'Gaudeamus Igitur,'* by John Stone
For this is the day of joy
which has been fourteen hundred and sixty days in coming
and fourteen hundred and fifty-nine nights
For today in the breathing name of Brahms
and the cat of Christopher Smart
through the unbroken line of language and all the nouns
stored in the angular gyrus
today is a commencing
For this is the day you know too little
against the day when you will know too much
For you will be invincible
and vulnerable in the same breath
which is the breath of your patients
For their breath is our breathing and our reason
For the patient will know the answer
and you will ask him
ask her
For the family may know the answer
For there may be no answer
and you will know too little again
or there will be an answer and you will know too much
forever
For you will look smart and feel ignorant
and the patient will not know which day it is for you
and you will pretend to be smart out of ignorance
For you must fear ignorance more than cyanosis
For whole days will move in the direction of rain
For you will cry and there will be no one to talk to
or no one but yourself
For you will be lonely
For you will be alone
For there is a difference
For there is no seriousness like joy
For there is no joy like seriousness
For the days will run together in gallops and the years
go by as fast as the speed of thought
which is faster than the speed of light
or Superman
or Superwoman
For you will not be Superman
For you will not be Superwoman
For you will not be Solomon
but you will be asked the question nevertheless **
For after you learn what to do, how and when to do it
the question will be whether
For there will be addictions: whiskey, tobacco, love
For they will be difficult to cure
For you yourself will pass the kidney stone of pain
and be joyful
For this is the end of examinations
For this is the beginning of testing
For Death will give the final examination
and everyone will pass
For the sun is always right on time
and even that may be reason for a kind of joy
For there are all kinds of
all degrees of joy
For love is the highest joy
For which reason the best hospital is a house of joy
even with rooms of pain and loss
exits of misunderstanding
For there is the mortar of faith
For it helps to believe
For Mozart can heal and no one knows where he is buried
For penicillin can heal
and the word
and the knife
For the placebo will work and you will think you know why
For the placebo will have side effects and you will know
you do not know why
For none of these may heal
For joy is nothing if not mysterious
For your patients will test you for spleen
and for the four humors
For they will know the answer
For they have the disease
For disease will peer up over the hedge
of health, with only its eyes showing
For the T waves will be peaked and you will not know why
For there will be computers
For there will be hard data and they will be hard
to understand
For the trivial will trap you and the important escape you
For the Committee will be unable to resolve the question
For there will be the arts
and some will call them
soft data
whereas in fact they are the hard data
by which our lives are lived
For everyone comes to the arts too late
For you can be trained to listen only for the oboe
out of the whole orchestra
For you may need to strain to hear the voice of the patient
in the thin reed of his crying
For you will learn to see most acutely out of
the corner of your eye
to hear best with your inner ear
For there are late signs and early signs
For the patient's story will come to you
like hunger, like thirst
For you will know the answer
like second nature, like first
For the patient will live
and you will try to understand
For you will be amazed
or the patient will not live
and you will try to understand
For you will be baffled
For you will try to explain both, either, to the family
For there will be laying on of hands
and the letting go
For love is what death would always intend if it had the choice
For the fever will drop, the bone remold along
its lines of force
the speech return
the mind remember itself
For there will be days of joy
For there will be elevators of elation
and you will walk triumphantly
in purest joy
along the halls of the hospital
and say Yes to all the dark corners
where no one is listening
For the heart will lead
For the head will explain
but the final common pathway is the heart
whatever kingdom may come
For what matters finally is how the human spirit is spent
For this is the day of joy
For this is the morning to rejoice
For this is the beginning
Therefore, let us rejoice
Gaudeamus igitur.
* Therefore, let us rejoice
** 1 Kings 3:16-27
Sunday, April 25, 2010
Quote on illness and health
Illness is the night-side of life, a more onerous
citizenship. Everyone who is born holds dual
citizenship, in the kingdom of the well and in
the kingdom of the sick. Although we all prefer
to use only the good passport, sooner or later
each of us is obliged, at least for a spell, to
identify ourselves as citizens of that other place
Susan Sontag
citizenship. Everyone who is born holds dual
citizenship, in the kingdom of the well and in
the kingdom of the sick. Although we all prefer
to use only the good passport, sooner or later
each of us is obliged, at least for a spell, to
identify ourselves as citizens of that other place
Susan Sontag
Poem: I Stepped Past Your Room Today
I Stepped Past Your Room Today
- Gerry Greenstone, M.D.
I stepped past your room today
Rushed to a crammed office
Rather than endure
The eerie calm of Palliative Care
It’s been three days now
Since I visited you
And that’s not good.
I was there from the beginning
When we split your belly
To find cancer
Erupting everywhere
The liver’s glistening surface
Ridged and spotted as the moon.
