Laura March* doesn’t seem particularly glad to see us. When I speak, her lashless eyelids flutter open then shut again. Her eyes follow my voice, find my face and then my partner’s face, try to focus. “What?”
I repeat myself, struggling to find the simplest explanation for our presence in this unlit hospital room. I want to come closer but am hesitant to push the partition back completely and intrude farther into her private space. The moment when we enter a patient’s room is always the most difficult and uncomfortable. How will we be received? “We wanted to talk with you this afternoon,” I say “We came to write you a poem.”
It’s no easy thing to approach a dying person and tell him you want to write him a poem. A year and a half ago, when I first started this project, my hands shook uncontrollably when we entered a patient’s room. I remember the very first time, how I peeked around the curtain to see a family clustered near the bed: a middle-aged woman reading a magazine, elbows resting on the patient’s meal tray; the man beside her, just looking off somewhere as if contemplating a view beyond the room; and their daughter in a chair in the corner, knees drawn up, watching a soap opera with a posture that suggested she had been doing nothing else for hours, days. Death, I reflected briefly, is not as dramatic as we imagine. The faces in the room reflected not terror or grief or awe, but boredom—a long, drawn-out waiting.
How unprepared I felt, standing just inside the door. When my eyes adjusted, I made out the bed. A man’s body lay there, light as a child’s, barely making an imprint in the mattress. The man’s mouth gaped open loosely, an oxygen tube fitted below his nose. My reaction then—as it is even now, every time I enter a patient’s room—was shock at how small he was, how entirely wasted and vulnerable. Tina, my partner at the time, was an old hand at this. “We’re with Poes1a del Sol,” she began, “a service of Mayo Clinic’s Humanities in Medicine program.” Watching the family as Tina spoke, I was unable to shake the overwhelming sense of being an intruder during a most vulnerable and private moment in the lives of strangers.
The task has gotten easier since then, but never easy. Now I am the one who explains the project, and still, after a year and a half, I feel clumsy every time. How to articulate an offer that has no easy language to describe it? “Poetry,” a word that carries unpleasant baggage for many people, never seems like the right thing to say. Once, when I explained Poes1a del Sol—Poetry of the Sun—to a patient, he smiled the way you might smile at a Girl Scout who has come to your door to sell cookies, a Girl Scout you are about to turn away. “You write poems? That’s really sweet,” he said, “but as you can see, this isn’t a good day for me.” Undoubtedly for this man, as for so many others, “poetry” evoked Hallmark greeting cards, “Chicken Soup for the Soul,” sentimental rhymed couplets, and he wanted no part.
For other patients, “poetry” is clearly a form ofhigh school torture that they don’t care to face again as free adults. One woman we talked to apologized: “It’s not that I don’t like to read, but I just don’t get poetry. It’s too bad my granddaughter isn’t here. She writes poems. She might like your project.”
I reflect on this as I announce our project to Laura, using the word “poetry” because I have nothing better to offer. The nurse brushes past us then, pushing the curtain aside with brisk efficiency, crossing to the window to let in the daylight. Cheerful and competent in her patterned blue scrubs, she bends to adjust Laura’s pillows. “Laura, I told these ladies it would be good for you to participate in their project. What do you say?”
I can see the room more clearly now, its neutral tones, the mess of medical apparatuses around the bed: tubes, cables, monitors. Laura has been on our patient list for about a month, but because she has been in and out of surgeries and treatments, this is the first time we’ve seen her face to face. She rests on top of her blankets, her thin legs stretching from beneath a hospital gown. A several-days-old stubble of blonde hair has begun to show across her pale scalp. “I’m not feeling very strong today,” she says, turning her cheek against the pillow, settling deeper into a posture of sleep.
It’s not uncommon for patients to be too unwell to see us. The program was designed especially for those in palliative care; most of the people we see each week have been given a year or less to live. The doctors and nurses will do what they can to alleviate a patient’s pain and to extend her life as long as possible, but for the most part, it’s understood that treatment will do only that: give the patient a few more months, maybe, but not make her better. The treatments are often aggressive, leaving the patients too exhausted or in too much pain to talk. Sometimes, we walk the halls of the hospital for two hours before we find a patient who will see us. On those days, I’m most glad to be working with a partner; I know if Leah doesn’t suggest giving up for the day, I won’t, either.
Today, as I turn to leave Laura’s room, I note that there are three patients left on the list for us to try, and I begin to figure which of the room numbers will be the closest to the one we’re leaving. But the nurse tells us to wait. “Laura, you really ought to give it a chance. It would do you good.” Laura doesn’t seem to hear her at first, but then, to my surprise, she reluctantly agrees.
