Christian Wiman, editor of  Poetry magazine since 2003, was recently interviewed by Bill Moyers about his journey with cancer, falling in love and finding faith in the midst of death. Wiman was diagnosed with Waldenstrom's macroglobulinemia 6 years ago.  He's recently undergone a bone marrow transplant and tells Moyers he's in the "wait and see" phase.

As only a poet can do, Wiman's experience of being in danger of dying has allowed him to capture sentiments many of our dying patients may identify with.  His latest book of poems, "Every Riven Thing" (Farrar, Straus and Giroux, 2010) captures these moments so artistically that it's easy to resonate with each word.

In the interview with Moyers found here, Wiman reads a poem he wrote while in the hospital. It was right before chemotherapy started, and written in just one day.

It begins,  "Love's last urgency/ is earth and grief is all/ gravity and the long fall/ always back to earliest/ hours that exist/ nowhere but in one's brain."

The poem later ends with "mystery mastering fear,/ so young, standing unstung/ under what survives of sky./ I learned too late how to live./ Child, teach me how to die."


Wiman goes on to talk about the opening line of the poem saying, "I think there's a notion that  when you're sick, when you're in danger of dying, that you want to get beyond. You know, you would think you want experience that takes you beyond earth. You want some since of an afterlife or ...beyond. But My experience has been the opposite, that when you feel threatened, what, in fact, you want is the earth. You want concreteness.That's what rescues you."

How profound. I also identified with the concept of going back to "earliest hours that exist", don't we experience this in palliative care? We often counsel families to not be alarmed when hearing a strange story from a loved one. It actually may be a memory that existed, "nowhere but in one's brain."

Besides being confronted with mortality, Wiman has also experienced excruciating pain throughout his disease process and treatment. He said that this even more than the idea of death has impacted him.

An essay he wrote related to pain was published in the Harvard Divinity Bulletin for Winter/Spring 2012  and Wiman read it during the interview. In the words below I am struck with his isolation but also with the final effect of desire for God in the aftermath.

"Six years have passed since I wrote the first words of these notes. I have been in and out of treatment, in and out of the hospital. I have had bones die; joints lock in my face and arms and legs so that I could not eat, could not walk; cancer pack[ed] my marrow to the point that it began to expand excruciatingly inside my bones. I ... filled my body with mouse antibodies, small molecules, chemotherapies eating into me like animate acids. I have passed through pain I could never have imagined, pain that seemed to incinerate all my thoughts of God and leave me sitting there in the ashes, alone. I have been islanded even from my wife, though her love was constant, as was mine. I have come back, for now, even hungrier for God, for Christ, for all the difficult bliss of this life I have been given. But there is great weariness too. And fear. And fury."

Thanks to Chris Okon for steering me to the interview. For those, like me, who had not read Christian Wiman's poetry or prose, this will be someone to add to your collection.

One of our readers sent this link of an amazing website devoted to pain. Palliative Medicine is no stranger to pain and the Pain Treatment Topics site has a plethora of information regarding pain topics. What our reader pointed out, however, was the website's gallery devoted to patients' portrayals of personal pain.

The site is quick to point out that many of their pieces are borrowed from yet another website called the Pain Exhibit. The Pain exhibit is devoted to personal artwork related to pain. The brainchild of Mark R. Collen, who himself suffered years of under treated pain, he found that art did more to communicate about pain than words themselves. The site is organized into themes such as "Suffering", "God and Religion", and "Hope and Transformation" to name a few.

What I appreciate most about both websites are the inclusion of statements from the artists. It adds so much more to be able to read something from the person who created the piece and the one suffering from the pain.

I'm including just a few of my favorites here. But be sure to follow the links and do some exploring yourself.

Title: Self Portrait, Green Shirt by artist Sterling Ajay Witt.

Artist's comment: "Pain is the beginning and the end of every day for me. I have suffered from chronic pain for so long that I can't imagine life without it anymore. As by back pain increased and the brace came into my life, I found myself painting an increasing number of self portraits. Through them I try to express a feeling I cannot put into words, attempting to explain the torment I am going through. For me, creating art is just something I do to hemp me survive a life of constant pain. It's as if the paintings have become a record of my pain, giving a face to an otherwise faceless enemy." Copyright 2007 Pain Exhibit (PainExhibit.com)


Title: Chronic Pain - Life Distortion by artist Jenny Greiner

Artist's Comment: "I created my vision of what would represent my chronic pain. Beginning with the "eye being the window to the soul," I showed the clear, yet bloodshot eye, shedding the blood-stained tear. Then I realized that this whole living with chronic pain, is very disorienting. Things can start to spin out of control very easily. This represent my pain and the distortion and confusion it brings to my life." Copyright 2008 Jenny Greiner Http://www.drawthepaw.com

Title: CPII by artist Mark Collen

Artist's Comment: "This sculpture represents suffering from chronic pain." Copyright 2007 Pain Exhibit (PainExhibit.com)



This next piece below was actually featured on the cover of The Journal of Pain and Palliative Care Pharmacology (2007) Vol. 21 NO. 2 but is also found in detail at the Pain Exhibit website here.