Then came the radiation
Malignant clusters beamed with cobalt
Bombarded with pions
In a cellular explosion.
And chemotherapy
Specialized molecules
To invade you like tissue
And work their complex chemistry.
But in the end
Our white-coated arsenal
Was powerless
Against the long trajectory
Of disease.
Now you lie there
Shriveled husk of a man
So pale and trembling
With barely enough weight
To press against the sheets.
In the harsh glare of those white sheets
I see the impotence
Of myself as a physician
Whose energy is aimed
At cure and renewal.
Can you understand
What it means to face you
Like this,
Your courage against my fear?
Let me not lose sight
Of what you once were
And still are
A man and a father
Who did the things fathers do
Watched your daughter at ballet
Her leaps and pirouettes
Cheered your son at his soccer games
Stood shivering in the rain.
To respect your humanity
To preserve your dignity
Because if I can hold you clear enough
There’s nothing more to fear.
- Gerry Greenstone, M.D.
I stepped past your room today
Rushed to a crammed office
Rather than endure
The eerie calm of Palliative Care
It’s been three days now
Since I visited you
And that’s not good.
I was there from the beginning
When we split your belly
To find cancer
Erupting everywhere
The liver’s glistening surface
Ridged and spotted as the moon.
Then came the radiation
Malignant clusters beamed with cobalt
Bombarded with pions
In a cellular explosion.
And chemotherapy
Specialized molecules
To invade you like tissue
And work their complex chemistry.
But in the end
Our white-coated arsenal
Was powerless
Against the long trajectory
Of disease.
Now you lie there
Shriveled husk of a man
So pale and trembling
With barely enough weight
To press against the sheets.
In the harsh glare of those white sheets
I see the impotence
Of myself as a physician
Whose energy is aimed
At cure and renewal.
Can you understand
What it means to face you
Like this,
Your courage against my fear?
Let me not lose sight
Of what you once were
And still are
A man and a father
Who did the things fathers do
Watched your daughter at ballet
Her leaps and pirouettes
Cheered your son at his soccer games
Stood shivering in the rain.
To respect your humanity
To preserve your dignity
Because if I can hold you clear enough
There’s nothing more to fear.
Poem: Night on call
Night on Call
- Rita Iovino, M.D.
There are sometimes such moments of magic,
when the sky and mountains melt into the dawn
when the blue-purple horizon yields to the sun,
and the trek home
becomes a moment of epiphany.
Everything is still
and only the faint noise of sparrows
permeates the air.
The exhaustion and sweat and scrubs
become an exclamation of rebirth.
The gift of being a doctor
is magnified like dandelions blowing in the wind,
and one knows the skill of giving life,
the gift of alleviating pain;
the long night suturing becomes a dream
because now one more person
becomes whole by your latex gloves.
The sun breaks into a million bright lights
as you go home to sleep.
- Rita Iovino, M.D.
There are sometimes such moments of magic,
when the sky and mountains melt into the dawn
when the blue-purple horizon yields to the sun,
and the trek home
becomes a moment of epiphany.
Everything is still
and only the faint noise of sparrows
permeates the air.
The exhaustion and sweat and scrubs
become an exclamation of rebirth.
The gift of being a doctor
is magnified like dandelions blowing in the wind,
and one knows the skill of giving life,
the gift of alleviating pain;
the long night suturing becomes a dream
because now one more person
becomes whole by your latex gloves.
The sun breaks into a million bright lights
as you go home to sleep.
Poem: Walking the dog
Walking the dog
John L. Wright, MD
She weighed
three hundred pounds.
Fat and high sugars
were killing her,
I thought.
So,
I thought.
So,
I gave her a puppy
with dark curly hair;
nothing else
had worked.
Walking the dog
twice a day,
I thought
might persuade,
might motivate.
She was pleased
with my prescription,
she laughed,
she rocked
from side to side.
She lived
for twelve years
hugging
that little black dog
while her lean husband
walked it faithfully,
twice a day.
John L. Wright, MD
She weighed
three hundred pounds.
Fat and high sugars
were killing her,
I thought.
So,
I thought.
So,
I gave her a puppy
with dark curly hair;
nothing else
had worked.
Walking the dog
twice a day,
I thought
might persuade,
might motivate.
She was pleased
with my prescription,
she laughed,
she rocked
from side to side.
She lived
for twelve years
hugging
that little black dog
while her lean husband
walked it faithfully,
twice a day.
Quote
One of the first duties of the physician is to educate the masses not to take medicine.
Sir William Osler
Sir William Osler
Poem: A sentiment
A SENTIMENT
Oliver Wendell Holmes, Sr.
