CHMP

The Examined Life, a journal from the University of Iowa's Carver College of Medicine

Joy Jacobson is the CHMP’s poet-in-residence. 

Last week CHMP senior fellow Jim Stubenrauch and I traveled to Iowa City for a conference called The Examined Life: Writing, Humanities, and the Art of Medicine. We attended panel discussions, writing workshops, literary readings, and other presentations by physicians, writers, nurses, medical students, patients, and others exploring the ways that literature and health care can intersect. It was exciting, sometimes downright thrilling, to be in Iowa City, a UNESCO City of Literature, and to hear what others from around the country and around the world have been doing to nurture these intersections.

The keynote address was delivered by Philip Levine, the current U.S. Poet Laureate. Levine has published 20 books of poems and won nearly every award we have to bestow on a poet. But he’s produced a body of work not overly concerned with illness or health care. So what was he doing at this conference? It’s a good question, one that raises another: can poetry have a vital role in health care?

Levine opened his reading with a poem originally published in 1980, “The Doctor of Starlight.” In it, a man visits his doctor with an odd ailment: “a tiny star above my heart.” The poem proceeds, through rhythmic short lines, to describe a medical exam in which the doctor asks his patient what he does for work. “I make the glare / for lightbulbs,” the patient says. It’s an extraordinary statement made ordinary by the workaday diction of the poem. Finally, the doctor and a strong-handed nurse pluck the star from the patient’s chest. “What does it mean?” the patient asks the doctor, and the doctor replies:

“Mean?” he said, dabbing the place
with something cool and liquid,
and all the lights were blinking on
and off, or perhaps my eyes were
opening and closing. “Mean?” he said,
“It could mean this is who you are.”

Levine is an entertainer, a storyteller, both in his poems and in his reading of his poems. (His between-poem banter itself rose to the level of art.) And in its realistic and surrealistic depiction of a medical encounter, “The Doctor of Starlight” reveals something about illness—and the distress surrounding illness—that health care does not always acknowledge: that our bodies are glorious, even when there’s something “wrong.”

That awareness ran as a subtle undercurrent through many of the presentations I heard last week. Nellie Hermann, author of the novel A Cure for Grief and a faculty member at Columbia University’s narrative medicine program, summed up, for me, why we need conferences like this. “Writing creatively,” she said in her lecture, “gives us access to parts of ourselves we might not access otherwise.”

Joy Jacobson is the CHMP’s poet-in-residence.

This week Andrew Merton’s first book of poems, Evidence that We Are Descended from Chairs, is being released from Accents Publishing. Merton may not be typical of a debut poet: he is an accomplished journalist and chairs the Department of English at the University of New Hampshire, where I was his student 30 years ago. I got in touch with him again when the founder of UNH’s journalism department, Don Murray, died in 2006. Murray and Merton had a strong influence on my writing life at that time, and now that I teach writing I’m grateful to recall what they taught me.

With this new book of poems Merton is instructing me in another way. As poet Charles Simic writes in a foreword, Merton’s “chief subject may be described as our human comedy mixed with tragedy.” A good example is this poem (reprinted with the author’s permission):

coming out of a depression

sleet

gravel in a chicken’s gut

flies buzzing feebly against a screen

crows

morels at the foot of a dead apple tree

shadow of a hawk, receding

whisper of snakes on stone

the sun that powers the heart of a flea

a history of oceans
written on the underside of clouds

in a worn wicker basket
abandoned by a stream,
galaxies blooming

We might see this poem as a topographic map, demonstrating in relief the hills and valleys of a particular psychic landscape. Or maybe, more aptly, it’s a travelogue of the byways leading out of Hell. Regardless, we have little choice but to trust our guide.