The idea of writing poems for patients did not originate in palliative medicine. A community outreach project through Arizona State University’s creative writing program, it first existed as a service to families of Alzheimer’s patients. Karla Elling, the programs coordinator, conceived of the project after experiences talking with her father, who had been diagnosed with the disease. Together, with students in the master of fine arts program and Alberto R1os, a regent’s professor and poet, she put the project to work in Alzheimer’s units around the Phoenix area.
Poes1a del Sol didn’t come about until almost nine years later when Elling ran into the coordinator for the Mayo Clinic’s Center for Humanities in Medicine at an arts commission conference. Mayo, renowned for its humanitarian patient care, had been introducing music therapy into patient rooms for some time. When Humanities in Medicine heard about the poetry project, they approached ASU about a collaboration. There are now three ASU poets serving on the project at any given time: two current graduate students in creative writing and one program alumnus.
Leah and I are the students, and so we work together. Today, we find chairs in Laura March’s room and begin to ask some questions. We enter the interview slowly, the way an artist begins a sketch before knowing what the final composition will be.
“Did you grow up in the Phoenix area?” Leah asks.
“No, I grew up in the suburbs outside San Francisco. We moved there when my mother got a divorce. We moved when I was. …” She stops, unsure, and we wait for her to go on.
After a long silence, I ask, “What was it like growing up there?”
She can’t remember now. Can’t recall much of her childhood. “It’s this medication,” she says, frustrated, tired.
We go on like this for a while, scavenging the shaky details we can, until the door opens and a woman in her mid-60s walks in. We hadn’t expected anyone else, and we’re a little surprised. The woman is carrying a grilled cheese sandwich from the hospital cafeteria, and she settles into the chair beside Laura’s bed with a sigh, kicking off her shoes to reveal glossy toenails painted a vibrant red. She introduces herself as Susan, Laura’s mother.
It’s been difficult to guess Laura’s age. The bones ofher face are clearly articulated beneath her pale skin, and it’s impossible to tell whether the darkness around her eyes is caused by age lines or swelling. In her slowness and forgetfulness, she seems old, and yet she appears so small in the hospital bed. Now, looking at her mother, I decide Laura must be in her early to mid-40s.
The task of drawing out Laura’s story becomes easier now. When Laura’s memory lapses, Susan is there to prompt her. “Remember your first job in Phoenix, Cookie? You worked at the ad agency. Tell them about the ad agency”
So Laura—Cookie—does. She tells us how she got a job escorting executives around the city in limousines, showing them the billboards her company had designed to advertise their products: Coco-Cola, cigarettes, beer. Sometimes, when the executives couldn’t come to Phoenix, Cookie would drive around the city herself, photographing the billboards so she could send the pictures to the companies by mail. “It was a cushy job. I’ve always loved photography”
There are so many details in a life that go overlooked, details that may seem “insignificant” in a personal narrative but that are, in another sense, extremely valuable because they make an individual’s experience real and unique. Close family members might remember these things, but no one else, and the details slip away over the years. Cookie’s stories about the ad agency are clearly of this category, and I take careful notes.
I once heard someone argue that every life ought to have a witness, that our daily experiences are rendered meaningless without someone else there to take note, to register the small gesture or loss or discovery that will otherwise go unremarked in the vast sea of experience. Sometimes, I think that Poes1a del Sol allows Leah and me to be this kind of witness to a life. We quite literally take note of whatever a patient has to tell, whether the telling lasts for half an hour or an hour and a half, and there is affirmation in this. You wouldn’t stop a person on the street and tell her that your grandson has just been born and your son named him after you or that, as a child, you used to watch steam rising off the hot springs in your backyard each winter, a vapor that coated the trees in thick, glittering ice. You wouldn’t do this—but haven’t you ever wanted to?
“These are my daughters,” Cookie says, lifting a framed photograph from her bedside table. “The one on the left is Emily, my youngest. She’s 17.”
“Here.” She hands us the frame. “Beautiful, isn’t she? She seems to think that’s all she needs to get along in life. She expects so much.” Susan and Cookie talk about the girls, how two sisters couldn’t be more different. At one point, Susan turns to us. “This is amazing,” she
says. “This is the clearest Cookie has been all week.” It’s true that much of the grogginess has receded. How can I explain what happens in this act of telling? It hardly makes sense.
On a different occasion, we talked to Dot, an elderly woman experiencing pain so intense that her face had gone ashy gray, her mouth set in an unwavering grimace. Dot’s right hand curled around a morphine dispenser, which she pressed every few minutes to bring some relief. As we began our interview, I was worried we wouldn’t be able to get a poem; she barely spoke, and when she did, her words hissed from between clenched teeth. “Do you have brothers and sisters?” we asked. “Have you lived in Phoenix long?” And she would say yes or no and then stop and close her eyes to signify that was all she planned to say.
