Poems and Patients: The Balance of Interpretation

xb, Poems and Patients: The Balance of Interpretation James S. Terry and Edward L. Gogel There are two frequent justifications given for pursuing die study of literature and medicine. One is an appeal to die development of skills: the improvement of language arts; the cultivation of tolerance for die ambiguity of words and signs; the fleshing out of stories from fragments; and other talents that can claim usefulness in both literary and medical work.1 This appeal is sometimes made obliquely by pointing at physician-writers who, it is alleged, must be using the same intellectual tools in both halves of their lives. A second appeal concerns emotional and ediical development : die cultivation of empadiy for the suffering; die puzzling over seemingly incommensurable values placed on human lives; die coming to terms with human frailty, failure, and mortality; and a general faidi in die broadening and enriching capabilities of literature for medicine and, more rarely, vice versa.2 In this paper we reexamine primarily die first of diese two clusters of themes and ideas, from the perspectives of poetry and diagnosis. The comparison of diagnosis to the explication and appreciation of poetry may at first seem odd, because diagnosis is central to the work of medicine, while poetry is one of the less frequently read forms of literature and is largely underutilized even in the field of literature and medicine.3 It would be disingenuous at the outset to ignore die obvious differences between analyzing a poem and diagnosing a patient. Opening die imagination to die nuanced language and oblique meanings of poetry is quite unlike mastering die technical language and probabilistic logic of scientific medicine. Moreover, physicians strive for a much stronger sense of certainty in diagnosis dian diey would require in their reading of a poem, and probably take comfort in laboratory confirmations for that reason. Another crucial difference from the clinical point of view is diat more may depend upon accurate diagnosis than upon accurate reading. The physician engages in diagnosis for die chance to make a difference, to help, to Literature and Medicine 6 (1987) 43-53 © 1987 by The Johns Hopkins University Press 44 POEMS AND PATIENTS ameliorate or cure the suffering of the fellow human before him or her, widi an implicit urgency that does not ordinarily exist in the reading of poetry. The encounter between physician and patient takes place face-toface , in what clinical shorthand refers to as "real time" —mat is, with others waiting, with pain or discomfort insistently present, surrounded by odier pressures of die hospital or office work place. Poems can be read, pondered, put aside, re-read, and so on. Even those that carry a high emotional charge may be more distanced as presences, as bodies, than human beings demanding interpretation. These differences notwithstanding, there remains much diat is analogous widiin these two branches of human study. To start the analogy, there is the problem of the part versus the whole. With a given poem, we want to end up with as complete an understanding of its meaning as possible, but the search for that understanding must start with particulars. We seldom begin by asking outright what the meaning of a poem is, though it is the question we hope to keep constantly in the backs of our minds. Instead, as soon as we finish reading a poem, we have narrowed down its possible meanings considerably and have begun to revise the hunches formed during our initial reading, strengthening some and discarding others by breaking the poem down into constituent parts of varying sizes on which to perform additional analyses. A patient would be treated much the same way. After only a few minutes of an initial interview, a diagnostic hunch is usually formed. One study found that clinicians had a working hypothesis within twenty-eight seconds of learning the chief complaint.4 Then begins the business of testing the hypothesis —additional questioning, physical examination, laboratory work-up, and so forth. Ideally, the whole thing is not lost in either the literary or the medical movement from the whole to the parts. This tension between the meaning of the whole and the analysis of the parts is what...