We start in a season of bad weather. A single word, sleet, acts as both noun and verb of its own endless sentence. This is a place of ineffectual flies and of many birds, caged or scavenging or predatory. One life form here, the morels, are saprotrophic, feeding on dead things, and I imagine the apple tree to be reaching for the memory of the forbidden fruit it once bore. Thou shalt not eat of it, God warned, and I wouldn’t dare. In this place I wouldn’t even gather the morels for consumption. It’s an environment that reduces its raptor to shadow and retreat.

Those first six lines seem to me to be in whispered conversation with some other famous literary depressives: Yahweh, Poe’s raven, Keats’s narrator “half in love with easeful Death” from “Ode to a Nightingale.” But in Merton’s seventh line a movement evidenced only by the swish of snakeskin on stone changes the view. It’s a sound I can see. I’m reminded of a friend’s sumi ink-stick drawings; one in particular depicts a gray road winding through gray-black trees. A simple, colorless elegance.

Now with the eighth line a real and measurable power asserts itself. It may be no more significant than the electroconductivity taking place in the heart of a flea, but a life can revolve around that sun. And it does, here. A couplet emerges, and in it a pairing of water and language—a natural history written in clouds that must fall inevitably down.

A rain of words: a poet’s dream of redemption.

Merton’s final tercet calls forth a basket, left behind and emptied, apparently, of its cargo—the infant Moses, perhaps? And why not? The poem has recovered itself enough to form a stanza, a complex interplay of lines and images. It’s a free-verse universe but it’s ordered. Even during a clinical depression, involuntary body processes like heart rhythm and respiration are kept up. You’ve survived it again, the poem says. You walked through sleet and ate gizzards, and your powers of observation were never lost to you. Take a peek inside the basket, the poem invites. Go on: you’ll be stunned all over again to discover galaxies so numerous they can’t be counted. But they can be contained in the worn wicker of your mind.

You can watch Andrew Merton’s recent poetry reading at UNH, a video in three parts, by clicking here. And you can order the book from Accents Publishing.

From The Blue Room: www.theblueroomblog.org

This week’s Healthstyles program focuses on the use of the arts to promote health and healing. I interview three people who have been engaged in this work in the NYC metropolitan region: Joy Jacobson, Poet-in-Resident and Senior Fellow at the Center for Health, Media & Policy (CHMP) at Hunter College, City University of New York; Jim Stubenrauch, CHMP Senior Fellow; and Diane Kaufman, MD, poet and child psychiatrist at the University of Medicine and Dentistry of New Jersey (UMDNJ)– University Behavioral HealthCare at Newark, NJ, where she is also the Director of Creative Arts Healthcare.  The three discuss various forms of art that are used with patients and clinicians to foster self-healing, as well as a collaborative project on narrative writing with nurses at UMDNJ. The program airs this week on WXMR-FM (Radio Bistro at www.wxmrfm.com; 100.7 FM) and on WBAI-FM (www.wbai.org; 99.5 FM in NYC on Thursday night from 11:00 to 11:30 PM). To listen to the program, click here: Arts UMDNJ.

Diana J. Mason, PhD, RN, FAAN, Co-Director, CHMP

Angilee Shah’s Career GPS blog for ReportingonHealth.org  interviewed Senior Fellow James Stubenrauch, who co-taught the first narrative writing course to students in the Hunter-Bellevue School of Nursing along with CHMP Senior Fellow and Poet-in-Residence Joy Jacobson. Her post, Why Health Care Professionals Should Write, addresses the reasons and benefits of writing for health professionals. Jim’s quote “”It’s part of a self-care strategy as well as making a better provider out of whoever does this kind of work,” he told Career GPS. “What I’m trying to do in this course is give people permission to get their own voices in the room and down on paper.”  Archived posts on Narrative Writing can be found here.

Reporting on Health is a project of USC Annenberg’s California Endowment Health Journalism Fellowships.

Credit: created by Mark A. Hicks, illustrator.

