The windows were wide open, but he could not stop panting; his temples were bathed in sweat. Dr. Schwöhrer arrived at two o'clock. When Chekhov saw him, he sat up, leaned back against the pillows, and in a final reflex of courtesy, mastered his weak German and said, "Ich sterbe." [I am dying.] Schwöhrer immediately gave him a camphor injection, but his heart failed to react. He was about to send for an oxygen pillow when Chekhov, lucid to the end, protested in a broken voice, "What's the use? Before it arrives, I'll be a corpse." So Dr. Schwöhrer sent for a bottle of champagne. When it came, Chekhov took a glass and, turning to Olga, said with a smile, "It's been so long since I've had champagne." He emptied the glass slowly and lay down on his left side. A few moments later he stopped breathing. He had passed from life to death with characteristic simplicity. [1]
What a beautifully evocative passage of prose. Consider Schwöhrer’s spontaneous yet deeply respectful gesture and Chekhov’s grace under pressure. The relationship between these men evokes a compassionate understanding and empathy that is central to all of the major Humanitarian texts, be they religious or fictional. In a literary context, the knowing reader will also note how the whole passage mirrors the understatement of Chekhov’s finest drama. In reality, it is unlikely that events happened as they are represented here. Chances are it was messier, more uncomfortable and more painful for all involved. Yet literature – and art in general – has the ability to transform experience into something pleasurable and memorable; it has the ability, in James Joyce’s words, to “convert the bread of everyday life into something that has a permanent artistic life of its own.” [2]
Narrative, poetry and drama are the three major forms of literature, and all three are present in the Chekhov anecdote. It employs narrative in the way that it makes a story of Chekhov’s death. Similarly, the bubbly works as a metaphor for the effervescent nature of much of Chekhov’s life, and so this metaphoric transformation exhibits the primary feature of poetry. Finally, the entire anecdote is suffused with the resonance of informed interpersonal relations that we find in the drama of Chekhov himself, and O’Neill, and O’Casey, and especially Shakespeare. Moreover, informed understanding of the nature of the three different types can positively influence medical practice.
Regarding how an understanding of narrative might help doctors develop nuanced clinical skills, it is worth pointing out that physicians often have to perform as narrative spokespeople insofar as they tell a patient the story of their illness and then the patient tells family relatives ‘the doctor said’ so that the doctor is always central to the story of the illness. It follows then that a doctor can help patients to think of their illness in a narrative fashion which can at once dispel panic and the horrible immediacy of the ‘now’ when one learns of a personal or family illness for the first time. Instead, and through narrative, this spontaneous panic can be replaced with a more considered narrative meditation that allows both for the future and illness as a new part of this future life narrative. In short, a doctor aware of the organizing and all pervasive power of narrative (it is almost impossible to imagine our lives as a series of utterly random events) can help forge explanatory links between disease and life, and so render the patients’ experiences more inclusive in the manner in which they understand their condition, and more empowered in how they attempt to deal with it. Moreover, doctors too can benefit from conceiving of patients within a narrative medicine paradigm. Dr Abigail Ford of New York Presbyterian believes that understanding the concept of narrative medicine changed her entire approach to medicine: “As a doctor you are really a co-author of patients’ experiences and need to hear their story and take it on.” [3]
It is not an overstatement to say, in turning to poetry, that metaphor actually transforms the world for the attentive reader. Consider the following Shakespearean sonnet written by the bard about the ravages of time:
Like as the waves make towards the pebbled shore,
So do our minutes hasten to their end;
Each changing place with that which goes before,
In sequent toil all forwards do contend.
Nativity, once in the main of light,
Crawls to maturity, wherewith being crowned,
Crooked eclipses 'gainst his glory fight,
And Time that gave doth now his gift confound.
Time doth transfix the flourish set on youth
And delves the parallels in beauty's brow,
Feeds on the rarities of nature's truth,
And nothing stands but for his scythe to mow:
And yet to times in hope, my verse shall stand
Praising thy worth, despite his cruel hand. [4]
The majority of this poem, in a rather brutal expository style, is concerned with demonstrating the manner in which time dismantles and disfigures our idealism. Yet the two innocuous lines that close the piece do an extraordinary thing. They manage to subvert traditional space/time perceptions because when he praises “thy worth” the individual addressed at the conclusion of the poem is the individual reader. Shakespeare speaks to “you” literally across the centuries, proving that his verse did indeed stand the test of time. The poem does, with ease, what science has been attempting for decades; time travel, in so far as it inhabits different temporal zones simultaneously, the moment of its conception and any other (and multiple) moments when the poem foregrounds a modern reader in its own living context. In just such ways, metaphor as the chief feature of poetry, transforms our experiences. It allows us to think of brighter futures beyond illness at a moment when perhaps hope is lost, and, by thinking of a brighter future, actively partaking in the realization of that future at the very moment of its conceptualization.
