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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

Rural Health Clinic, 4:00 a.m.
By Thomas C. Garland, M.D., M.P.H.

"I feel faint, Doc."
"You can't faint, you're lying down."
No breath.
No pulse.

Who will call the code?
Who will come running?
Who will pump?
Who will breathe?
Who will shock?
Who will, who will, who will . . . . . . .

You drive your hand up
Through the ceiling,
Through the roof,
Through the clouds, past the stars
You grab God by the throat—

You do.

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.

The Healing Bond
By Stanley Willenbring, Ph.D.

On my way to work,
pedaling hard
fingers bitten by the morning cold,
dwarfed in the shadow
of the hospital wall,
I passed a man walking toward the entry.
He stopped suddenly
clutching in hand
a tearing bag full of things familiar.
He craned his neck,
with his other hand
shielding his eyes less for the sun
that barely showed
through a misting rain
but rather against the reflection from
that imposing tower
of glass and stone.
He scanned the blank and faceless wall
and set his eyes
on one small pane,
which to me appeared indistinct
from its myriad twins.
He waited until
one small figure leaned up inside
and shouted voiceless
through the glass.
Then, standing below with his clumsy burden,
lifting the visor
hand from his eyes,
he cast his arm in a broad silent arc
that moved his body
from side to side
and from behind the sheltering glass
one small arm
mimicked the motion,
completing the circle in the mirror of time.

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.

Where the Soul Meets the Body
By Hanghang Wang

White walls, nurses hurrying by, machines beeping,
That's where he spent this early spring.
Sedated and intubated, peaceful and quiet,
Eyes tightly shut as if he was enjoying a dream.
I came by to check on him,
Even though he couldn't look back at me;
I came by to say hi to him,
Even though he couldn't talk back to me;
I held his hands with mine,
Even though he couldn't lift a finger.
I knew I was there, and he must have known, too.
He saw me, heard me, and felt my hands
In the deepest of his dreams.

"I am only accepting good news,"
She said as I opened the chest x-ray.
There they were—two shadows that didn't belong in her.
In a minute, I could tell her world was collapsing,
I could feel the tremble in her voice. She tried to be strong, though,
Sitting up straight and interrupting me;
Her voice sounded angry from time to time.
As she walked out toward the door,
I got up and hugged her.
Tears came streaming down her face,
As she apologized for being angry
And thanked me for being there.

I was not there when his heart stopped beating.
I was not there when his wife cried her eyes out.
I had promised I would come over, but I was not there.
I had a million reasons—exams, stresses, and the rain.
I tried to comfort myself:
He probably didn't even remember me;
He had only seen me twice, after all.
Still, I couldn't forgive myself.
The million excuses could not mask the one big reason:
I was not there—not for them, not for myself.

Beyond the layers of white walls
is where the soul meets the body.
Beyond the courage and bravery
is the deepest fear.
I know because I was there.
I may not be able to bring hope,
or even good news.
But I need to be there for you—even when you can't see or hear or tell,
even when you think you could take it all,
even when you don't remember me.
I need to be there for you,
and for myself.

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."

Funerals and Phone Calls
By Deborah A. Lindberg, B.S.N., M.B.A.

Well, yes, I am home again,
I suppose.
After all, the same town, same street, same driveway
same house.

So why does it look so different?
feel so vast, empty?
You see, the halls—they go on forever, filled with empty rooms
filled with no one.
Every corner leads to another endless corridor,
another vacant extension.

And the windows let in too much light.
Can't I draw the curtains,
close out the light, keep in the echoing darkness?

But I don't want to look out,
Feel the sunshine, see the trees.
Only to hide,
To turn aside,
To sink down
into the rug and cry.

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."

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