Manuscript of "The New Colossus" by Emma Lazarus; photo credit / The Center for Jewish History, NYC

In July, I wrote a post on the first-ever narrative writing course for nursing students at the Hunter-Bellevue School of Nursing. CHMP poet-in-residence Joy Jacobson and I taught the five-week course, which met twice each week for three hours per class. I’m happy to report that it was a great experience for us as instructors and, by the end of the course, the consensus among students was that they didn’t want the class to end.

Eleven nursing students were enrolled and one Hunter staff member audited the course; seven of the 12 participants were not native English speakers (their first languages were Mandarin, Korean, Russian, and Yoruba). Most had done little writing for themselves and all needed to improve compositional and grammatical skills. Nevertheless, all of the students produced creative and moving original writing in a variety of formats, including in-class exercises, blog posts, and personal essays.

Several readers of my previous post asked for more particulars about our teaching methods. Here I’ll focus on the in-class writing exercises.

We spent about the first half hour of each class on one or more “quick writes”—guided writing exercises designed to get everyone writing quickly and spontaneously, without concern for the rules of grammar, spelling, and punctuation. The ideas for the quick writes came from several sources, and we adapted freely from books such as Natalie Goldberg’s Writing Down the Bones: Freeing the Writer Within, and The Essential Don Murray, edited by Thomas Newkirk and Lisa C. Miller. We encouraged students to keep their hands moving and to trust their impulses, in the hope that they would get in touch imaginatively with emotions, memories, and sensory impressions, and write about experiences they wouldn’t usually commit to paper. Joy and I did the writing exercises along with the students.

We then spent the next hour of the class reading and discussing what we had just written. While sharing was optional—no one was forced to read aloud—most students were eager to read most of the time. It was remarkable how quickly this sharing helped establish a sense of trust and an atmosphere of mutual support and respect. The feeling that we were coming together as a community of writers proved to be essential as the course progressed and some of the writing prompts led class members into deep and sometimes turbulent emotional waters.

The idea for what may have been the most powerful of the quick writes came from Between the Heartbeats: Poetry and Prose by Nurses, an anthology edited by Cortney Davis and Judy Schaefer. A short piece by Ruth E. Brooks, “Dear Alma Mater,” is in the form of a letter addressed to the Harlem Hospital School of Nursing, which was closed in 1977. The author writes to her alma mater as if it was a person, saying how news of the school’s closing gave her a profound sense of loss. “Let me tell you what part of me was sealed behind those doors,” she writes, and then enumerates not only some of the nursing skills but also the philosophical perspectives she learned there. In concluding, she expresses her sense of indebtedness to the school for helping her transform her life in the process of becoming a nurse.

I found the piece very moving, so I began one class by reading this letter aloud and then asked the students to write a heart-felt letter to a place or a person—living or deceased—that is important in their lives; and I asked them not to hold back, and to write all the things they wish they could say or could have said. When given the chance to express their feelings about what matters most to them, even those students who had the most difficulty with written English wrote clear, straightforward sentences that carried tremendous emotional weight. The stories that came out, the courage the students showed in sharing them, and the way they supported each other’s telling were cathartic and inspiring.

Students also were required to keep a daily journal, and there were assigned readings and writing projects. The final project was a personal essay. One student, Jamie Torres, wrote about her experience of the course itself, and how the close reading and discussion of some of the poems in the Heartbeats anthology had given her a new appreciation of poetry and her own abilities as a writer. She kindly gave me permission to quote from her essay, in which she wrote:

I would encourage all nurses to step out of their comfort zone and start reading poetry, write in a journal, and begin to share their stories. We can call it Narrative Nursing. Louise DeSalvo, author of Writing As a Way of Healing, says, “Through writing we see ourselves as able to solve problems rather than as beset by problems. We enjoy a heightened sense of self. We become more optimistic.” This is what nursing desperately needs. Narrative nursing will give us an opportunity to practice hearing our voice, in a new and fresh way. Maybe through writing we will recognize our own worth.

We’re looking forward to a guest blog post from Jamie sometime soon.

