The Left Atrium

CMAJ 2001;164(13):1872-5

One of the reasons I continue to read Charach's new collections is for his felicitous opening lines. "Dungenessque" does not disappoint: "Crack me open like a crab / amused at the strange soft fur along my shell." Finding it hard to resist such an imperative, I read on:

Tour my body
find the emotional limits,
dredge my character
for small signs of pretense;
you know they're there.
Haven't others glimpsed claws
beneath my hands?
You listen so closely,
stretching out my present against my past
on a long net,
laying bare ...

Before the reader lies an anatomy of broken relationships, familiar territory for Charach. He is, after all, psychiatrist by day and poet by night. I suspect, though, that he is both simultaneously, distilling narratives of silently exploding marriages, of vulnerability beneath the carapace, of small perversions and the cannibalism of mutually self-destructive relationships. Both trenchant observer and flotsam on the beach, Charach writes in the first person. I hear a faint echo of Prufrock's "pair of ragged claws scuttling." He understands that we are all damaged goods, some of us less able than others to withstand daily shocks and storms.

"Dungenessque" also works well as a metaphor for the life and work of the poet:

Crack me open like a crab ...
dredge my character for small signs of pretense ...
all that's left is to analyze
what can and can't be consumed ...
There may be a joke or two.

The imperfectly realized creations of personal life are mirrored in the incomplete successes of the poet's craft: "Tomorrow you and your analyst / will pick through the bowl of white flesh / from my brittle compartments." But Charach doesn't let the seriousness of the theme pinion the reader for too long before he relieves the tension. He upends the crab with an ironic and self-deprecating paraphrase of Lady Macbeth: "Who'd have thought the old boy would have so much meat in him?"

In "Thank you," the final poem in the book, Charach offers us an eight-line cameo of an old "gnarly-fingered lady," a patient in his waiting room scanning Time and Life with a magnifying glass while the poet-psychiatrist looks on covertly and feels "healthier."

Moving from finale to opener, I discover how the first line of "Advisement" sets a hook into the reader: "Declining to do her yoga stretches in the nude ..." In this piece Charach introduces a recurrent challenge that all poets, all writers face: how to enliven the verse, how to give the writing energy, effortlessly. From the woman of the opening line comes the taunting advice: "If you need excitement, / put animals into your poems." At the far end of this elliptical poetic journey are the solicitous words of the emeritus rabbi who recalls his artist-brother's talent for "capturing" birds: "If you too crave excitement, / have you considered placing birds in your vers libre?"

Before the "Boeuf bourguignon à trente-cinq mille pieds" lands on my table tray, I arrive at the epigraph, an excerpt from Ken Babstock's poem, "Crab." Here is the source of Charach's title. The eight lines include a finely detailed description of the crab's "knobbed" claws and "wispy ferns at the mouth," the light-distorting quality of "the sea's lens," the taste of the briny water and a hint of lost youth — elements similar to those natural materials Charach uses to construct his poems.

More than food for thought, the poetry of Ron Charach sustains the reader even in the rarefied atmosphere of the Airbus 319. Charach's clever wordplay, the tumbling, inescapable details of life, and his empathic humour keep the reader's feet planted solidly on the ground. For many years poetry has been available on the London Underground. Our national airline should consider distributing free verse along with magazines, so that (as Cathay Pacific used to say) we might all arrive in better shape.

*Dungeness Crab, Cancer Magister, the most important commercial crab of the Pacific northwest coast of the USA. (From Alan Davidson's The Oxford Companion to Food.)

Vincent Hanlon
Emergency physician
Lethbridge, Alta.

I am not like most doctors. The marvels of medicine do not fascinate me. Rare syndromes and abnormal findings do not inspire me. Physiology and pharmacology do not leave me breathless.

I do not like medicine.

As I force myself out of bed each morning and put on my happy face for work, I am convinced that I should quit. Yet somehow I make it through the day. I return home physically and mentally exhausted. My extracurricular activities have become a chore. I let them slide, which is a mistake, since I clearly need an outlet.

Nonmedical friends tell me to give it up and go back to teaching. My medical friends cannot sympathize, since their lives are just as hellish, or worse: some are in surgery. Acquaintances and relatives can't believe I would consider leaving this noble profession after I've "come so far."

I'm in a pediatrics residency. I like everything about it except the medicine. I love what most people dislike. I love developmental, behavioural and psychosocial pediatrics. I love to play, to read and to cut and paste with children. Unfortunately, a busy service, many admissions, presentations, journal clubs and mock oral exams leave little time for play in or outside the hospital. I remain in pediatrics because I see things somewhat differently. I value emotional medicine more than the science of disease.

A recent conversation with one of our patients troubles me. He was being worked up for subacute bacterial endocarditis. This adorable four-year-old looked healthy but continued to spike temperatures. Our team entered his room to listen to his murmur. He welcomed us with a smile and laughter. When the third person (of five) was listening to his heart, he was told we needed more blood.

He was going to get poked. He began to whimper.

You're going to take blood?
Why?
Are you going to take it now?
Will it hurt?
Can my Mommy stay with me?
What will it feel like?
Are you going to do it now?
Mommy, I don't want another needle!
Can you do it tomorrow?
What kind of band-aid will I get?

His questions were limitless. We answered each one honestly. The medical student listening to his chest asked him nicely to please be quiet, so she could hear his heart. He complied for about 45 seconds and then began firing more questions. The next person to examine him prefaced her auscultation with a reminder to be quiet.

I wish I had interrupted the clinical exam and tried to alleviate his fears. Instead, I only helped to stifle them, for both he and I stayed quiet.

