Through the Clouds

The emotions involved in medicine are as gripping and poignant as those of any profession. Some people process the angst of close contact with life and death by indulging in introspection, others by giving voice to their feelings in verse. Here, four individuals with ties to Dartmouth share poems they've written about especially moving events.

Illustrations by Bert Dodson

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Garland, a 1971 graduate of Dartmouth Medical School, spent 24 years practicing internal medicine on Deer Isle, off the coast of Maine. He and a couple of other physicians, plus a mid-level practitioner, provided 24/7 care for the island's 2,600 year-round residents—more than half of whom have some tie to the fishing industry. "We specialized in whatever walked through the door," Garland says.

Medical emergencies there have "a totally different character," recalls Garland. Deer Isle is connected to the mainland by a bridge, but the nearest hospital is 25 miles away. "You never feel as alone," Garland explains, when a hospital is close at hand. But on Deer Isle, in a crisis "it's just you, the patient, and whatever you can create."

The poem above describes one such incident. "I was alone in the clinic before dawn, with a patient and his wife," Garland explains. "I was seeing him for chest and abdominal pains, when the patient uttered those words and had a cardiac arrest." But, he continues, "we successfully resuscitated him, and he is alive today."

Also a 1965 graduate of Dartmouth College, Garland has been writing poetry ever since he took a creative writing class as an undergraduate. "I write about what I know," he says, calling his poems "small vignettes" from a physician's point of view. "My whole purpose in writing poetry," he continues, "is clarity: to try to shed light on some human experience."

In 2000, Garland decided to try a different kind of human experience and traded rural medicine for inner-city medicine. He moved to Washington, D.C., and joined a nonprofit organization called Unity Health Care that delivers care to patients in homeless shelters, the correctional system, and underserved neighborhoods.

But he recently retired from medicine—and perhaps from writing poetry—upon stepping down from Unity in August 2009. "Although I have maintained my licensure," he says, "I think it is unlikely that I will ever practice again. Medicine consumes me when I practice it, so I think I have to be either in or out."

And, he admits, "I don't know if in retirement I'll be able to be in touch" with the emotions that have for so long stoked his creative impulses—which include prose, too; Garland wrote an essay about practicing medicine on Deer Isle that was published in Dartmouth Medicine several years ago.

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Willenbring earned his doctorate in physiology at DMS in 1995 and then did a postdoctoral fellowship in Tulsa, Okla. He is now on the faculty of a community college in western Virginia, a small school where, he says, "I am the biology department." He teaches biology, anatomy, physiology, and microbiology to students who plan to go into health professions such as nursing or physical therapy.

He wrote the poem above while he was at Dartmouth. He often biked to his lab in the Borwell Research Building, and one day, at the north end of DHMC, he noticed a man standing on the lawn outside the inpatient towers. The man was clutching a paper bag with one hand, Willenbring recalls, and had his other hand up like a visor, to shade his eyes. "Maybe he sees something interesting in the sky," Willenbring recalls thinking. Then he realized what the man was looking at. "I saw a little person at one of the windows" on the pediatric floor. The child was "making big, arcing waves with his arm." Suddenly, "the dad also started making big, arcing waves with his arm. The kid was almost like a little reflection of the dad."

The tableau was "very poignant," says Willenbring. "It really struck me." So much so that he went straight to his lab and "started jotting down little pieces of imagery." He kept working on the poem off and on for several years and "finally got it to where I liked it."

He began writing poetry thanks to a humanities requirement when he was an undergraduate at the University of Maine in Presque Isle; he chose a course in writing verse and found it "a wonderful experience." In fact, he adds, "I've been very fortunate in all my educational experiences," including at DMS. He says his advisors, Drs. Joyce DeLeo and Jay Leiter, "really taught me how to write science, how to make it clear and concise." Rather like a good poem.

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Wang, a third-year M.D. student at DMS, grew up in China and started teaching herself English when she was 11 years old. She came to the U.S. in 2003 to attend Grinnell College in Iowa, where she majored in biology and almost satisfied the requirements for a major in German as well; during a semester in Berlin, she took courses (conducted in German) in biology and chemistry and did human genetics research at the Max Planck Institute.

During her first year at DMS, she spent time shadowing the chief of cardiothoracic surgery, Dr. William Nugent, also a member of Dartmouth Medicine's Editorial Board. Nugent says that one day, Wang "appeared in my office, asking to see some surgery. Over the ensuing year, she shadowed me in the OR, clinic, and office and in that time . . . witnessed the breadth of my practice." At the end of the year, he continues, "I asked her . . . to write down her impressions. . . . I expected an essay—or nothing—but received instead a poem."

In the poem, Wang writes in the first three stanzas about three memorable patients she encountered: one who lay unconscious in the ICU, one who was receiving a diagnosis of cancer, and one who died after Wang had met him only twice. The poem's fourth stanza, Wang says, is "my reflection on the fact that sometimes doctors are not there because they cannot face mortality . . . that being present is not just about being able to offer help or bring hope, but about being there for the patient even when they don't seem to know you are there."

The patient in the first stanza, she adds, "recovered fully, and he and his wife are still in touch with me."

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Lindberg is the nurse manager of Dartmouth-Hitchcock Medical Center's outpatient gastroenterology and hepatology clinic. The position involves both hands-on nursing and management; "it's a nice combination," she explains. Lindberg has been at DHMC for five years and was previously the nurse manager of the Dartmouth-affiliated Family Medicine Institute in Augusta, Maine.

"I have enjoyed writing poetry since I was in grade school," she says. She sometimes writes free verse but sometimes works in more structured forms, using rhyme and meter. She admits, however, that she is "not disciplined" in her writing. "Writing is a creative outlet. It helps me tap into some of the less right-brain, type-A-personality" aspects of herself, she says.

"I . . . remember very clearly the circumstance that prompted me to write" the poem published here, Lindberg explains. It arose from an experience she had when she lived in Augusta, where she also served as a member of the board of directors for a volunteer hospice organization.

One of her fellow board members was the pastor of a local Baptist church; when his wife died, Lindberg attended the funeral. The church was packed, she recalls, and "the outpouring of sentiment was palpable." Lindberg had only met the pastor's wife briefly, but she found herself unusually moved as the service brought home to her the deep sense of loss that the woman's husband must be feeling.

And that made her realize, she says, how often, even after a devastating loss, people "pretend everything is just fine."

Lindberg left the service and "drove home with a feeling of hollowness." An image came to her of a long, empty corridor, she says, while the words of the poem "almost formed themselves in my mind without putting pen to paper."

But no matter how easily the first draft of a poem flows, Lindberg rereads and revises her work numerous times. "I let it sit" for a while, she says, then "go through version after version of rewriting." There usually "comes a time when I think I'm satisfied with it," she adds. But even so, whenever she looks back on a poem, she "can always find something I want to change."