Jim Stubenrauch

A platform for poetry, health care policy, & conversation

Poet Rachel Hadas

will read from her recent book

 STRANGE RELATION:

A Memoir of Marriage, Dementia, and Poetry

and join in conversation with

Rita Charon, MD, PhD,

Director, Program in Narrative Medicine, Columbia University College of Physicians and Surgeons

September 22, 6:30 pm

The Roosevelt House Public Policy Institute at Hunter College

47-49 East 65th Street, New York, NY

This is event is free. Seating is limited and RSVPs are essential. Please respond as soon as possible: chmp@hunter.cuny.edu

In 2004, after nearly 30 years of marriage, Rachel Hadas’s husband, George Edwards, a 61-year-old composer and professor of music, was diagnosed with early-onset dementia. Strange Relation is her account of the difficult years of “losing” George—a time when reading and writing were essential parts of what kept her going, as she “tried to keep track … to tell the truth.” The writer and physician Danielle Ofri has said of the book: “A poignant memoir of love, creativity and human vulnerability. Rachel Hadas brings a poet’s incisive eye to the labyrinth of dementia.”
Rachel Hadas, PhD, MA, is Board of Governors Professor of English at Rutgers University in Newark. She is the author of many books of poems, essays, and translations, including The Ache of Appetite, The River of Forgetfulness, Laws, Indelible, and Halfway Down the Hall: New & Selected Poems. She co-edited the anthology The Greek Poets: Homer to the Present. Her honors include a Guggenheim Fellowship, an Ingram Merrill Foundation grant, and an award in literature from the American Academy and Institute of Arts and Letters.

Rita Charon, MD, PhD, is Professor of Clinical Medicine and the founder and director of the Program in Narrative Medicine at the Columbia University College of Physicians and Surgeons. A general internist in primary care, Dr. Charon took a Ph.D. in English when she realized how central is the telling and hearing of stories to the work of doctors and patients. She is the author of Narrative Medicine: Honoring the Stories of Illness and a co-editor of Psychoanalysis and Narrative Medicine and of Stories Matter: The Role of Narrative in Medical Ethics.

Media Partners & Co-Sponsors:
THE CENTER FOR HEALTH, MEDIA & POLICY (CHMP) at Hunter College is an interdisciplinary initiative for advancing the health of the public and healthy public policies. CHMP is a catalyst for shaping crucial conversations about heath and health care through media, research, education, and public forums. http://centerforhealthmediapolicy.com/

THE WRITING CENTER: The Writing Center CE, new to Hunter College and directed by Lewis Burke Frumkes, encourages creative writing and learning across the cultural spectrum. To that end the Center offers workshops taught by professional writers and presents speaking events with world-class figures that are open to students, faculty, and the public without charge. www.hunter.cuny.edu/ce

ARTS ACROSS THE CURRICULUM: This summer Hunter College received a planning grant from the Andrew W. Mellon Foundation to pilot a new initiative that will capitalize on the College’s renowned arts programs, faculty, and facilities during this academic year. A variety of approaches will introduce the arts throughout the curriculum and expose more Hunter undergraduates to the rich cultural resources of New York City.

THE ROOSEVELT HOUSE PUBLIC POLICY INSTITUTE AT HUNTER COLLEGE http://www.roosevelthouse.hunter.cuny.edu

Notebook collection, a photo by Dvortygirl on Flickr.

A new writing course for Hunter–Bellevue School of Nursing graduate students got off to a great start this past Thursday evening. CHMP poet-in-residence Joy Jacobson and I will teach the class for the next four and half weeks of Summer Session II. Our immediate goal is to help the students sharpen their skills in writing—scholarly writing, blogging, and narrative writing—and in on-the-job communication. But we also hope to motivate students to invest more energy in their writing by developing a daily writing practice focused on their clinical and personal experience. We’ll supplement this work by close reading of literary and scholarly texts that deal with the experiences of illness and caregiving.