Usually, if a family member is in the room, he or she joins in, as Cookie’s mother does today, filling the holes in a story or speaking for the patient when the patient is too weak. But Dot’s husband, a slight man in late old age, spoke to us only once, when we entered the room, to ask—half apologetically—how much our service would cost. When we assured him it was free, he settled into a chair near the window and opened a book.
At some point, Dot’s responses started to get a little longer, but each one came with clear effort so that it was painful for me to listen to her. I considered calling the interview off. Then, Tina asked a question that triggered something.
“Dot, how did you and Lewis meet?”
Dot smiled, actually smiled. “We met at a naval base during the war. I was a nurse. He was an officer.” She began to describe how handsome Lewis had been, how she had seen him across the mess hall and, too afraid to approach him directly, asked around to find out if he was single. Lewis, who, as it happens, was also interested in Dot, heard from a friend that she was asking about him.
My note-taking was picking up pace, and I noticed that Dot’s voice was losing its hard edge. “When he found out that I liked him, he decided to play a practical joke on me.” Dot’s eyes were shining now, and as she told the story about their courtship, she even laughed when she got to certain parts. By the time the story was done, it occurred to me that the morphine dial had fallen out of her hand without her even noticing. Lewis still sat quietly in the corner, but there was a secret smile on his face.
For that hour, Dot was no longer in the room with us; she had transported herself back to 1942, to a time when she was young and in love and when her life was still full of possibility. The act of speech, of losing oneself so completely in the telling of a story, is inexplicably restorative. I don’t mean that patients can get better just by talking, but I’ve seen the way their bodies relax after a time, the telling freeing them momentarily from their pain, slowing their heart rates, bringing clarity.
“My friends always said I was the perfect mother,” Cookie tells us now.
“It’s true,” Susan chimes in. “When the girls’ teachers asked for parent volunteers, Cookie was always the first one there to help.”
“I wasn’t the perfect mother,” Cookie says after a while. The silence in the room is cut by one of the monitors near the bed. It begins to beep steadily, and I realize how impossible it must be—even at a hospital like Mayo, which tries to create a warmer, less sterile environment for patient comfort—to forget for a moment that you are sick. Even with your eyes closed, there is the medical machinery, the nurses passing in the halls, the sound of the TV from another patient’s room.
“I wasn’t perfect,” Cookie says again. “I wanted to lead a spoiled kind of life. I would get up, go out to lunch with my friends. Got up, went to lunch. …” Cookies eyes have grown red, and now, as a few tears roll over, she reaches to wipe her cheeks with the back of her hand. “I’m sorry,” she says. And I don’t know if she means for the tears or for something from her past.
“It’s all right,” I say, but have little else to offer. I have always been a poor comforter. When people cry in front of me, my instinct is usually to pretend it isn’t happening. I never seem to have the right thing to say.
These days, complete strangers cry in my presence nearly every week: Lisa, who tells me she doesn’t like her 3-year-old son to visit her here, that he’s too little to have a concept of death; Sue, whose sister doesn’t know she’s dying because the two of them haven’t spoken in 20 years; or Cookie, who worries about her teenaged daughters, is terribly proud of them and grasps at the improbable hope that she will be around long enough to see what kind of women they become. These people cry, anticipating loss of a kind I have never experienced in my own life. I very much doubt that anything I say in these circumstances could be the right thing, that my words could offer any kind of solace. Instead, I have learned to listen, and I have come to find that this is all most people want.
It is a strange kind ofintimacy that occurs between strangers, a threshold we cross sometime near the end of the interview. People want to unburden themselves, and maybe, in the end, I’m safe because I’m a stranger. I receive memories and fears and, sometimes, strange confessions. Some of these go into poems, but most I store up. Even though I will never see many of the patients again—in this project our contact happens just once—their stories become a part of my experience.
As the interview draws to a close, Cookie is fully alert. She tells us about scuba diving—a hobby she found late in life—and about swimming with sharks off the coast of Mexico and the absolute peace she finds underwater. I’ve never been scuba diving, but I can imagine this more than anything Cookie has yet described, and I know it will be an entry point for the poem. When I sit down with my notes after an interview, I look to these entry points as ways I can begin to inhabit the patient’s experience, give it substance on the page, turn it from simple narrative into poetry.