Guilt also plagues the next memory. Surgery was my first rotation as a medical student. I had just finished the first history and physical of my medical career. My patient had hepatomegaly. An abdominal ultrasound and CT showed hepatic cancer. The prognosis was poor: only six months to live. During morning rounds, our team of five walked into his room at 6:20. He was alone. His wife and family were at home. After asking him how he was feeling, the attending physician gave him the news. In front of five strangers, our patient found out he had cancer.

"So you're sure it's cancer?" he asked.
"I'm afraid so."

The team proceeded to the other side of the curtain to ask the next patient if he'd passed any gas.

I next see my patient staring out a hallway window at 3 a.m. My first inclination was to leave him alone with his thoughts. But I turned back to talk to him. Selfishly, I needed to talk to him. I feel guilty at the memory of it: when we talked, he was trying to make me feel better.

I feel guilty about the manner in which he was told of his impending death.

I feel guilty knowing about his impending death.

I still search obituaries for his name, although I know he has passed away.

Medicine brings joy into millions of lives. Unfortunately, accompanying this joy is overwhelming hardship. This misery explains my attraction to psychosocial medicine. I interpret its sorrow with less morbidity.

On our service is a teenager with pseudoseizures. Neurology has cleared her of any pathology. Her tox screen is negative. She is a top student who has a boyfriend, plays hockey, works two jobs, is bulimic and desperately wants to talk to her mother but does not know how. Her teenage angst has finally manifested itself in pseudoseizures. I find this fascinating from both a medical and a personal viewpoint. Rejecting my woes and shutting out the world is, at times, pathetically attractive. Sadly, catatonia has become enchanting.

These thoughts make me want to quit and to remain in medicine at the same time. A wonderful senior resident once told me to look for something unique in each patient, to look for my own "take-home message." For me, the breathtaking, heartstopping moments in medicine occur when I gain my young patients' trust and they let me play with them.

In a profession that I permit to rob me of my energy and emotional strength, I hope to find stability. I hope to strike an equilibrium between my life and my profession, hoping that in this way I will find happiness. But if, in my search for serenity, I choose a path away from medicine, I will still treasure what I have gained: the ability to transform patients back into people.

Kerri Lambert
Dr. Lambert is now a resident in psychiatry at the University of Manitoba, Winnipeg, Man. She feels "rejuvenated and excited about medicine" and is planning to pursue a career in child and adolescent psychiatry.

This article is one of the runners-up in the student/resident category for the 2000 CMAJ Essay Prize. The contest winners appear on pages 1860 and 1862. The contest is described on page 1859.

In a city the size of Toronto people can get lost. My ten-year-old self knew this because I once spent a frantic twenty minutes in Eaton's searching for my mother. My papa has been lost for six years: an accident of history, geography and iatrogenesis. His story is full of hiding. He vanished from the sight of Cossacks, wandered at night along mountain passes to safer lands and disguised himself by day when the politics of his country deemed him criminal. My mother tells me he has died — a missed diagnosis, preventable — and that no child should lose such a loving father. But I know the truth. He has not died; his hiding has gone awry. Somehow he is lost and cannot find us.

I am not without solutions to this problem. The Toronto telephone book, whose purpose until now has been to boost my chin above the edge of the kitchen table, offers four possible fathers. His name is there in black and white, but which one should I call? If I had a phone listed in my name, then he would be able to find me instead. But revealing that my father is still alive would upset my mother, and she does not believe that children need telephone lines.

One day I notice a company logo bearing my father's name. A businessman in a suit gets added to the images I conjure up from old photos and overheard whispers. We are walking down the street hand in hand. My father laughs as the autumn leaves we are tossing about lodge in his collar and pant cuffs. To me he is a giant tree, moving with the wind but never shaken by it.

I remember a Papa who comes whenever I wake, frightened, from sleep. I call on him to protect me from harm and loneliness, and even from the dreaded annual "What does your father do?" question from teachers. Whether to be polite and truthful, or to hide the fact that I am different by keeping silent about my apparent half-orphaned state, is an irresolvable dilemma. Why others speak so sadly of my loss I do not understand. My papa is hidden, but he is with me at all times, in the pocket in which I carry the little pair of blunt scissors that he gave me, in the blue eyes the family say are his, and in the name I bear.

Over the years the immediacy fades. I can no longer feel my small hand in his or remember his accented English. I continue to search for Papa stories but give up the phone book. I take readily to my preceptor's teaching that the medical history we glean from a patient is only one chapter in a life history. Chance encounters add detail to the biography I know only in summary. One day, as a medical resident, I meet a doctor who cared for my father as he died. Another day a patient looks at my name tag, my eyes, and says he thinks he has something for me. Two weeks later he returns with the only photograph I have of my father as a young man, taken shortly after he and my father arrived in Canada together. Medicine has enriched my life in unexpected ways.

Throughout, I dream all the dreams of a young person who thinks the impossible is not an insurmountable obstacle but an opportunity. I have done what medicine cannot do: I have kept someone alive after death. Therefore anything is possible. The absoluteness and absolution of death allow me to recreate this man about whom I know so little. When I want to offer roots and religion to my children, my father picks up a prayer book and walks with them to a religious service. I cast him as an intellectual upon whose thinking I must build, and so convince myself to read history and philosophy.

Should death have been made as real to me as was the presence of my father after his life? Is the magical thinking of a child who remedies loss with illusion a sign of resilience, or of resistance to reality? I was not taken to the funeral. Had I attended, I could have lost my father in this finality. Instead he is with me wherever I go, as a guide, a protector, a papa.

I have chosen not to identify myself, because a part of me still fears that by allowing others to see my father he will be lost forever to me.

Anonymous

This article is one of the runners-up in the student/resident category for the 2000 CMAJ Essay Prize. The contest winners appear on pages 1860 and 1862. The contest is described on page 1859.

Copyright 2001 Canadian Medical Association or its licensors