#4 Living (while bleeding)

These notes on our fourth session are brought to us courtesy of one of the group, Diane Doran.

‘While Bleeding’ by Doireann Ní Ghriofa

The poem has many layers, hinting at: –
1. Social status (too expensive/vintage shop)
2. expectations on women to be/look a certain way (blusher on cheeks/lipstick on tissues)
3. Shame many women carry about what are normal is a normal bodily function
4. The poet uses red to sum up the female experience – red an emotionally intense colour.

After the poem we discussed how Viagra was once discovered to be effective or period pain however due to apparent side effects was shut down – It was agreed that we should look further into this – does it draw parallels between the papacy and the pill debate recently?

Conversations with Friends by Sally Rooney

Conversation with Friends brought up some discussion on: –

Silence in pain – why are women expected to put up with pain?

What is stopping women from asserting themselves and breaking out of the patriarchy?

We touched on the theme of rich v’s poor – wealthy people are more resourceful due to money and as such will always find a way to get ahead – an inequitable system is leading to an even bigger divide amongst people and this divide becomes more apparent when we consider different races & genders in society.

The importance of consent – twice the consent of the patient in the text wasn’t sought

We talked about the importance of considering the perspective of the patient – in the text she stated both she and the doctor hated each other – What are the elements that will potentially lead a person to feel this way about their caregivers, to have no trust established between them?

The doctor in the text seems oblivious to the patients pain – where do doctors need to draw the line with respect comforting patients

Discussed the importance of giving patients information about what it is that is happening to them.

Discussed the societal expectation to keep your emotions locked up until appropriate time – what is causing this disability when it comes to expressing ourselves? – leads to repressing our true history when in a hospital setting – again comes back to putting up with pain & silencing ourselves.

Some elements of shame expressed – unprotected sex/sex outside of marriage – the girl felt embarrassed to disclose the full details of her sexual experience to the doctor.

Talked about women’s paraphernalia for periods and how men need to be more open and receptive to what women’s body’s are capable of and not add to the shame by keeping it a secret.

‘Notes on Bleeding’ by Emilie Pine, from Notes to Self

Again the theme is around the shame of having a period – hiding it from others – the idea that it is dirty and somehow women/girls are somehow stained.
Focuses on the expectation of women to look & act a particular way (shave/apply foundation)

From my perspective – i found it ironic that we read a redacted text – why is it embarrassing for us to sit and read/listen to the full no holds barred text? – as medical professionals I feel the ability to not get embarrassed by the things we hear will be a very important skill.

Session #2: giving birth

I read two short poems by Doireann Ní Ghríofa: ‘I carry your bones in my body’ (“––– nobody ––– nearlybody ––– my small someone.”) and ‘Jigsaw’ (“how the arch of your foot / fit the hollow of my palm …”)

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We then read an extract from the chapter, ‘Birth’ from Anne Enright’s Making Babies (2004), discussing it as we went:

– the frankness of the writing, as in, for example, the description of what it felt like after her waters were broken; and how unlikely it would have been that such a frank text would have been published or even written a generation ago

– the subject matter being not what some people would consider “worthy” of literary treatment, lacking literary potential: “to compare dressing-gowns – it took me so long to find this one, and I am quite pleased with it, but when I get up after the meal, the back of it is stained a watery red.”

– the humour, as in the description of men sneaking out from behind the curtains to watch the replay of a goal from a Portugal v France match

– the exaggerations for effect & how tolerable they are, as in surely not all the men were interested in the football

– the willingness of the writer not to endear herself to the reader, the importance of that in her efforts to be truthful; for example, in relation to one woman: “I am trying to be sympathetic, but I think I hate her. She is weakness in the room.”

– the crudeness (= honesty?)

– the idea of when labour starts officially: “I am in what the Americans call pre-labour, what the Irish are too macho to call anything at all. ‘If you can talk through it, then it’s not a contraction,’ my obstetrician said …”

– the believability of some of the states described

– the detail of her observations of her fellow unit C occupants, at times cartoon like

– “The room is full of miracles waiting to happen”

– the tenderness of some of her descriptions, yet even within those the signature blunt style: “When I put my hand on it, there is the baby; very close now under the skin. I just know it is a girl. I feel her shoulder and an arm. For some reason I think of a skinned rabbit. I wonder are her eyes open …”

– the visceral vividness of her descriptions of pre-labour and of the ward itself and what her fellow occupants

– the beauty & power of the writing about the build up to the delivery and the delivery itself and the newborn baby (with echoes of Ní Ghríofa’s poem: “I laid her on my stomach and pulled at my T-shirt to clear a place for her on my breast.”)

