him exceedingly.
For he is the quickest to his mark of any creature.
For he is tenacious of his point.
For he is a mixture of gravity and waggery.
For he knows that God is his Saviour.
For there is nothing sweeter than his peace when at rest.
For there is nothing brisker than his life when in motion.
For he is of the Lord’s poor, and so indeed is he called by benevolence perpetually—Poor Jeoffry! poor Jeoffry! the rat has bit thy throat.
For I bless the name of the Lord Jesus that Jeoffry is better.
For the divine spirit comes about his body to sustain it in complete cat.
For his tongue is exceeding pure so that it has in purity what it wants in music.
For he is docile and can learn certain things.
For he can sit up with gravity, which is patience upon approbation.
For he can fetch and carry, which is patience in employment.
For he can jump over a stick, which is patience upon proof positive.
For he can spraggle upon waggle at the word of command.
For he can jump from an eminence into his master’s bosom.
For he can catch the cork and toss it again.
For he is hated by the hypocrite and miser.
For the former is afraid of detection.
For the latter refuses the charge.
For he camels his back to bear the first notion of business.
For he is good to think on, if a man would express himself neatly.
For he made a great figure in Egypt for his signal services.
For he killed the Icneumon rat, very pernicious by land.
For his ears are so acute that they sting again.
For from this proceeds the passing quickness of his attention.
For by stroking of him I have found out electricity.
For I perceived God’s light about him both wax and fire.
For the electrical fire is the spiritual substance which God sends from heaven to sustain the bodies both of man and beast.
For God has blessed him in the variety of his movements.
For, though he cannot fly, he is an excellent clamberer.
For his motions upon the face of the earth are more than any other quadruped.
For he can tread to all the measures upon the music.
For he can swim for life.
For he can creep.

Alexander and his Doctor, about 1648-9, Eustache Le Sueur

According to classical anecdote, Alexander the Great suffered from mysterious maladies and from his own mystique. No one dared to treat him for fear that a bad outcome would doom the would-be healer to certain persecution by Alexander’s wildly solicitous minions. Finally, Phillip, Alexander’s physician, frustrated by the young king’s decline, offered care in the form of a salubrious potion. But a general had already impugned Philip in a letter to Alexander, which claimed Philip to be acting seditiously on behalf of Alexander’s Persian enemies, and not to be trusted. Despite this warning, Alexander boldly drank the medicine, as he did so, handing the letter to Philip to read.

In the painting, Philip stands above a recumbent Alexander, as the doctor-patient relationship would demand. But Alexander’s broad chest and raised eyes reveal his power, while Philip’s stooped posture and frown expose the frailty of his position. The painting reveals, perhaps unwittingly, the vital duality of the relationship, each risking himself, proffering his full commitment to the other. Here the physician assumes the role of servant rather than patriarch, though his experience and wisdom are evident.

The intern who cared for Vincent van Gogh after he severed his ear. The painting was a tributary gift. While Dr. Rey was quite fond of Van Gogh, who mentioned the physician favorably and intimately in his letters, Rey did not appreciate the painting, at least not at first. His parents used it to cover a hole in a chicken coop. Nevertheless, Dr. Rey clearly appreciated the essential role art played in his patient’s life, and recommended Van Gogh continue to pursue it. At this time, of course, Van Gogh’s painting was for the most part unknown and/or dismissed.

Understanding how a patient makes sense of chronic or disabling illness can be critical to the effective treatment of that illness.  Repairing the body doesn’t necessarily repair the life. Patients must confront changes to their bodies and in how they live their lives, psychological dimensions of disease physicians and allied practitioners have appropriately tried to address more vigorously.  But human beings, perhaps uniquely, not only live in the here and now but also in a larger narrative of their existence that includes their past and also projects a future.  Our identity and self-esteem are not only tied up in what we see in the mirror, but in what others see, and in who we see ourselves becoming: our plans and expectations for ourselves in the context of a long and healthy life.  All of this helps us tell the story of who we are. The term “biographical disruption” has been applied to the pernicious ability of disease to damage this narrative.   To fully treat disease one must also treat the damaged story.  There is evidence that poetry can be part of such treatment, allowing patients to creatively frame and perhaps modify their story through dialogue with themselves and with others.

Below is a poem written by a young woman afflicted with severe arthritis, reprinted from Cases Journal (Cases J. 2008; 1: 153).

Where have I gone?

Where’s the woman who weighed less than 9 stone?

Who wore a dress size 12 and didn’t need to wear shapeless clothes or jogging suits?

Who had shaped and tidy eyebrows that would complement her latest hair colour and style?