Title: A Liar Is Not Believed Even Though He Tells The Truth by artist M.R. Shebesta

Artist's Comment: "The painting is a representation of the flesh being scraped from my body. Shards of metal appear to slide and cut into the fleshy oil painted canvas that is held into place by intricate lacing of fishhooks and taxidermy floss. The painting floats in the center of a custom wood frame similar to the visual effects of primitive tribes' techniques for cleaning and drying animal hides" Copyright 2007 Pain Exhibit (PainExhibit.com)

Through life’s meridian bound,
In silent pain I weep;
What joy on earth is found!
Too slow the minutes creep.
O death! Thy aid I crave,
Advance to my relief;
Consign me to the grave,
And banish all my grief.
(An Invocation to Death 21-28)

This is an excerpt taken from the poem "An Invocation to Death" by Jane Cave Winscom. In the 1790s, Winscom wrote three poems ("Written the First Morning of the Author’s Bathing at Teignmouth, For the Head-Ach", "The Head-Ach or An Ode to Health" and "An Invocation to Death") describing living with chronic headache pain. In the above lines, she describes the silent agony she is feeling. The pain is so bad, she craves the "aid" of death to relieve her suffering.

Jane Cave Winscom is somewhat of an obscure poet. Not much is known about her life outside of her poetry. Winscom first published "The Head-Ach" in a newspaper in 1793 as a plea to readers.

Live’s one on earth possess’d of sympathy,
Who knows what is presum’d a remedy?
O send it hither! I again would try,
Tho’ in the attempt of conqu’ring I die.
(The Head-Ach 45-48)

Although written over 200 years ago, some of Winscom's sentiments may seem familiar to modern times. In her three poems, she describes her agonizing pain, multiple treatments she has tried, and a frustration with the medical community who apparently promise much but deliver little.

Physicians, and ye crowd,
Who boast of physic-skills;
I may proclaim aloud,
You’re but a splendid ill!
In vain I’ve sought for cures,
As tortures still confine:
What fruitless pounds are yours!
What pain and anguish mine!
(An Invocation to Death 9-16)

Something that strikes me about Winscom's poetry is the evolution of hope. In the first poem, she seems hopeful that her pain can be can be relieved by bathing in the Teignmouth (a popular treatment at that time for many different illnesses).

I chid my fears—my cowardice was nipped,
And next below the wave my head was dipped:
A strange sensation—in a second o’er,
And I quite braced, much happier than before;
When I bathe next, I’ll have two dippings more.
(Written the First Morning of the Author’s Bathing at Teignmouthlines 18–22 )

By the time she writes the last poem, her hope has changed. She no longer believes in the physicians or other practitioners who have tried in vain to relieve her pain. She now places her hope in death. Through dying, she may finally be at peace.

And ye of tend’rest tye,
To whom I yet am dear!
Heave not a fruitless sigh,
When you behold my bier!
But join me to the dead:
Rejoice my days are o’er;
And say,—“that peaceful head
Shall bow with pain no more.”
(An Invocation to Death 41-48)

Winscom is not alone in using poetry to express physical pain. The American Pain Foundation has more contemporary poems written by those suffering from chronic pain.

References: McKim, A. Elizabeth, "Making Poetry of Pain: The Headache Poems of Jane Cave Winscom" Literature and Medicine 24, no. 1 (Spring 2005) 93–108

There is a certain theme surrounding much of the art and music discussed on these pages; that creation is often born of personal suffering. Perhaps no better example of this exists than the life and work of Frida Kahlo.

Born in 1907 in Mexico, Frida was aspiring to be a doctor, when at the age of 18, a tragic bus accident forever changed her life course. Having been impaled by a metal pole, suffering a fractured pelvis among other injuries, she spent her recovery time exploring the world of painting.

She later met and married a man 20 years her senior, a famous painter himself, Diego Rivera. Much of the tragedies she encountered during her life have been portrayed masterfully in Frida's surrealist paintings. Diego called her art, "agonized poetry", and certainly agonizing is one of many words people use to describe her work.

Frida had several great losses in her life. Due to the bus accident, she discovered she wasn't able to carry a pregnancy to term. Desperately wanting to be a mother, both the loss of actual pregnancies as well as the loss of the idea of being a mother come across in her works.
The painting "Henry Ford Hospital"(1932) was painted after one of her miscarriages. This was the very first time in art history that an artist created a painting specific to the death of an unborn child. The painting communicates more than this loss. It also portrays Frida's suffering and isolation which followed. Represented here are 6 objects symbolizing different aspects of her anguish: Model of female reproductive system, a male fetus, a snail (represents the slowness of miscarriage), pelvic bones responsible for the loss, an orchid (symbol of fertility) and an autoclave for surgical instruments.

Although the bus accident happened at age 18, Frida continued to have problems with her spine requiring extended periods at home in traction. This next painting "The Broken Column"(1944) was painted during a 5 month period that she wore a steel orthopedic corset. She wrote in her diary, "To hope with anguish retained, the broken column, and the immense look, without walking, in the vast path...moving my life created of steel".

Notice the cracked iconic column in place of her injured spine and her flesh pierced with nails. The background landscaped is also cracked and open as tears fall from her eyes.


The final painting of suffering to look at is "Without Hope"(1945). The name itself should give indication to the feelings portrayed in this painting. Here again is Frida, stuck in her four poster bed that she spent so much time in. The landscape has become even more barren than the 1944 picture. Above her is a funnel, force feeding her all types of meat products. Again the classic white tears fall.This time of constant pain and isolation from surgeries was more profound knowing that in 1940 she and Diego had divorced. He had not only been caught being unfaithful many times, but in fact had a yearlong affair with Frida's younger sister Cristina. This then was yet another huge loss in her life.

As she became more and more ill, she became very aware of her own mortality. She had had over 35 operations in her lifetime. She wrote of her own death, "I hope the departure is joyful, and I hope never to return". Frida Kahlo died in 1954, thought ultimately to have died of a pulmonary embolus.

If you're in California, the San Francisco Museum of Modern Art is hosting a Frida Kahlo exhibit until Sept. 28, 2008. For Online I suggest The Art History Archive which has over 70 of her works.