The combination of reflective writing and close reading is an adaptation of the pedagogical approach used in the emerging field of narrative medicine. The mission statement of Columbia University’s Program in Narrative Medicine provides a good introduction to the aims of this discipline:

Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues. . . .

(I wrote a previous blog post about a presentation given by the founder of the Columbia program and one of the pioneers in this field, Rita Charon, MD, PhD. An extensive bibliography with links to several publications by Charon and others can be found here.)

We adapted our guidelines for developing a daily writing practice from Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives, a fascinating book by Louise DeSalvo, professor of English at Hunter and leader of a memoir workshop in the MFA Writing Program. (She also blogs at Writingalife’s Blog.) Anyone interested in writing as a means of exploring the self will find sound advice and much food for thought in this book. DeSalvo writes

This book is an invitation to engage with your writing process over time in a way that allows you to discover strength, power, wisdom, depth, energy, creativity, soulfulness, and wholeness. . . . to use the simple act of writing as a way of reimagining who you are or remembering who you were. To use writing to discover and fulfill your deepest desire. To accept pain, fear, uncertainty, strife. But to find, too, a place of safety, security, serenity, and joyfulness. To claim your voice, to tell your story. And to share the gift of your work with others and, so, enrich and deepen our understanding of the human condition.

These are not mere self-help bromides. DeSalvo draws on a growing body of evidence from research conducted by James W. Pennebaker and others that demonstrates the beneficial psychological and physiological effects of a specific kind of writing about disturbing or powerfully emotional events. According to DeSalvo, Pennebaker discovered that “to improve health, we must write detailed accounts, linking feelings with events [the emphasis is DeSalvo’s]. The more writing succeeds as narrative—by being detailed, organized, compelling, vivid, lucid—the more health and emotional benefits are derived from writing.” (Pennebaker’s Web page at the University of Texas, Austin, has an extensive bibliography of his research, with links to free downloadable files. Click on Publications. He is also the author of Opening Up: The Healing Power of Expressing Emotions.)

DeSalvo and others, such as Sara Baker, who facilitates what she calls Woven Dialog creative writing workshops with patients at the Loran Smith Center for Cancer Support in Atlanta, Georgia, and elsewhere, also note an important caveat: this kind of writing practice, especially at the beginning of the process, can stir up strong negative feelings, particularly among those who have experienced real trauma (for example, those who have survived cancer or violent abuse). It’s important not to push oneself too far; or, as Baker writes: “We must not use our work to retraumatize ourselves or put ourselves in danger.”

Baker encourages imaginative writing—using the tools of fiction and poetry to offer what she has called “an oblique route” that may give a survivor of trauma “more freedom to connect with emotional and often buried truths” than the more direct route of memoir would provide. (Sara Baker blogs at Word Medicine.)

At the first class meeting last week, students dove right into a guided writing exercise called “My Least-Favorite Patient or Colleague.” First, each of us made up a list of nouns or adjectives beginning with the letter ‘B’ that described the person we had in mind; then another list of words beginning with the letter ‘S’ that described how that person made us feel; and a third list, of verbs or verb phrases beginning with the letter ‘T,’ that described what we would like to do to or with that person. Then, based on this material, each of us wrote a simple “list poem”—that is, a poem in which each line begins with the same word or phrase (such as “I remember…”). The last line has to have a strong twist or surprise, something like the punch line of a joke. And to cap it off, the title of the poem is written last (and is often humorous or ironic in retrospect). You can imagine how this little exercise got the juices flowing.

Stay tuned. We may be publishing some of our students’ writing on the CHMP blog in August.

Dean Young / Photo by Matt Valentine

Joy Jacobson is CHMP’s poet-in-residence. Follow her on Twitter: @joyjaco

Last week the poet Dean Young got a new heart. He had been on the organ-transplant waiting list for four months, having lived for years with hypertrophic cardiomyopathy, a degenerative heart condition. (The waiting list is a crowded place; this morning, 3,143 people were waiting to receive a donor heart.) Young’s friend Joe Di Prisco wrote to me on Sunday that “all the early reports from the docs are encouraging. He has a long and arduous path ahead, and the needs are great, but his heart is now beating on its own.” Di Prisco is the head of a national fundraising campaign set up to help offset the enormous costs of Young’s heart transplantation.

