Commentary on “Imagist Poetry and Clinical Medicine

That is the poet’s business. Not to talk in vague categories but to write particularly, as a physician works, upon a patient, upon the things before him, in the particular to discover the universal. 1 Physician William Carlos Williams had a busy day job as a general practitioner and pediatrician, but it was what he did at night and between patients that made him famous: he wrote poetry. Among general readers, Williams (quoted above) is perhaps best known for: “The Red Wheelbarrow” so much depends upon a red wheel barrow glazed with rain water beside the white chickens. “The Red Wheelbarrow” is an exemplar of Imagist poetry, which was especially popular in the 1910s in England and the United States. Imagists rejected the idea that a poem has to mean something. Instead, they sought to convey the essence of an image through sharp focus and meticulous word choice. 2 Such exacting measures resemble those of clinical medicine. Before physicians can determine the meaning of a clinical sign, they must first pinpoint the specifics of what—and who—is before them. Differential diagnosis calls for paring away the superfluous so the clinical problem can be precisely articulated. Members of the Penn State Health Physician Writers Group 3 employ these skills of observation and precision to create Imagist poems inspired by their everyday practice. For example, “Microcosm” captures what a pediatric ophthalmologist experiences as he performs a routine examination. Soni ushers readers into mystery and awe as “the passage widens,” allowing us to enter the glow and glint of light; it is as though a whole new world appears right before—or inside, as it were—our eyes. He accomplishes this feat by selecting words that suggest wetness and the interplay of light and darkness: still depths of a “dark pool,” soft light “illuminat[ing a] bowl,” and a “floating,” “glistening” web. As “Microcosm” illustrates, these minimalist poems have no rhyme or set meter; rather, their poetry resides in nuance and connotation, in the music of words themselves. Physician writers work to discover just the right words and sounds to convey their experience and its impact(s). Even though a reader might not be aware that a poet has made such deliberate choices for singular effect, the sounds help create overtones of meaning that contribute to holistic comprehension of the image. For example, Kaur, a nephrologist, uses sibilance—s, sh, and z sounds—to emphasize the liquid property of urine, and gastroenterologist Razeghi deploys a series of t sounds (classified by linguists as “voiceless alveolar stops”) to suggest a ticking clock, a metaphor for the limited time this patient has to live. Gastroenterologist Ouyang depicts aggregating blood and water by coupling back vowels (u and oo sounds) with l, the alveolar sonorant (also known, interestingly, as “liquid”). When these sounds are juxtaposed—especially when the back vowels precede the sonorant—the utterance drops low in the mouth and creates a kind of audible depth that a hearer intuits. While vision is arguably the most popular of the 5 senses for Imagist poetry, some physician poets choose sound, touch, taste, or smell as their focus. Stoute’s “Heart Failure” features back vowels, sonorants l and r, and sibilance (in the words “gallops,” “water,” “settles,” and “bubbles”) to simulate an imagined slosh of the water-logged heart; and in “Wisdom of Fingers,” Simms, a family medicine physician, presents 3 kinds of tactile sensation to convey a shift in mood during a physical exam: the degree of pressure applied, the firmness of what is palpated, and the warmth of sun on the skin (and the implicit lack thereof as clouds move in). Some Imagist poems mix 2 or more senses to achieve a kind of synesthesia, as revealed by palliative care physician Spiegelman in “Progress.” Note Spiegelman’s use of other musical devices, including assonance (“breasts,” “red,” “stench,” “flesh,” “spreads”) and alliteration of voiced bilabial stops (“bloody beefy breasts”) to bombard the reader with a stark image of putrefaction. Especially because of their customary brevity and concentration, Imagist poems share an affinity with haiku: both distill an essence and may convey a kind of numinous, transcendent, or epiphanic quality in their subjects. Understandably, then, Imagist poems work well in haiku form, with the 3-line, 5-7-5 syllable count, as in Kinard’s “Tactile Navigation,” wherein readers vicariously experience the satisfaction of a successful lumbar puncture, and Julian’s “Solitary,” which depicts a colleague’s inspiring devotion to work, late at night, alone. Writing Imagist poems requires an ability to see something noteworthy in the ordinary and the precision necessary to convey “an intellectual and emotional complex in an instant of time,” 4 a “radiant gist” 5 that readers can perceive immediately and intuitively. When brought back into the clinic, this creative process of observation, precision, and expression may enhance physicians’ curiosity about the subtleties of patients’ bodies and their stories, and may inspire physicians to seek just the right words to convey important information with clarity and compassion

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