– the immediate return to full-on description of the facts: “smeared as she was with something a bit stickier than cream cheese”

– the poetic nature of the final scene which in a way echoes the birth scene that precedes it, only in this case Enright-the-mother is being “delivered”, speechless like a baby, by the nurse who saves her from drowning in the amniotic fluid of the shower!

– “she is saturated with life”

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Finally, we read and discussed the chapter, ‘Abdomen 2003’, from Maggie O’Farrell’s I Am, I Am, I Am in which she describes her experience of an emergency Caesarean section and the prelude to it.

– the unacceptably abrupt interruption of the registrar, who failed to allow MF to finish her “speech”

– the physical appearance of Mr C, the consultant, as described by MF, the details she has chosen to draw attention to perhaps reflecting the impression she got of him and wants us to get: “tall man with severe comb-tracks in his black hair”

– the prototypical nature of Mr C, the consultant’s behaviour: “to yank me bodily up out of my seat” … “‘Get up,’ were his first words to me …” … “‘There is nothing wrong with you,’ he pronounced …” … “talked over me…” … “What was wrong with me, that I was so afraid of a bit of pain?” … “‘Do you have any proof?'” …

– the believability of this given he is such a textbook version of the rude & brusque doctor & a perfect representative for the patriarchal nature of certain parts of medicine

– the dynamic between the consultant & the registrar, and how this might point to the negative influence he might have on all the team he is in charge of

– the factors in why MF didn’t do or say what she knows she should have to call a halt to Mr C’s patronising, insulting, unethical & bullying behaviour

– the poetic quality of having the stranger in the operating theatre represent everything that Mr C & the system wasn’t about healthcare: simple, human attention & empathy & comfort

Final session, in St James’s Hospital

Two things got us off to a bad start for this one:

  1. This was meant to be last week’s session so that all the social & political material of last week would be the climax, but it wasn’t logistically possible.
  2. The transport from Trinity Biosciences Institute was late & some students got lost which meant we were very late getting started & therefore had to cut a few texts that I’d planned to read with them 😦

We met at the entrance to the hospital & I briefed them on a small exercise I wanted them to do: inspired by Danielle Ofri’s idea of literary rounds, I gave them each the text of a different poem/text & asked them to read it to themselves for a few moments. Each poem was set in a hospital. I then asked to make their way at their leisure to the seminar room and on the way to observe as much as they could about the hospital environment connected with, inspired by, or entirely unrelated to the poem they’d just read!

In class, we started with the Yeats poem & tried to recall it without reference to the text. It wasn’t entirely a success, let’s just say.

We then went around the group, with each person reading aloud the poem they had received and then sharing with the group their observations about hospitals/ the hospital we were in / the hospital in the poem. Each contribution led to further discussions & chats & recollections.

The poems were Leanne O’Sullivan’s ‘Tracheotomy’, & ‘Leaving Early’, ‘In the Way’ by Elaine Feeney, ‘Postcards from a Hospital’ by Doireann Ní Ghriofa, ‘Visitors, Kidney Ward’ by Enda Coyle-Greene, ‘Leaving the Ward Behind Me’ by Tommy Lambert & ‘The Chapel Corridor’ by Barry Mitten (both from Climbing Mountains in our Minds, edited by Sylvia Cullen) and Patrick Kavanagh’s ‘The Hospital’.