“Let us suppose that everyone in the world wakes up today and tries to write a poem.” So Dean Young begins The Art of Recklessness: Poetry as Assertive Force and Contradiction. The book extols the mess of the artistic impulse, that kinetic force beneath all creative works, great and small. It’s a gutsy way to start a book on poetics—imagining that every one of us might permit poetry, this “wild democracy of language,” a place of primacy in our daily lives.

Young’s latest book of poems, Fall Higher, is being released this week. The following poem shows both his craft and his daring in the face of illness (reprinted by permission of Copper Canyon Press):

The poem begins and ends with a sigh—“If only”—and in between the poet contemplates our central affliction, the temporality of life, and the primal beauty we stand to lose. But he won’t permit himself the easy luxuries of self-pity. This meditation on the fact that “[b]reathing will destroy us” necessarily involves fireworks, a vulnerable alligator, a trapeze artist, a risotto, a hinted-at whiff of a celebratory (and analgesic?) shared joint. Stars and sternums all threaten to return to dust by poem’s end, and the simple measures by which we sustain the body—imagined in the title as a glove discarded into a bush of roses (and thorns)—provide nutriment even as they fail us.

We’re more than halfway through National Poetry Month, and I haven’t written a poem yet. Have you? If you’re not in the mood for quite that much recklessness, perhaps you might want to join the Rumpus Poetry Book Club, a reading group from one of the better literary blogs out there, in reading Dean Young’s Fall Higher, its April selection.

Joy Jacobson is CHMP’s poet-in-residence. Follow her on Twitter: @joyjaco

Marie Ponsot

I recently watched an online video of a roundtable discussion, Recovering Syntax: A Poet’s Struggle with Aphasia, held in October at the Philoctetes Center for the Multidisciplinary Study of the Imagination. In it, the poet Marie Ponsot describes the stroke she had last year, at age 89. And she details, with remarkable fluency, her experience of aphasia, an impaired ability to process language—in speaking, writing, reading, or hearing—that can result from brain injury.

“There’s something that I have in my mind that I sort of want to say and it’s not going to say itself,” Ponsot says of her efforts at recovering speech, “so I go under it and speak on the other side of it.” In the following poem, written before her aphasia and published in her 2009 collection, Easy (reprinted with the author’s permission), Ponsot explores the terrors and joys of learning to talk.

In trying to “acquire” the language of this poem, I copied it out, longhand. I read it aloud. Try it. Give your voice to these lines: “while sun sucks earth juices up from wry / root-runs tangled under dark…” Poetry is an oral (and aural) art form, and by reading Ponsot’s poem aloud I begin to feel the way language is discovered.

This sonnet opens with a couplet, toppling convention (a Shakespearean sonnet ends with a pair of rhyming lines). That upending seems important. In the beginning was the Word, the Biblical prophet said, but this poem begins with a wordless tree, an oak. The need for utterance starts before we have the capacity for speech—that is, before we acquire the quality that makes us human. The passion must therefore express itself or destroy itself.

It’s an apocalyptic vision, but this universe also has its mercies. The infant apprehends the world through the tongue, organ of taste and of speech. She detects the “liquor of sweetness” in everything, knowing the world through tasting it, touching it. (It’s no surprise to learn that Ponsot reared seven children.) In making that single, long vowel sound, “I”—“her self-finding pronoun”—she moves earth. As sound becomes word, infant becomes individual. And “no longer vegetal” she disentangles from the primeval, wordless root-runs she sprang from to find “You.”

It’s a love poem to language, isn’t it?

