Words for the Wordless

TEXT

Morning Song

Here, I place

a blue glazed cup

where the wood

is slightly whitened.

Here, I lay down

two bright spoons,

our breakfast saucers, napkins

white and smooth as milk.

I am stirring at the sink,

I am stirring

the amount of dew

you can gather in two hands,

folding it into the fragile

quiet of the house.

Before the eggs,

before the coffee

heaving like a warm cat,

I step out to the feeder—

one foot, then the other,

alive on wet blades.

Air lifts my gown—I might fly—

This thistle seed I pour

is for the tiny birds.

This ritual,

for all things frail

and imperiled.

Wings surround me, frothing

the air. I am struck

by what becomes holy.

A woman

who lost her teenage child

to an illness without mercy,

said that at the end, her daughter

sat up in her hospital bed

and asked:

What should I do?

What should I do?

Into a white enamel bath

I lower four brown eggs.

You fill the door frame,

warm and rumpled, kiss

the crown of my head.

I know how the topmost leaves

of dusty trees

feel at the advent

of the monsoon rains.

I carry the woman with the lost child

in my pocket, where she murmurs

her love song without end:

Just this, each day:

Bear yourself up on small wings

to receive what is given.

Feed one another

with such tenderness,

it could almost be an answer.

"Morning Song" by Marcia F. Brown, from What on Earth. © Moon Pie Press, 2010. Reprinted with permission.

CONTEXT

I first heard the poem “Morning Song” from the pulpit of my synagogue, woven into my rabbi’s weekly message. The words, spoken in a hush, felt sacred and I distinctly sensed that this was not only about hearing them within a holy sanctuary. I too was struck, to echo Brown’s poignant verse, “by what becomes holy”—the comforting routines of life and love, the haunting, unexplained realities. This reached, for me, an emotional space and truth. “One of the mysteries of poetry,” Brown observed, “is the very unique and sacred communion which occurs between a reader and a poem that is (happily) completely independent and out of the hands of the poet.”¹ “Morning Song” had entered my world, conveying messages that I hope may be of value to the medical students I teach.

We enter this poem with the repetition of “here,” summoning presence in the here and now. Within soft hues of blue and white, the reader is absorbed in ritual and finds comfort in the familiar, predictable and orderly. Sensually alive in the moment, “on wet blades,” the nurturer attends to the fragile birds, compassionately nourishing the tiny ones with thistle seed before nourishing the self.

Ritual, however, cannot forestall the sense of peril that pervades this quiet. With sharp contrast, the narrative collides head-on with the glaring non-routine of youthful demise, rhetorical questions of our ephemeral existence and the unexplained chaos of life. We are emotionally vexed and humbled. Death’s disruption of routine is authentically portrayed within the poem, notably altering the poem’s cadence. Yet the routine resumes and love endures (“kiss the crown of my head”), rejuvenated with the advent of the monsoon rains.

“Morning Song” captures our attention with salient themes for medical education, compassionate patient care, and providers’ self-care. Immersion in the “here” within poetry, and this poem in particular, may help to foster mindfulness in our learners, transcending the poem itself, inviting them to consider the essential role of such presence in their clinical work.² Furthermore, “Morning Song” challenges us to carefully consider how to remain attuned to the cry of the individual, resonating with the cry of the daughter, within the reality that is our own here and now—algorithms, electronic medical records and population-based statistics. The challenge is to resist emotional anesthesia and be fully present and aware within the inevitable struggle with loss and suffering which characterize both life and medicine. To meet this challenge, clinicians must work to foster emotional resiliency, maintain sensitivity and avoid depletion, even as we endure “morbidity & mortality,” patients “passing” or “expired”—death as routine and never routine.

Staying emotionally connected while confronting suffering and trying to master new clinical skills can pose a significant challenge for our learners, especially in undergraduate medical education.³ To be authentically engaged and acknowledge difficult emotions can be uncomfortable, even frightening. Almost as if acknowledging this discomfort and risk, Brown’s verse takes us to the abyss but does not abandon us; we are held and sustained through that which leaves us most vulnerable. In the absence of words, there are words and relationships. No neat and tidy conclusion, no clear answers, just words and basic human connection offered as bridges to carry us back to where we belong—life, engaged in the healing arts.

Even still, this poem does not imply a return to business as usual. There is a transformation in “Morning Song”—an expanded consciousness akin to the emotional and spiritual transformations clinicians can achieve if we allow ourselves to be altered by the patients who enter our lives and those who depart. “Carry” them with you, Brown suggests (triggering an association with Tim O’Brien’s The Things They Carried),⁴ not as a burden but as part of the fabric of your being—in Brown’s words, a “love song without end.” The message here seems to be to carry not only your medical tools and manuals in your white coat pocket but “carry the woman with the lost child” too: your patient care experiences, your emotional competency, your memories of difficult and meaningful events. In other words, don’t harden your heart; remain open to the transformative experience of shared humanity, continuing on with “such tenderness” toward other and self.

In the broader context, integration of humanities within medical education, it has been proposed, can enhance clinical effectiveness through empathic emotional engagement and improved understanding of the patient’s experience of illness.⁵ Humanities, with use of poetry as an exemplar, can be a vehicle for removing the student—or seasoned professional—from the treadmill of clinical practice (where doing is emphasized); providing a space to pause, take a cleansing breath, and reflect on doing and even more so on being. Poetry for an examined life—on rounds, within small-group teaching or even in one’s house of worship—helps to capture thoughts and feelings, creating meaning.

Within medical education, consider this—just as we send our learners scientific literature to buttress a point, so too may we offer a poem that potentially illuminates the emotional experience of that learner, a patient or a patient’s family. A gift, a present of poetry to our learners to help them be present. Reflecting on Brown’s ”Morning Song” as well as other poetry may help us (learners, teachers and clinicians generally) to “bear” ourselves up “on small wings,” promoting empathic connection with patients and families and compassion towards ourselves as health care providers when there is an absence of answers—as we try to find words for the wordless.

Questions for Discussion

• How does this poem speak to you?

• Have you ever escaped to routine or “ritual” to maintain distance from and/or heal yourself after an emotionally challenging patient experience or interaction? What helps to keep you emotionally connected?

• Have you been changed and/or has your practice of medicine been informed by caring for a suffering patient or by experiencing the loss of a patient or loved one? How do you “carry” this experience with you?