Bronwen Barrett & Martha Knight of Freshly Ground Theatre

The texts we didn’t get to, but which I distributed nonetheless and which I will be using with a new group next term instead, were Eleanor Hooker’s ‘The Man in Bed Eight’ & the first scene from a new play called the Bold Step by Bronwen Barrett & Martha Knight of Freshly Ground Theatre, which I saw (& was totally bowled over by) at the weekend. (They kindly emailed me the opening scene, which they based on interviews with their mothers about their own births: “M: There was a student midwife sitting beside me, shaking … B: ‘you’ll be grand, you’ll be grand.’ M: I remember turning to this nurse, typical teacher, like, in the middle of the epidural, saying ‘sure, I could be correcting copies”!!!!! 🙂 

I then read a few bits of Danille Ofri’s essay ‘The Poetry Ward’  about introducing poems to the routines of doctors in hospitals. I finished up with a full reading of John Stone’s ‘Gaudeamus Igitur’ & dismissed everyone with best wishes. 🙂 

Anatomy awesome, awful and aesthetic

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First & foremost to say, it was such a thrill & privilege to be able to conduct – thanks to Siobhan in the department – our session in the beautiful atmosphere of the old Anatomy Building lecture theatre (as photographed so perfectly here by Fionn McCann). Everyone was most impressed … even a tad sorrowful!

Opened up with our group recitation of Yeats’ ‘Paudeen’. They’ll know it off by heart by the end of the module!

Then had quick recap from one of the group on last week’s proceedings.

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Then I set the mood for this week by reading Tríona Ní Dhomhnaill’s ‘The Mermaid in the Hospital’ as translated by Paul Muldoon. (“It was the sister who gave her the wink / and let her know what was what.”)

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Then, somewhat unusually, I gave a sort of lecture on anatomy as a human pursuit and its significance in medical training – based on an essay I wrote for the ‘Irish Medical Times’ years ago when the Anatomy department was moving from its charming, nineteenth century home to the shiny new Biosciences building >

https://arsmedica.wordpress.com/2011/08/02/feature-on-anatomy-building-in-trinity-college/

The idea is that perhaps to ensure the students adopt the appropriate attitude towards the privilege that it is learning from cadaveric dissection, some civilising influence of the aesthetic on display in the old building (architecture, art, history) needs to be / is being replaced by comparable influences in the new facilities – the orientation programme, the relatives room.

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Keeping it somewhat personal, I told them about an old friend, Max Aguilera-Hellweg, who sat in this very room as a first year MATURE medical student in 1998/99, but who transferred back to the USA for the rest of his degree because of a dispute with the School arising from conflicting views of his book ‘The Sacred Heart’, which he had just published the year before. I read and analysed extracts from Max’s book, highlighting how his interest in medicine arose (a photographic assignment that led to an obsession) and his resulting intense, artistic fascination with representing the most full-on images of the workings of the body as revealed by surgery.

… Far from getting sick, I felt what I can best describe as awe. Photographing my first surgery was so foreign to any of my previous experiences that I couldn’t place it. I couldn’t compare it to anything. It is one thing to know there is a spinal cord in the hollow of your back; to see one for real is altogether different…

The cardinal glow of oxygenated blood reminded me that there was a man in there. A thick, milky-white strand covering the nerve tissue that stretches from brain stem to tailbone, splitting off into minute and multitudinous nerves, producing the sensations of heat, cold, pleasure, pain; the dura of the spinal cord lay revealed. I saw the painting above my grandmother’s bed. The one I saw as a child waking up from my nap. The one of Jesus. His heart bleeding, wrapped in thorns, engulfed in flames.

I realised I was in the presence of the most intimate, most vulnerable, most inviolate thing I had ever seen. The spinal cord had never seen light, wasn’t meant to see light, and at this moment was bathed in light. My first impulse, I must confess was to spit. To defile it in some way. Bring it down to my level. I didn’t, of course, but I felt I was in the presence of something so precious, so amazing, so powerful, so pure, I couldn’t bear the intensity.

“What is that?” I asked. “What’s it made of?”

“It’s like a sausage,” the surgeon said, “with toothpaste inside.”

 

We discussed the heightened language and thinking here; the artistic impulse; the impact such descriptions have on a reader, particularly whether or not they can be said to have benefits for medical student readers; we debated why Max’s impulse was to spit (including wondering was it actual!); we discussed the surgeon’s disabusing and mundane reply, in terms of professional distance and general normalisation.

