The Problems of Seeing and Saying in Medicine and Poetry

Introduction

We see and we say--but how do we see, and how do we say? No doubt we speak in body language. Bookstores carry shelves of self-help books on how to interpret each other's stance and movement, how to recognize welcome, rejection, seduction, disgust, threat, and fear. The claims are exaggerated, but not without commonsense substance and a possible neuroanatomic basis. Chimpanzees, although they have little to say, have a remarkably pronounced "language center," the planum temporale of the left brain; it is larger than the planum temporale of the human. A reasonable explanation is that it subserves a language of gesture and movement (Blakeslee 1998).

There are thyroidologists who assert that we would still be grunting and gesturing, stuck in the Neanderthal period, if not for the mutation that allowed the thyroid to actively trap iodide (Carrasco 1999). Nephrologists and pulmonologists also probably have their favorite mutations of progress, but D. B. Morris (1998) comes closest to the mark. He argues that "no single feature--including upright posture and the opposable thumb--is more important in the development of human society than the emergence of language."

Much can be said without words, but to increase the power of expression logarithmically, to recall the past, to contemplate the future (and, unfortunately, to be thoroughly inhuman), we need words--written and spoken language. Even though language ultimately may be impenetrable, our strength is in language, the use of words. What has this to do with the problems of seeing and saying in medicine and poetry?

Dr. D., a well-known breast surgeon, uses his scalpel with exquisite precision. When Mrs. M. was seen for her follow-up visit after her mastectomy for cancer, her wound was painless, clean, and well healed. At this visit, when she asked about what to expect, Dr. D. told her (or so she recalls) that "You have an 80 percent chance of the cancer recurring in the next four years." Three years have passed without recurrence, but she anxiously hears this statement in her mind every day. It is a wound like the wound of Philoctetes--open, festering, foul, and insufferably painful. Dr. D. used his scalpel carefully, but he used his words clumsily. A surgical act ends with the final suture, but the physician's words, like envoys of hope or death foretold, act on and on.

Sylvia Plath (1965), in the poem "Words," written very shortly before her suicide, laments the futility of "words dry and riderless," yet the very lively words of her poem, unlike the poet, live on eternally, the words "indefatigable hoof-taps." Plath's words are as "axes/After whose stroke the wood rings,/And the echoes!/Echoes travelling/Off from the center like horses." Using a different metaphor for the permanence of words, Gary Snyder (1976), in his poem, "Rip Rap," offers an image of words "like rocks/placed solid by hands," "granite ingrained/with torment of fire and weight." It is these words, the "rocky sure-foot trails," which connect the physician and the patient and define the boundaries of disease.

The cultural theorist H. G. Gadamer (1996), for example, contends that "Dialogue is what we are--being able to listen to one another--the capacity to attend another human being . . . treatment always involves dialogue." H. Crawford (1993) points out that disease "must be comprehended and articulated" for "disease doesn't exist without language." Considering the importance of language to the physician, it would seem obvious that a serious course on language and rhetoric should be part of the medical curriculum. Language--and if language, then poetry, the oldest form of language--should be studied alongside of anatomy, physiology, molecular biology; it should be part of the basis of a medical education. This is not an original idea. Many North American medical schools offer courses (including poetry) in the well-established...