A TRIPLE health to Friendship, Science, Art,
From heads and hands that own a common heart!
Each in its turn the others' willing slave,
Each in its season strong to heal and save.
Friendship's blind service, in the hour of need,
Wipes the pale face, and lets the victim bleed.
Science must stop to reason and explain;
ART claps his finger on the streaming vein.
But Art's brief memory fails the hand at last;
Then SCIENCE lifts the flambeau of the past.
When both their equal impotence deplore,
When Learning sighs, and Skill can do no more,
The tear of FRIENDSHIP pours its heavenly balm,
And soothes the pang no anodyne may calm
May 1, 1855.
Oliver Wendell Holmes, Sr.
A TRIPLE health to Friendship, Science, Art,
From heads and hands that own a common heart!
Each in its turn the others' willing slave,
Each in its season strong to heal and save.
Friendship's blind service, in the hour of need,
Wipes the pale face, and lets the victim bleed.
Science must stop to reason and explain;
ART claps his finger on the streaming vein.
But Art's brief memory fails the hand at last;
Then SCIENCE lifts the flambeau of the past.
When both their equal impotence deplore,
When Learning sighs, and Skill can do no more,
The tear of FRIENDSHIP pours its heavenly balm,
And soothes the pang no anodyne may calm
May 1, 1855.
Poem: The stethoscope song
On the perils of blindly trusting new-fangled technologies (this was written in the 1800's).
THE STETHOSCOPE SONG
A PROFESSIONAL BALLAD
Oliver Wendell Holmes, Sr.
THERE was a young man in Boston town,
He bought him a stethoscope nice and new,
All mounted and finished and polished down,
With an ivory cap and a stopper too.
It happened a spider within did crawl,
And spun him a web of ample size,
Wherein there chanced one day to fall
A couple of very imprudent flies.
The first was a bottle-fly, big and blue,
The second was smaller, and thin and long;
So there was a concert between the two,
Like an octave flute and a tavern gong.
Now being from Paris but recently,
This fine young man would show his skill;
And so they gave him, his hand to try,
A hospital patient extremely ill.
Some said that his liver was short of bile,
And some that his heart was over size,
While some kept arguing, all the while,
He was crammed with tubercles up to his eyes.
This fine young man then up stepped he,
And all the doctors made a pause;
Said he, The man must die, you see,
By the fifty-seventh of Louis's laws.
But since the case is a desperate one,
To explore his chest it may be well;
For if he should die and it were not done,
You know the autopsy would not tell.
Then out his stethoscope he took,
And on it placed his curious ear;
Mon Dieu! said he, with a knowing look,
Why, here is a sound that 's mighty queer.
The bourdonnement is very clear,--
Amphoric buzzing, as I'm alive
Five doctors took their turn to hear;
Amphoric buzzing, said all the five.
There's empyema beyond a doubt;
We'll plunge a trocar in his side.
The diagnosis was made out,--
They tapped the patient; so he died.
Now such as hate new-fashioned toys
Began to look extremely glum;
They said that rattles were made for boys,
And vowed that his buzzing was all a hum.
There was an old lady had long been sick,
And what was the matter none did know
Her pulse was slow, though her tongue was quick;
To her this knowing youth must go.
So there the nice old lady sat,
With phials and boxes all in a row;
She asked the young doctor what he was at,
To thump her and tumble her ruffles so.
Now, when the stethoscope came out,
The flies began to buzz and whiz
Oh ho! the matter is clear, no doubt;
An aneurism there plainly is.
The bruit de rape and the bruit de scie
And the bruit de diable are all combined;
How happy Bouillaud would be,
If he a case like this could find!
Now, when the neighboring doctors found
A case so rare had been descried,
They every day her ribs did pound
In squads of twenty; so she died.
Then six young damsels, slight and frail,
Received this kind young doctor's cares;
They all were getting slim and pale,
And short of breath on mounting stairs.
They all made rhymes with "sighs" and "skies,"
And loathed their puddings and buttered rolls,
And dieted, much to their friends' surprise,
On pickles and pencils and chalk and coals.
So fast their little hearts did bound,
The frightened insects buzzed the more;
So over all their chests he found
The rale sifflant and the rale sonore.
He shook his head. There's grave disease,--
I greatly fear you all must die;
A slight post-mortem, if you please,
Surviving friends would gratify.
The six young damsels wept aloud,
Which so prevailed on six young men
That each his honest love avowed,
Whereat they all got well again.
This poor young man was all aghast;
The price of stethoscopes came down;
And so he was reduced at last
To practise in a country town.
The doctors being very sore,
A stethoscope they did devise
That had a rammer to clear the bore,
With a knob at the end to kill the flies.