Where before [as photographer] I searched the eyes of a man [for his soul!], the wrinkles of his clothes, the wear and tear of his shoes, I look now in the recesses of his flesh, the colour and texture of his liver, the markings and capacity of his lungs.

We discussed our impressions of Max from the extracts we’d read and how suitable his motivations were for someone becoming a doctor. We got into a detailed discussion about empathy.

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Then we read and analysed extracts from Sinéad Gleeson’s essay ‘Blue Hills and Chalk Bones’.

We discussed how the suddenness of the migration from the Kingdom of the Well to the Kingdom of the Sick is handled (“It happened quickly, an inverse magician’s trick: now you don’t see it, now you do. From basketball and sprinting to bone sore with a limp. Hospital stays became frequent, and I missed the first three months of school four years in a row.”); the unbelievable trauma to the body and soul some treatments involve; how quickly a patient, even a young patient, become conversant if not fluent in the language spoken in the Kingdom of the Sick.

We went into some detail on the particular impact of physical difference on young people (“I got used to the limp … but gained a new self-consciousness… What I felt more than anything was overwhelming embarrassment. Ashamed of my bones and my scars and the clunking way I walked.”) and how if it’s difficult for a doctor to properly empathise with an adult patient, it can be even more difficult when the patient is a young person or a child. (Though some of them have thicker skin than others, was a point that was made.)

We discussed the clinical aspects of acne and blushing.

There are a couple of particularly harsh doctors portrayed in Gleeson’s essay, and we discussed how prevalent their behaviour might be in healthcare settings these days and whether or not efforts were being made to reduce the instances of such ignorant behaviour:

I explain this to the orthopaedic doctor, this man I’ve never met, and he does that thing I’m used to male doctors doing: he tells me I’m overreacting. A rotating blade is slicing into my flesh, but I need to calm down. When my mother starts to cry, he demands that she leave the room. Fifteen minutes later, I plead with him to stop and he finally gives up, annoyed.

And:

On an early visit to the surgeon, to check my spine for scoliosis, I was asked to wear a swimsuit. Mortified, I cried all through the exam, and the doctor, growing impatient, threw a towel over my lower body.

‘THERE, is that better?’

It wasn’t. I was a self-conscious girl being humiliated for her sense of shame.

Perhaps understandably considering her analysis and perspective, Gleeson summarises perfectly the lop-sidedness of the relationship, particularly as it was back in the 80s:

The Doctor patient relationship had its own imbalances. I have never forgotten the sense of powerlessness in instruction: lie down, bend forward, walk for me. I have felt it counting backwards from ten under the stark lights of an operating theatre. Or when skin is sliced cleanly through. You are in someone else’s hands. Steady, competent hands – hopefully – but the patient is never in charge. The kingdom of the sick is not a democracy. And every orthopaedic doctor who examined me during those years was male.

We discussed the difference between Gleeson’s language / perspective and Aguilera-Hellweg’s.

A variety of analyses were put forward on this idea: “Our bodies are sacred, certainly, but they are often not ours alone… we create our own matryoshka bodies, and try to keep at least one that is just for us. But which one do we keep – the smallest or biggest?”

We noted the empathy behind her observation of another person in Lourdes hoping for a miracle: “He twitches occasionally but is otherwise motionless. There is drool on his face, and I want to say something to him but can’t.”

Also the pathos in: “This is the breakdown of bones, the slowing of a heart, the confinement of our own bodies: a being that once sprung into the world, vibrant and viscous and pulsing with life.”

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Finally, we read and discussed Doireann Ní Ghríofa’s poem ‘To the Stranger Who Will Dissect My Brain’ (unpublished) and the students who spoke were extremely moved and impressed with the final description of the “exchange” that happens at the end of the poem between the remains and the (say) anatomy student: “Your brain will blaze bright,// alive and wild, and I,/ I will be the light.” Not only capturing the awe felt by medical students (& some photographers) but also the enlightenment – the final gift of the person who has donated their remains to medical education.

One student spoke about how the poem captured in a way that she could never achieve herself (and that no other language register could, perhaps) that feeling of awe that some students experience when they begin their anatomy dissections.

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And to top it all off, the students were able to look around the old Anatomy Museum and get a sense of the history – betimes quite freakish and grotesque – of their studies.