Whose painted nails, with manicured hands and feet, were perfect for holidays in the sun?

Where’s the woman who had a vocation not just a job, but who exists on benefits, a step away from poverty?

Where’s the woman who owned her own home that gave her safety and privacy, it was her pride and joy?”

Where’s the woman whose hobbies include travel, gardening, decorating, furniture restoring, sewing, reading and studying at home?

Here I am and life before my impairment has gone, the only thing I can do is hold a pen with a special grip and writing is agony.

Where has she gone?

Where has she gone?

WHERE HAVE I GONE?

Do you see me?

How can you ever know me, when all you see is my chair?

My limitations are all you see and you say they complicate your life.

Will you ever see the deep pools of love in my eyes for you?

When you half close yours with pity and turn away from me.

The beating of my heart in expectation of your closeness isquickly cooled by your fleeting hug or, worse, patting my shoulder.

I wait in anticipation remembering the taste and softness of
your kiss, you offer me a warm ‘peck’ on the cheek.

I smell your aftershave … you say I smell clean!

I remember running my fingers through your hair,

Ripping buttons off your shirt but that’s difficult when you
stand behind me pushing my chair, we can’t even hold hands anymore.

The power of my emotions makes me feel strong,

Then I catch that pitying look in your eye,

They die in my heart.

I do not speak, my smile fills my face but you will never know …

You’ll never see the real woman who is me

Who sits and is seen by the world framed by a wheelchair

Cut off emotionally just because I cannot stand or walk.

Thank you

Thank you to those who take the time to listen to difficult and unclear speech, for you help us to know that if we persevere we can be understood

Thank you to those who walk with us in public places, ignoring stares and whispers from strangers, for in your friendship we find enjoyment, laughter and happiness

Thank you for never asking us to ‘hurry up’, but even more special is you don’t snatch our tasks from us or offer ‘Care’ in such a way as to make us feel that we are still children, with no control and respect

Thank you for standing beside us when we enter new experiences and try new adventures
Though our success may be outweighed by our failure, the experience will stay with us forever and there will be many occasions when we surprise ourselves and maybe even you!

Thank you for asking for our help and expertise,
As self-confidence and awareness come from being needed by you and others

Thank you for giving us respect

You acknowledge our value as experts in our fields and that we require to live with equality in society

We shouldn’t have to ask or have laws to enforce it or remind you

Thank you for assuring us that the things that make us individuals are not our medical impairments, as everyone has those and they don’t define ONE’S SELF, it’s people’s attitudes that create barriers that exclude us from you.

Treat us as we treat you.

It is now a common practice for first year medical students to take part in a ceremony honoring the donors of cadavers used in dissection for the teaching of anatomy. The manner of the students’ participation is up to them; the reading of poetry, including original poems is not uncommon.

Here is such a poem by Fiona Horgan, reprinted from Yale Journal of Biology and Medicine.

                                                                 

Lab 16

Today’s session begins just as those gone by.
As my labmates begin to unfurl the gauze and commence our exploring,
instinctively, but unbeknownst to the others,
I am quick to assume my self-appointed duty of rewrapping,
carefully ensuring that her hands are not exposed.
Is this naïve, knowing that today would come
and I would have to spend my entire afternoon focused on them?
And why, after so many hours with her,
so many delicate procedures,
does looking at her hands still stir unparalleled emotion in me?
“Trace the radial artery . . .”
I only see hands that still possess the pallor of life,
nails bearing the remnants of rose-colored polish.
Did a loved one tenderly paint them?
And did they hold her hands as she faded from this life?
I search for her pulse.
“Divide the transverse carpal ligament . . .”
Isee my grandmother’s hands.
Hands that expertly smoothed wrinkled sheets.
Hands that pressed coins to buy sweets into her grandchildren’s eager palms.
Hands that wore a symbol of my grandparents’ love for 56 years.
I trace the fine lines on her palms.
“Examine the thenar muscles . . .”
I see my mother’s hands.
Hands that nurture children when they are sick.
Hands that dance along piano keys.
Hands that feed and clothe the homeless.
I smooth her wrinkled skin.
“Identify the tendons of the superficial and deep digital flexors . . .”
I look at my hands alongside hers.
They are the tool with which I will first touch my future patients.
Each time I lay my hands on those I hope to heal,
I will remember hers.
I reach out and fully grasp her hands.

                                                                  –Fiona Horgan

(From: The 2008 Anatomy Ceremony: Voices, Letter, Poems
Yale J Biol Med. 2009 March; 82(1): 41–46)

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