Monday, March 16, 2009

"To the end of her life"

I came across this poem in The Pharos a few years ago. Dr Eugene Hirsch has been writing poetry since medical school. Although his background is in cardiology and geriatrics, He most recently has been teaching an end of life physician education program with residents and medical students in Pittsburgh. His teaching has enabled learners to reflect on their experiences in medicine and that of end of life care.

To the end of her life

Two flights up,
she cradled a swollen belly
in memorabilia,
in the bowels of her bed.

Her sallow face told me
how near to death she must be.

She paused and stared into space,
Asking not for medicine, but for prayers.
I led her to find those she knew.

I'd learned some, not others.
In my confusion, I searched
for a "likeness" of her God
(shaped with the palms of my hands)
to sit there beside her and smile. I led her
to tell Him what she wanted Him to know-
to take away her terrible pain,
to forgive,
to bless.

She wanted never
to be alone again, never
to die each day, never
to really die.

The poem describes an encounter, not unlike ones we've all had. A dying patient requesting a prayer. Instead of walking away the writer does the best he can. There is such honesty in the line "in my confusion I searched/ for "likeness" of her God". How true this is, for even if we attempt to join in the rituals of our patients, per their request, our attempt should be to find the likeness of their God. We know inherently that their comfort comes from their personal theology, and to bring maximal comfort we try to fit our words into their world view.

I love that his response then isn't to spout off his own words and prayers but to lead her to action. She is led to commune with her God, to ask, to cry out, etc.

At the end when the patient prays "never/ to die each day" I am struck with how deep her existential pain must be. I wonder how many of my patients feel as if the are dying each day, over and over again? And yet, she ends with the plea "never/ to really die", as if death will not bring the relief she is seeking either.

The skill in poetry is to take all of the emotions, thoughts, history and reality of an encounter and in very few words allow that situation to transcend to the reader. I'm sure the story of this moment could have been written out in prose, taking pages to recount. Yet, Dr. Hirsch leaves us with such a precise feeling of this patients struggle in just 22 short lines. Well done!

PDF version: Hirsch, EZ "To the End of Her Life". The Pharos. Winter 2007, pg 19

1 Responses to “"To the end of her life"”

Gail Rae said...
March 16, 2009 at 1:11 PM

This poem wouldn't be what it is without all 22 lines, especially the skillfully etched portrait of Dr. Hirsch leading the woman into her own last prayer, but I, too, focused on the last four lines, especially the last four words, although I interpreted them differently than you, most likely because of my experience tending my mother as she died. My mother (who had non-progressive Dementia-Lite over the last several years of her life) decided, a little over a year before her death, that she would not be dying. Thus, when she died, she didn't believe she was dying. The last four words of this poem, especially, remind me of all the ways we don't "really die", of my mother's assertion that she would not be dying (perhaps, I sometimes entertain, she didn't, and we don't, "really") and that dying, to the dying, is completely different than it is to those who witness another's death.
I know my mother continues to live within me and those who knew her, as well as through the endurance of her works. I hope she continues to live, since that's what she wanted and what she decided. I hope the woman who is the subject of this poem does, too.