Now use your ears, all you that can,
But don't forget to mind your eyes,
Or you may be cheated, like this young man,
By a couple of silly, abnormal flies.
(It appears I last randomly found this back in 2006: http://thoughtfulwander.blogspot.com/2006/10/poem-stethoscope-song.html)
THE STETHOSCOPE SONG
A PROFESSIONAL BALLAD
Oliver Wendell Holmes, Sr.
THERE was a young man in Boston town,
He bought him a stethoscope nice and new,
All mounted and finished and polished down,
With an ivory cap and a stopper too.
It happened a spider within did crawl,
And spun him a web of ample size,
Wherein there chanced one day to fall
A couple of very imprudent flies.
The first was a bottle-fly, big and blue,
The second was smaller, and thin and long;
So there was a concert between the two,
Like an octave flute and a tavern gong.
Now being from Paris but recently,
This fine young man would show his skill;
And so they gave him, his hand to try,
A hospital patient extremely ill.
Some said that his liver was short of bile,
And some that his heart was over size,
While some kept arguing, all the while,
He was crammed with tubercles up to his eyes.
This fine young man then up stepped he,
And all the doctors made a pause;
Said he, The man must die, you see,
By the fifty-seventh of Louis's laws.
But since the case is a desperate one,
To explore his chest it may be well;
For if he should die and it were not done,
You know the autopsy would not tell.
Then out his stethoscope he took,
And on it placed his curious ear;
Mon Dieu! said he, with a knowing look,
Why, here is a sound that 's mighty queer.
The bourdonnement is very clear,--
Amphoric buzzing, as I'm alive
Five doctors took their turn to hear;
Amphoric buzzing, said all the five.
There's empyema beyond a doubt;
We'll plunge a trocar in his side.
The diagnosis was made out,--
They tapped the patient; so he died.
Now such as hate new-fashioned toys
Began to look extremely glum;
They said that rattles were made for boys,
And vowed that his buzzing was all a hum.
There was an old lady had long been sick,
And what was the matter none did know
Her pulse was slow, though her tongue was quick;
To her this knowing youth must go.
So there the nice old lady sat,
With phials and boxes all in a row;
She asked the young doctor what he was at,
To thump her and tumble her ruffles so.
Now, when the stethoscope came out,
The flies began to buzz and whiz
Oh ho! the matter is clear, no doubt;
An aneurism there plainly is.
The bruit de rape and the bruit de scie
And the bruit de diable are all combined;
How happy Bouillaud would be,
If he a case like this could find!
Now, when the neighboring doctors found
A case so rare had been descried,
They every day her ribs did pound
In squads of twenty; so she died.
Then six young damsels, slight and frail,
Received this kind young doctor's cares;
They all were getting slim and pale,
And short of breath on mounting stairs.
They all made rhymes with "sighs" and "skies,"
And loathed their puddings and buttered rolls,
And dieted, much to their friends' surprise,
On pickles and pencils and chalk and coals.
So fast their little hearts did bound,
The frightened insects buzzed the more;
So over all their chests he found
The rale sifflant and the rale sonore.
He shook his head. There's grave disease,--
I greatly fear you all must die;
A slight post-mortem, if you please,
Surviving friends would gratify.
The six young damsels wept aloud,
Which so prevailed on six young men
That each his honest love avowed,
Whereat they all got well again.
This poor young man was all aghast;
The price of stethoscopes came down;
And so he was reduced at last
To practise in a country town.
The doctors being very sore,
A stethoscope they did devise
That had a rammer to clear the bore,
With a knob at the end to kill the flies.
Now use your ears, all you that can,
But don't forget to mind your eyes,
Or you may be cheated, like this young man,
By a couple of silly, abnormal flies.
(It appears I last randomly found this back in 2006: http://thoughtfulwander.blogspot.com/2006/10/poem-stethoscope-song.html)
Friday, April 02, 2010
Medicallly related things to read...
List of things I want to read that widen the perspective on practising medicine:
http://www.thenewatlantis.com/publications/the-moral-education-of-doctors
http://lifeinthefastlane.com/2008/10/top-eleven-books-well-rounded-physician/
http://www.nytimes.com/2008/10/24/health/chen10-23.html?_r=3 -
Stories in the Service of Making a Better Doctor
Empty pockets
http://www.annals.org/content/139/6/525.full.pdf+html
http://www.thenewatlantis.com/publications/the-moral-education-of-doctors
http://lifeinthefastlane.com/2008/10/top-eleven-books-well-rounded-physician/
http://www.nytimes.com/2008/10/24/health/chen10-23.html?_r=3 -
Stories in the Service of Making a Better Doctor
Empty pockets
http://www.annals.org/content/139/6/525.full.pdf+html
Subscribe to:
Posts (Atom)