The doctor as poet can heal body and spirit

EVASCO says how words are used can change a patient’s perception of suffering and death.

When poetry and medicine entwine, even the sick and dying discover the beauty of the “finite life,” an award-winning poet’s research showed.

Metaphors may seem out of place in the jargon-filled medical profession, but Palanca awardee Marjorie Evasco said romanticizing a disease or comparing childbirth to a song or death to a summer day could heal and uplift a patient’s spirit.

In her lecture, “The Art of Healing and Poetry,” at this year’s De La Salle University (DLSU) Research Congress, Evasco said poetry as “empathic language” could “transform.”

The use of language “in the sense of the sensuous, aesthetic, instinctive and emotional roots of words” rather than “words as generalized abstractions and jargon” could change a patient’s perception of suffering and death, the creative writing professor said.

Her study on the clinical practices of five Filipino doctors found that combining compassion and creativity gave hope, alleviated suffering and helped patients recover “if not in the physical sense, then in the psycho-spiritual levels of being—in order to come to terms with our mortality and that which we believe surpasses our finite lives.”

The “imaginatively” woven words of Dr. Noel Pingoy, a medical oncologist in General Santos City, healed “Mr. Basilio,” an avid bird-watcher who had metastatic lung cancer, she said in an interview.

To empathize with his patient, Pingoy in his essay, “Mr. Basilio, the Sunlight and the Birds,” imagined what it was like to be him.

“Mr. Basilio was strangely cold and numb. The only sounds audible were the strident thump-thumping of his heart and the restrained sobs of his wife….”

The cancer specialist wrote that Basilio was a difficult patient because he would not go to another oncologist and “he had such a low sense of self,” Evasco said.

Dr. Pingoy always talked to Basilio and his family, she said. “He is very committed to all of his patients. He listens.”

Salves, not scalpels

Pingoy’s essay ends with Basilio watching birds fly on a summer day, with his wife and children beside him. Basilio “marveled at the sunlight that seeped through his window and he basked in its warmth … and closed his eyes forever.”

Basilio had a “good death,” Evasco said. “He was cured within.”

In her lecture, she quoted Pingoy: “It is the doctor’s duty to recognize that what he says to a patient matters a lot, and it is a choice between allowing words to come across as scalpels that pierce and hurt or as salves that comfort and soothe.”

Evasco and Pingoy met at the 2005 National Writers Workshop in Dumaguete City. He told her that “the constancy of death” in his practice encouraged him to learn to write better.

The meeting sparked the interest in the relation between poetry and medicine of the poet from Bohol, who called herself a “meta-physician.”

Two of Evasco’s students in DLSU’s Master of Fine Arts in Creative Writing program were also physicians who recognized the relevance of poetry to their field.

Dr. Alice Sun-Cua, an obstetrician-gynecologist at San Juan de Dios Hospital, has published a collection of 45 poems about her profession.

In her poem “Midwife,” Cua writes: “There is timelessness in what I do. To be midwife is to be ‘woman, with woman assisting,’ witness to a daily renewal … It is to wait until the birth of a song.”

Because of Cua’s presence and assurance that the pain of childbirth was bearable, a 17-year-old who had a “psychologically difficult” pregnancy was able to endure the 16-hour ordeal. And the baby bridged the gap between parents and daughter.

Evasco said the doctor-poet “believes that a doctor’s capacity for empathy is not only in communicating sensitively with her patients, but also in listening astutely to the patient’s words and silences.”

Another student, Dr. Susano “Yves” Tanael, a medical oncologist and associate professor at the University of the Philippines College of Medicine, studied the poem “The Pain” by Dr. John Graham Pole and translated it into Filipino.

In his paper, Tanael mentioned how Pole likened cancer pain to “a guest or stranger lurking in the dark.”

“Many do not know what [cancer] is,” Evasco said. “It is the medical oncologist who helps the patient understand the condition and the complexities of cancer, even the fact that many things about it are still unknown and awaiting more advanced medical discoveries.”

Communicating hope

For neurosurgeon Alfred Tan, it was crucial to choose the right words to “carry the weight of authority as well as the lightness of … ‘hope.’”

“There are doctors who pass judgment in terms of evidence from medical statistics and who do not have qualms in withholding hope from patients with difficult medical cases. But every doctor should hold on to this hope and communicate it to his patient,” Evasco quoted Tan.

She said stories of survival inspired patients.

Conversations with patients could change doctors’ attitudes, Evasco said, citing the experience of her friend, Dr. Charito Cloma, an anesthesiologist at Makati Medical Center, with a 72-year-old patient who had to undergo surgery.

He was known as a “very angry and unapproachable patient” but Cloma greeted him with a smile and talked to him. Before the operation, they both prayed and when he woke up, he said: “Thank you, doctor.”

A day after the surgery, the nurses and doctors noticed a change in the patient’s demeanor and spirit, Evasco said.

The Filipino physicians, Evasco said, used the “magical instrumentality of the voice to communicate to their patients that they care.”

Quoting American poet Denise Levertov, she said: “Empathy and compassion, functions of the imagination, lead to the ‘inspired’ word or phrase, the verbal accuracy… which leads to further enlightenment, and in turn to a deeper comprehension of the situation.”

With the surge of Medical Humanities, leading university hospitals like Harvard, Johns Hopkins and the New York University School of Medicine had incorporated the language of empathy in their curriculum, she said.

Evasco, who teaches creative writing to human biology students at DLSU, said that in her classes, she would stress the importance of choosing “precise and imaginative language” in expressing thoughts and conveying emotions.

Their works did not have to be publishable, she would tell her students. “But they are future doctors. They should learn how to deal with humans.”

Evasco added that literature courses would also expose them to the works of masters like poet-doctor William Carlos Williams and poet-nurse Walt Whitman, writings that taught us “we can leap across the abyss of anxiety and debilitating despair on the strength of our imagination, our spirit shaping in our minds that which we know to be a meaningful life, a kinder humanity, or a truly life-preserving and life-enhancing world.”