Just a few weeks before her stroke Ponsot told the online journal Guernica, “At the stage of babbling, everyone is a poet. In those first three months of life, everyone says, ‘ah-bah bah bah bah bah bah bah bah’ or whatever consonants they’ve tapped out in their little brains.” Ponsot’s poem works on many levels: while it maps out an infant’s delighted discovery of language, it also depicts the pleasures of learning to read poetry. And, rather presciently, it lays out the method by which Ponsot herself would reacquire language in her ninth decade.

After her stroke, Ponsot’s students and friends visited her in her home and read poems to her as part of her rehabilitation. As of last fall she had recovered much, but not all, of her speaking and writing abilities; she hadn’t yet written any poems. Yet because she’s an artist for whom language has been not only a medium but also a subject, I’m hopeful that as she celebrates her 90th birthday this week, she is acquiring new ways with language, inventing a new poetry.

Joy Jacobson is CHMP’s poet-in-residence.

Rachel Hadas, a well-regarded writer of poetry and essays, has just published a new book of nonfiction. Strange Relation: A Memoir of Marriage, Dementia, and Poetry chronicles how the writing and reading of literature helped Hadas to cope when her husband, George Edwards, a composer, was told at age 61 that he had either Pick’s disease, also known as frontotemporal dementia, or a combination of Pick’s and Alzheimer’s diseases. Hadas wrote the following poem (reprinted with her permission) after his symptoms became apparent but before they received that diagnosis.

The taxi contains an unnamed “we” moving in a halting, nearly peristaltic fashion toward a diagnostic procedure. “I try to concentrate,” the speaker begins, and as someone who has been in such a taxi—my mother died of dementia in 2005—I know how dread can overtake the ability to concentrate. But by the second line the speaker and everything else “deliquesces.” The world is melting, and only through the direct comparison of simile—this is like that—can the speaker recognize her surroundings.

Hadas first published the poem in 2008 in Pulse—voices from the heart of medicine and wrote at the time that she “instinctively knew” what her husband’s scan would reveal. Before diagnosis, the poem suggests, one can apprehend the truth of illness only in flashes and flickers. “Anything more than the truth would have seemed too weak”—that remarkable line defies rational sense but rings true, somehow. Uncertainty, the dread unknown, may be hard to endure, but living with certainty will be “worst of all.”

Lucidity returns, momentarily, in the form of a poodle. Hadas writes in Strange Relation, “The kingdom of illness gives some gifts; it bestows an alarming clarity on the way those inside it view those outside.” For now, time stops just long enough for the speaker to observe the dog, and then time reverses. Or rather the speaker asserts her power and converts her own emotion—at once self-affirming and self-pitying—into a parenthetical, past-tense, third-person utterance: “(she said).” It’s as though she is watching herself begin to compose her own memoir.

But expressions of broken-heartedness cannot end because they cannot begin. The mind knows only to question itself—“ A future? How to get there? And once there / how to escape?”—and receiving no answer repeats that odd phrasing encountered earlier: “Anything more than the truth would have seemed too weak.” This time, the speaker recognizes “the blinking” of time and truth, and while still enclosed within the taxi, names it a kindness.

Hadas has written of an increasingly common experience. The Alzheimer’s Association announced this week that 15 million informal caregivers provided 17 billion hours of unpaid care to people with dementia last year. There are many resources to assist them; Hadas serves on the board of the Well Spouse Association, for example, a nonprofit that provides support to caregivers of ill and disabled spouses. And Hadas will provide a keynote address at The Examined Life: Writing and the Art of Medicine, a conference at the University of Iowa, April 21–23.

George Edwards now lives in a facility, and Rachel Hadas is still writing. “My poems have always known much more than I know,” she said in an illuminating interview on National Public Radio’s Talk of the Nation on March 10. “My subconscious appears to be smarter and much braver than the rest of me.” Indeed, “In the Taxi to the MRI” maps out a precipitous terrain as perhaps only poetry can do.