On the other hand, if such spatio-temporal gymnastics are impossible in the face of grave illness then, conversely, the expansive power of metaphor might be employed to lend context to our own mortality. If we are to think of death at all, do we tend towards thinking about its grandeur? Metaphor allows the possibility of grandeur to shine through rags – for humanity to perceive itself as more than “a tattered coat upon a stick” [5] – and the literary doctor can help a patient to perceive their illness, and perhaps their mortality, in terms broader, deeper and more meaningful than clinical language and certainly “every day” languages allows. Students who are not interested in literature frequently baulk at poetry and refer to it as boring because they have no sense of their own mortality. On the other hand, poetry takes on its greatest resonance when it is all that the individual has left to articulate that last, often ineffable experience of death, of having come and having, finally, to go. Consider for example, the words of Yeats in meditating upon his own passing and that of those around him:
Now shall I make my soul,
Compelling it to study
In a learned school
Till the wreck of body,
Slow decay of blood,
Testy delirium
Or dull decrepitude,
Or what worse evil come –
The death of friends, or death
Of every brilliant eye
That made a catch in the breath –
Seem but the clouds of the sky
When the horizon fades;
Or a bird's sleepy cry
Among the deepening shades. [6]
One way or the other, through metaphoric transformation or with profound tears, the poetic physician can transform patients’ experience so that their illness, or even their last days are rendered meaningful in an otherwise difficult environment.
Lastly, the role that drama as a literary form might play in enhancing doctors’ skills is self-evident. Doctors need to think of performance as a positive “act” that they can undertake. Certainly, “to act” often means to pretend in the sense that it is less immediate than ‘reality’ and less authentic than a ‘real’ gesture. However, it also means “to act” in the sense of “to do;” in other words, to do something positive and proactive in order to change a pattern of events. Millions of people around the world have stories involving a doctor who imparted bad news with perceived coldness or disinterest. The story often runs that the doctor “didn’t care” about the patient’s and/or family’s feelings, particularly the overworked MD in A&E. What price a few short drama classes to teach medical practitioners the basics of human performance? Learning about eye contact, body language and verbal communication means that armed with these tools, even the most exhausted A&E doctor can “act” positively in comforting family, patients and friends. Further, what if a doctor does not really feel empathy with a particular patient? The benefit of learning how “to act” is that the gesture you made in learning a way to comfort people repays you with equal humanity. To conclude with Shakespeare:
All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts [7]
The doctor who has a knowledge of the forms of literature, and their applicability to her or his profession, will play a more important part, or parts, than most all others who inhabit this inevitable hospital we call life. Equipped with narrative, metaphor, and knowledge of how to communicate through body, eye and voice, the literary doctor will prosper, and so enrich the lives of others. And for proof of this assertion, look no further than where this essay began: with Dr. Chekhov and his enduring human dramas.
Endnotes:
- Henri Troyat. Chekhov (New York: Ballantine Books, 1988): 332-333. Quoted in Abraham Verghese, “The Physician as Storyteller,” Annals of Internal Medicine, 135/11 (December 2001): 1012.
- From a letter written by James Joyce to his brother Stanislaus. See Robert Scholes and A. Walton List, "Epiphanies and Epicleti," James Joyce. Dubliners: Text, Criticism, and Notes, eds. Robert Scholes and A. Walton Litz (New York: Penguin, 1976): 250.
- Pauline W. Chen, M.D. “Stories in the Service of Making a Better Doctor.” New York Times 23/10/08.
- William Shakespeare. “Sonnet LX” http://shakespeare.mit.edu/Poetry/sonnets.
- William Bulter Yeats, “Sailing to Byzantium,” in The Norton Anthology of Modern Poetry. Ed. Richard Ellman and Robert O' Clair. 2nd edition. (New York: Norton, 1988): 189-192.
- William Bulter Yeats, “The Tower,” in The Norton Anthology of Modern Poetry. Ed. Richard Ellmann and Robert O' Clair. 2nd edition. (New York: Norton, 1988): 243-247.
- William Shakespeare, As You Like It (London: Arden Shakespeare Editions, 1994) Act II, Sc vii, ls. 1-5.
Written for November 2015 by
Rodney Sharkey, PhD
Associate Professor of English
Weill Cornell Medicine - Qatar