As I’ve worked on this project week after week, I’ve become convinced that empathy is an act of imagination, imagining myself into someone else’s skin. I can’t imagine the grief some of these patients are experiencing; I don’t mean that. For their grief, I can only express compassion, having never lost a child or parent or sibling in my own life and having never come face to face with my own death. I can’t tell them, “I know how you feel,” because those words would be untrue and empty. But I can imagine myself into a patient’s life. It becomes a necessary part of the process. The patients give us narratives, and out of these narratives, we choose moments and details: the Thanksgiving trip to Costa Rica, when, on an impulse, Cookie put down the turkey she was basting and ran out to the beach in her swimsuit to take a scuba certification course; the war letters that Kathy’s husband had sent each week from the South Pacific and that she kept hidden beneath her bed in a cookie tin; the house on Lake Michigan that a patient named George and his family built with their own hands.
The patients rarely offer the atmospheric details around these moments, and so I imagine my way into the moments and find them. This happens in surprising ways, though rarely more surprising than the night I woke from a sound sleep, having dreamed I was Kathy Baker.
Kathy was a patient in rehab, recovering from a recent stroke. When we asked her a question, she had trouble finding the word for the thing she wanted to say; sometimes her answers were only one syllable. The few details that came were precious, and I snatched them up.
Kathy’s husband was from a farming family. He and Kathy met during WWII while he was home on leave from the South Pacific. They never dated. All through the war, he sent her letters from his ship, and when the war was over, he returned to the United States, and the two were married. Just like that.
And then, only a month after the wedding, Kathy followed her new husband out to the God-forsaken Arizona desert, to Phoenix, a small town at the time, where they started a cotton farm among the saguaro and prickly pear and dry, red earth.
“What was Phoenix like back then?”
“Oh … you know,” Kathy looked around helplessly, shrugged her shoulders.
“In what ways has the city changed in the 60 years that you’ve lived here?” I found that fascinating: 60 years.
She was silent for a moment. “It changed in a lot of ways.”
“It must have been much smaller back then,” I offered.
“Oh, yes. Much smaller.”
I was finding a pattern with her, allowing the conversation to circle back on itself. “And I guess there was no air conditioning when
you moved here?” The Phoenix summers regularly get up to 120 degrees and hang there for weeks at a time.
Kathy shook her head.
“What did you do to keep cool?” I asked.
She looked perplexed for a moment.
“How did you sleep at night, for instance?”
“Oh, sometimes we slept out on the … the. …” She gestured at the ground. “On the lawn, to keep cool.” I mentally conserved this detail, convinced it would wind up in the poem. Sometimes, you just know; details like this are the kind we hope for.
When Leah and I approach our poems, we generally don’t discuss the patient interview much before starting. We’ve developed a routine in which we both sit down with our separate laptops, sort through our separate notes and write separate pieces. Only toward the end will we compare poems, and, occasionally, when the things we’ve written are very similar, we’ll combine the two into one. More often than not, the poems are distinct enough that we decide to keep them separate, presenting the patient with two side-by-side versions in a single frame when we return to the room. But even in these instances, you can bet that both of us will have fastened onto many ofthe same fragments.
I have heard poetry described as a discipline ofruthless attention, and I think this captures it well. A poet learns to look for the small thing that reveals much. Alberto R1os says ofPoes1a del Sol that the task is to find “the power ofthe single detail rather than the quotidian experience.” So I knew the image ofKathy Baker sleeping on the lawn would appear in Leah’s poem, too.
Sitting down to write Kathy’s poem once our interview was finished, I began, as usual, by reviewing the notes, pulling out the strongest details and looking for patterns. There was the correspondence between Kathy and her husband, their new life together in the desert, a few sketchy details about the things Kathy does now. How did these things all add up?
As I paged again and again through Kathy’s interview notes, there was one thing I couldn’t get out of my head. How was it that this woman, who had spent so little time with her husband before their wedding day, was willing not only to marry him but then to pick up and move, for him, to a small town in a blistering desert miles from home? Either he was a remarkable man, or she was a remarkable woman. What could Phoenix have been like when she saw it for the first time? Did she regret the decision as soon as she got here? Did she desperately wish for a way out?
Though the Phoenix of today is an entirely different city from the Phoenix of 1945, I know the desert here. I began to imagine what it must have been like before all the condominiums and freeways and strip malls. There was certainly no more water then than there is now—less water, in fact, because they hadn’t yet started to pipe it in from out of state. I knew from Kathy s interview that there had been no irrigation, that they had to bring water to the cotton fields by hand. And in such tremendous heat! The Arizona cotton harvest happens in the fall, so planting must have taken place at almost the hottest part of the year.
