Medicine & Metaphor

Medicine gives rise to many of the poems I write. But people often ask: Does it work the other way? Does poetry ever enter into your practice of medicine?

Certainly, when I am with a patient, I am with them totally. I am not jotting poems on a prescription pad and stuffing them in my pocket; or thinking up a set of rhymes for a sonnet while Mr. Z is telling me about his back pain. And though I do occasionally mix a poetry journal or literary magazine in with the issues of National Geographic and Smithsonian in the waiting room, I am not one to push my favorite poems on patients (at least not yet).

However, one way I think that poetry enters into my practice of medicine, is in the use of metaphor. For instance, if a patient has a chief complaint of chest pain, or chest pressure, I must first do a complete and thorough medical work-up (because it could be a potentially fatal condition, like heart disease). But if this work-up is negative, and there is no “organic” explanation for the patient’s symptoms, then we need to consider if his chest pain has an emotional basis. And this is often difficult territory to broach. They sometimes feel as if I am telling them "it's all in your head.” When the truth is I am not saying that at all. I don’t believe the mind and body are separate — I think they are one in the same, and physical symptoms are part of the mind and emotions and vice versa.

So I might use a metaphor as a way to connect mind and body for this patient. I might say to him, regarding his chest pain and chest pressure: “Maybe there is something you are needing to get off your chest?” And if I am lucky, a light will go on in his eyes. And he will stop for a second, and say, “You know, I am really angry at my boss. He has been very unfair to me the past few months. And it is causing me a lot of stress. I can’t take the pressure anymore. It’s driving me crazy.” And hinged to this metaphoric leap, the first tentative steps toward healing may proceed.