Continuing our new series on Spirituality and Palliative Care where we look at how people deal with crisis and suffering when confronted with life-threatening disease. Today, Dr Frank Brennan, a palliative care physician from Australia, explains the importance of language in our daily work and how, in times of sorrow, grief and perplexity, we reach beyond the everyday into poetry, music and art.
It is difficult/ to get the news from poems / yet men die miserably every day/ for lack/ of what is found there.
William Carlos Williams. Asphodel, That Greeny Flower.
Spirituality waves to us from all points of the human horizon. Broadly defined, spirituality includes all form of meaning and transcendence in human beings. Not all of us have a religion, but all of us have a spirituality. That spirituality reminds us that the tone and feel of our lives, the depth of our experiences, is as vital as the purely physical. What happens to us spiritually, marks us. It charges us as humans. And so, when it comes to the care of people with life-limiting illnesses, we need to be constantly aware of that horizon. Not just aware, but engaged.
So much of our work in palliative care is the use of language. There is a deep craft to this. Blandishments and clichés are seen through quickly. Sentiment, untethered to reality, will not help. Our words, our demeanour and, surprisingly to clinicians in other disciplines, our silence, all matter. They matter intensely. What is said and how it is said will be remembered long after the encounter. None of this is easy. It calls for a constant creativity. Bending and swaying to the demands of the moment.
Poetry, that other great discipline of language, mirrors our work. The searching in darkness for the truth, the balance of emphases, the unstated lying next to the stated, the soft phrase, the flash of wit and laughter. The reach into metaphor when we meet mystery. Our patients, their families and we, their clinicians, are repeatedly met by the inexpressible. All wrestle with it. It is not surprising then, that in times of sorrow, grief and perplexity we reach beyond the everyday into poetry, music and art. We are spiritual beings.
Writing after the death of a loved one, the Scottish poet Norman MacCaig wrote Memorial.
Everywhere she dies. Everywhere I go she dies.
No sunrise, no city square, no lurking beautiful mountain
but has her death in it.
The silence of her dying sounds through the carousel of language… (1)
Beyond mirroring palliative care, poetry may play an active, potentially therapeutic role in our work. In their narrative reviews Davies (2) and Gilmour and colleagues, (3) respectively, examined the multiple ways poetry may be used by patients, families and clinicians. Much of that therapeutic value lies in using a poetic voice to open up, reveal and expand the spirit of the person: grace, humour, enchantment and solace.
For some patients, religious faith holds them firm and brings great comfort.
Religions are poems. They concert
Our daylight and dreaming mind, our
Emotions, instinct, breath and native gesture. (4)
In others, close to death, I have witnessed a yearning to be at home, to sit in their garden, to rest by a river, to be enchanted by music, to seek forgiveness, to watch their grand-children play. To hold all in balance: to see the world both afresh and for the last time.
Seasons of mists and mellow fruitfulness,
Close bosom-friend of the maturing sun;
Conspiring with him how to load and bless
With fruit the vines that round the thatch-eves run…
And still more, later flowers for the bees,
- MacCaig N. Memorial. IN : MacCaig N. The Many Days ; Selected Poems of Norman MacCaig, Polygon, 2011.
- Davies EA. Why we need more poetry in palliative care. BMJ Support Palliat Care 2018;8:266-270.
- Gilmour F, Riccobono R, Haraldsdottir E. The value of poetry therapy for people in palliative and end of life care. Prog Palliat Care 2020; 28(1):6-13.
- Murray L. Poetry and religion. In : Les Murray Collected Poems. North Ryde, Angus and Robertson, 1991.
- [Keats J. On Autumn. In : Keats J. Poems of John Keats. Penguin Classics, London, 2009,
More about the author…
Dr Frank Brennan is a palliative care physician based in Sydney, Australia. He wrote a series of narratives drawn from his work that were broadcast on ABC Radio National and collected in ‘Standing on the Platform’. Frank recently published a short commentary on ‘Poetry and Palliative Care’ in Progress in Palliative Care 2019; 28 (1):14-16. He has published a collection of essays, ‘As Vast as the World’, looking at the way great writers view illness, death, bereavement and palliative care.
To order a copy of this collection and ‘Standing on the Platform’ please email Anne-Marie Traynor. The proceeds of the sale of this book will go to charity.
Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog for the first six months of 2020.
Follow our series on Spirituality and Palliative Care on the EAPC blog. Next week, we hear from Valéria Milewski from France who talks about hospital biography.