Still, there is a spare, wild beauty to the desert. There must have been something, after all, to keep her here for 60 years. I thought of the wide sky here, which stays almost perpetually cloudless, and I imagined the extravagant stars she must have seen, before all the light pollution, while sleeping out in the grass on a summer night.
I thought about the desert in the daytime and Kathy s little farmhouse lost in the bare, flat land. She must have felt stranded; the house must have felt like a ship out on the open sea—that same sense of scale. Yes, just the way her husband must have felt, months earlier, on his ship in the South Pacific, sitting up on deck, writing Kathy letters. This is where I began my poem.
When I brought the poem back several hours later, Kathy’s husband had arrived. I hadn’t counted on another audience member, especially one who would test the validity of the poem’s claims. In the end, I had taken a good amount of liberty with the poem, imagining all kinds of things between the details I knew to be true. What if the whole poem was so incredibly far off that it would seem silly? Or worse, what if it was untrue, and he was angry that we had fabricated this image about his wife and the life they had led together? My voice faltered a little as I began to read. When it was over, I was met by silence.
Then, Kathy thanked me with her spare words, and at last, her husband spoke. “Golly,” he said. “That’s exactly the way it was. Incredible.”
Several hours have gone by since Leah and I left Cookie’s room. We’ve written our poems, printed them on our portable printer and framed and matted them. Susan is still seated next to Cookie when we re-enter, and both are distractedly watching TV. As the final act of the service, we stand beside the patient’s bed and read her poems, which we do now for Cookie. This is mine:
Beneath the surface, aquarium: schools of glittering fish, sharks’ long bodies, atmosphere an unreal blue.
For years, you chauffeured executives,
captured billboards on film:
cigarettes, Coca-Cola, sleek
across the Arizona sky—your own life
neat and easy as these airbrushed spreads.
Sarah was born, then Emily, different as flower from fruit. Each summer the three of you speeding West, windows unrolled, car filled with wind. The Magic Kingdom’s denial never wore out: timecards, invisible sickness, men who lie, gone in a vanishing act.
When they said you wouldn’t do it, you learned to dive. You plunge under and your body is whole. So quiet, that world that won’t keep you.
Leave the turkey raw in the sink, leave your shoes at the edge of the street.
I don’t look up until I’ve finished. Cookie is crying again, and Susan is dabbing at her eyes with a wad of tissues. The poem, I know, is nothing extraordinary, but I know, too, that’s not the point.
We don’t write anything the patient doesn’t know about himself, but we take the life he has shown us and reflect it back to him. And this mirroring of the thing that has been there all along almost always comes as a surprise.
Susan and Cookie have thanked us several times over, and now Susan walks us out into the hallway “Thank you,” she says. “It’s so good to have a chance to talk about Cookie as a person, to talk about her life for a while. Ever since we came to the hospital, all anyone has time to talk about is her sickness.”
This is it, I think. She’s said it.
When we first began Poes1a del Sol, I went in fully aware of the misconceptions most people have about poetry. I was certain our poems would disappoint in the end, because how could they be what the patient was expecting? I knew that the poems we would write would not offer any easy answers, that they might not always be pretty, and that they would most certainly not rhyme. After all, we have only a few hours to take a life and turn it into a poem, which is no small feat in itself. I am not going to turn out a sonnet in that time; I am no super-poet. So the thing that has surprised me consistently is the joy, the amazement, the delight with which these poems are received.
As a writer, I want to do good through my work, but, of course, it’s always hard to see the effects of a process that happens mostly in isolation. I think of Raymond Carver’s short story, “A Small, Good Thing.” At the end, there is a confrontation between a couple whose young son has just died and a baker who made a birthday cake that the couple never came to pick up. When the baker hears about the death, he takes the couple into his kitchen and gives them each a cinnamon roll, warm from the oven. He tells them to eat because “eating is a small, good thing in a time like this.”
I have always been a little jealous ofthat baker because it’s true that it is often the small, practical things in life that can make a difference for someone. Of course, I can make dinner for my friends or bake a pie for someone who is going through a hard time, and occasionally I do. But the work I do on a daily basis is so often impractical. I can pour myself into a poem for days, and in the end, I know that if the poem has an impact on anyone, somewhere down the road, I may never hear about it.
I’ve come to think ofthe poems we write once a week for patients at Mayo like those cinnamon rolls in the story—a small, good thing that helps, in some way, in the process of crossing over, letting go.
Cookie has called her brother, and as Leah and I walk past the nurses’ desk and out the door, I can hear her excited voice from down the hall. “You’ll never guess what happened to me this afternoon. Are you coming to see me tonight? I’ll show you.”
* All patient names have been changed.