Connelly, Julia E. MD
Dr. Connelly is codirector, Program of the Humanities in Medicine, and professor, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia.
Seamus Heaney, winner of the Nobel Prize for Literature in 1995, provides insight into the relational experience between doctor and patient through his poem “The Rain Stick.” However, this poem makes no mention of doctors, nurses, or medical students, no details about patients, and no illness narratives reported to provide insight into the world of the ill. The reader as physician must know or be willing to realize that each patient holds a deep secret within, much like the rain stick does.
In 1992, I experienced the rain stick for the first time. With several friends, I had hiked from the South Rim of the Grand Canyon through the many colorful layers of deposited rock to the Tonto Plateau overlooking the steep, ancient walls of the inner canyon and finally crossing the Colorado River some 6000 feet below the canyon's rim. Several days of exploring waterfalls, canyons, and buttes left us in awe. Later, back on the rim, I walked into the gift shop to find my friends standing together in the far corner, smiling, listening, laughing, as if held in a mystical trance. Each one was holding a long, light brown, tube-like cylinder slowly being upended, one end then the other. As I neared, I began to hear the secret of the rain stick: tinkling sounds, light and airy, floating and drifting. Years later I discovered Heaney's poem with its vivid description of the sound.
“The Rain Stick” contains secrets for all who want to, try to, and long to heal and care for others. The opening lines direct the reader toward a mystery that is not often acknowledged in medicine, the mystery of not-knowing. Medicine knows, or at least it thinks it does, so it rarely teaches or explores this territory that holds so many surprises, delights, and even answers. True understanding requires the physician to follow the narrative thread, ask questions to clarify asides, and listen on many levels. Learning from “The Rain Stick” interested physicians could ask: If I engage this patient from a perspective of not-knowing, how might I be surprised? If I am open, interested, curious about the patient, what might I understand about him or her or even myself?
When physicians jump to conclusions and close down avenues of inquiry, they eliminate the possibility of experiencing the mystery, the epiphany of understanding. Who would have thought in a dried cactus stalk there exists all of this possibility: surprise, freshness of perspective, and joy? Who would have imagined that a particular patient might have such a touching, tender message for the physician? And, how might these narrative details bring understanding and clarity to the clinical situation? And, what if the patient's tale was just what the physician's heart needed to open? Who would have guessed this possibility might be present in a single moment with another?
Heaney urges us to listen even more closely: “Upend the stick again. What happens next/Is undiminished for having happened once,/Twice, ten, a thousand time before.” “The Rain Stick” allows us to see and appreciate the uniqueness of each patient, from visit to visit, even as years of interactions pass. Each visit requires a fresh perspective because lives unfold and flow from one moment to the next. No one remains the same month to month or year to year. The impression that patients are static objects is flawed. From another point of view, Heaney reminds us that no experience is routine or everyday. Each patient no matter how routine the symptom, as seen by the physician, holds a unique experience within.
As the poem comes to a close, Heaney points to the importance of not making judgments about patients, that is, if physicians want to invite surprise, delight, joy, and precision into their work: “Who cares if all the music that transpires/Is the fall of grit or dry seeds through a cactus?” As judgments precede interactions, physicians become closed, not interested, not curious, not receptive, not caring. And in this diminished state, they do not see or hear the truth arising in the experience with the other.
The secret message for physicians shows them the vast array of opportunity that results from not-knowing. However, many physicians fear being open and vulnerable with patients. Yet, a closer look at the fear may reveal a deep and personal misunderstanding. Fear does not require abandonment of self. This discomfort can easily be diminished by direct and real human contact as demonstrated by true listening such that the other feels heard and understood. Through “The Rain Stick,” Heaney urges the reader to move toward not-knowing so that the richness and potential of experience will not be missed: “You are like a rich man entering heaven/Through the ear of a raindrop. Listen now again.” Ultimately physicians may be able to share interpersonal lessons and kindness as well as nurturing the potential for personal growth, change, even transformation, if they are willing to—“listen now again.”
Julia E. Connelly, MD