The Power of Poetry in Hospice Care
Poetry about Real People - The power of poetry in hospice care
There is a tension between the advance of medical science, that pursues its ability to fix and treat, and an acceptance of the natural order of death and how that may be experienced. Atul Gawande, a surgeon and health researcher, has reignited this debate with his book 'Being Mortal' (and also presented the 2014 Reith Lectures on BBC Radio). He writes: "As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They only ask to be permitted, insofar as possible, to keep shaping the story of their life in the world – to make choices and sustain connections to others according to their own priorities." He puts forward strong arguments for medicine, and society, to review its approach to end of life care.
Gawande’s Reith Lectures in December were widely acclaimed. When 2015 began, however, the press were much less encouraging about Dr Richard Smith’s blog on the BMJ website: ‘Dying of cancer is the best death’. His ‘romantic’ view was rather insensitive, but he was, however clumsily, arguing for a reformed dialogue and the ‘good death’ in the face of over-enthusiastic treatment options. The best result from his clumsiness came on the morning of 4 January'15 on BBC Radio 4’s Broadcasting House programme. Two Sue Ryder hospice workers (Carol Howard and Louisa Nicoll) were interviewed by Paddy O’Connell, who referenced Dylan Thomas’s poetry to question society’s approach to death in the light of Richard Smith's blundering attempt. Our hospice workers reaffirmed that the best hospice care enables us to talk about death, not to ‘rage’ against it but to seek to ‘go gentle into that good night’.
I have been a volunteer poet at Bolton Hospice since 2010. I don’t take any lead from Dylan Thomas, or the many others, to write poems about death. I write about lives, about creativity, about the wonder and detail of simply being. When I read Atul Gawande’s book it immediately affirmed my belief that my role was indeed helping patients 'to keep shaping the story of their life'. It is a privilege for me to work with patients and to be at Bolton Hospice where there is a great commitment, not just to excellent medical care but also to the value of creative therapies: the hospice employs an art therapist, whose work includes supporting and encouraging poetry (a painting by a hospice patient can be seen below, right).
I hope to give some insight into my approach with a view to inspiring other poets to work in end of life care, not just in short, awareness-raising projects, but as long-term writing opportunities, integral to hospice care. Art and poetry in the hospice helps patients to be aware of their own creative significance. I am inspired to write poetry based upon each individual’s story, or their own art or craft work. I think I can express my approach most clearly through a beachcomber analogy, to take the idea of a ‘walk’ with a patient along a conversational or creative beach area. A work of art, a ‘found’ poem, can be assembled from whatever we come across together. The value of the walk and the quality of the art are both equally important and the two are, in fact, inseparable. As I discover and create the poem I am simultaneously helping the patient to (re)discover something amazing about themselves and, potentially, about the legacy of art - which is able to signify a life as 'other’, a presence in time and space not restricted to a medical history or a curriculum vitae.
The writer Virginia Woolf talks about life being in the ‘luminous halo’ of a journey. Keats advocates ‘negative capability’ - to be at peace with uncertainties, mysteries and doubts. Coleridge asks for a ‘willing suspension of disbelief’ to be able enjoy art. Ted Hughes speaks of the ‘momentary’ as the vital signature of a human being. James Joyce finds wonder in the everyday and ordinary. My particular inspiration from talking to hospice patients has been to capture the sudden lightning flashes of significance that celebrate life. The numinous connection is to dwell, to practice being with patients among the 'mysterious flickerings' when meaning and understanding prove inadequate.
End of life care services have formed an approach to good death. I simply argue for poetry, and other creative activity, to be fully included. I have produced a 1,500 word ‘Guidance Framework for Poets in End of Life Care’ and the following is an extract.
‘A poem may take a single phrase or idea or a topic discussed. It may be a longer linear narrative of a life, or a particular experience in work or war or a childhood tale.
A poem may form a series of snapshots or an abstract reflection of a story. It may contain no direct personal reference and yet capture an individual’s lifelong passion for place or hobby. You may write as to accompany a patient’s own art, a picture or piece of craft work. A simple guide is to allow yourself, through conversation, to be inspired by the patient. Explain this to the patient the first time you meet them and why you have a pad and pen and will scribble notes as they speak. Every day in the hospice I learn many things new – a word, a story, a piece of history, a way of seeing something – and I thank the patient every time. Such things are inspiration, occurrences which themselves declare ‘something needs to be written about this’. The poem is not an evaluation or a narrative or biography. It is not a eulogy. It is art.’
Poetry can be in the smallest thoughts, the remembered ‘flickerings’ represented by the three-line Haiku-type poems. I’ll finish this blog with a number of longer poems for you to dwell upon – not explained or elaborated upon. Like patients, they just are; they may have been read at funerals, framed or placed in a memory box, but poems are also ‘being with’.
Some places you never really leave.
Part of me still sits on the terrace or strolls
the edge of Jakobs Dam. The pure air is insistent.
A union in a needle-leaved, boreal landscape.
This silence remains. I am never sure if my
ears or my eyes hear the easy soaring of
the eagles’ wings. There are no songs.
I am enchanted and you are with me.
We gaze to the southwest horizons, to
Skrim and Telemark, sanctioned by the wilds of
tree and snow. Those far granite hands fix and
crack the sky, cradle the cloud and the mist.
I am enchanted and you are with me. Here.
We never needed to talk about returning.
© Phil Isherwood 2014
Trucks and Travelling
My granddad taught me
to build a bike, to make each
wheel run true and then
set out, enjoy the ride.
I travelled, I built, I worked
it out. A lot of trial and error.
Study it. Tackle anything.
That’s the way of an engineer.
Lights and sounds and electronics.
Leaf springs and shock absorbers.
Memories in models; the best
you can buy are Tamiya. Spot on.
A trans-continental Road Train.
A Globe Liner. A Wrecker Truck.
HMS Matabele and a Supply Vessel,
both built, balanced, but yet to sail.
There was a real Zephyr Mk. 2
that I left in Australia with a note.
‘The keys are inside, yours to take
if you want it.’ I was going home.
© Phil Isherwood 2014
in the silence of a place
becoming something new.
Unformed histories, a
murmuration, seconds of
A chaos to hold the signature of art
then let it go.
The silence of a place
that is devoid of fear. Everything
settles amongst the reeds.
----------------------------- a final 'synopsis' poem inspired by the recent BBC Horizon Broadcast of the same title.
We Need To Talk About Death
Biography, not biology
Tasks yet to be finished
A ‘sorry’. A ‘thank you’
Questions beyond the grave
Intensive care conversations
Letting me go, I’m ready
Death is not a failure
Medicine. Help not hinder
Speak plainly and frankly
Control of the Care Conveyor
Better tomorrow? Better blood test?
Hospice care is about life
Living well to the end
Decide. Remember, cherish
All that makes me human.
All our lives are terminal
Everyone needs palliative care
On discovering mortality
We need to talk about death.
BBC Horizon 23 January 2019
‘We Need To Talk About Death’
Phil Isherwood Hospice Poet