Poetry in Medicine: A Doctor’s Walk to Work
By Daniel J. Bressler, MD, FACP
Published in San Diego Physician Magazine, July 2004
During the walk between home and office, my New Balance shoes make their way over asphalt, cement, mud and muck. One of the biggest obstacles to instituting my long-planned transition from car to foot travel was the real and imagined issue of sanitation. From a disease vector perspective, even the remote prospect of introducing inoculations of pathogenic staph and shigella species into an exam room occupied by vulnerable patients gave me pause. I solved that problem by realizing that I could change into “surgeon’s clogs” once at the office. The street shoes get stowed under the credenza. The clogs stay in the relatively protected environs of the office. They rarely visit the outside street scene with its wash of swarming microscopic organisms that are neither contained in red hazard bags nor washed with OSHA-mandated antiseptic multiple times a day.From the perspective of a poet, a city walk can be a rich encounter with an unedited version of life coming at you, as the saying goes “point blank.” As Michael Blumenthal puts it in a birthday poem called “This Is It,”
This is the world:
The street, the bus, the garbage…
Not the heaven we dreamt of, but
the sweet sewage of something better
and worse that flows in the streets
and we have no choice but to call: home.
Though Mission Hills-to-Mercy Hospital is hardly a “mean streets” route, the path does often take me past street dwellers, panhandlers, and other lost souls. There are businesses both thriving and bankrupt, shops new with promise and broken by failure. During the grocery workers’ strike at Albertson’s through the fall and winter, the tired sign-carrying strikers came to expect my salute of support. This past week, a clump of pre-teen girls jabbering their way to St Vincent’s Catholic School ignored me as just another grown up; the old widower with her vertical wheeled grocery basket trudging her way on arthritic legs back to the Green Manor senior housing answered my gaze with a suspicion; the mother who was waiting with seeming infinite patience along with her three small children at the bus stop on Washington, seemed to appreciate that I addressed her four-year-old son as “mijo”. The pageantry of the life-cycle itself, something that drew me to medicine is the first place, displays a variety of its facets during my trudge. That I, too, am part of that cycle is more apparent to me during my walks than during that other pageant that takes place back at the office. There I am set apart by my white coat, role, and health. On the street, with my tennis shoes, baseball cap and rucksack, I’m just part of the show.
Shakespeare’s famous speech, All The World’s a Stage (also called The Seven Stages of Man), as spoken by Jacques in the play As You Like It, lays out a seventeenth century version of this tableau, the modern equivalent of which I fashion daily both from sidewalk and exam table:
All the world’s a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages
At first the infant,
Mewling and puking in the nurse’s arms
And then the whining schoolboy, with his satchel,
And shining morning face, creeping like snail
Unwillingly to school.
And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow.
Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honor, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth.
And then the justice,
In fair round belly with good capon lin’d,
With eyes severe and beard of a formal cut,
Full of wise saws and modern instances;
And so he plays his part.
The sixth age shifts
Into the lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose well sav’d, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound.
Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
A variety of studies have made a strong case for the health benefits of regular walking. Heart disease, diabetes, various cancers, obesity, all cause mortality and even depression are all lower in people who regularly hoof it. I do walk for those reasons, too; just as I sip a glass or two of Pinot Noir many nights knowing that it is the varietal highest in the anti-oxidant resveretrol. But the Pinot is not just for my anatomical heart; I drink it as a celebration with family or friends and as one way of glimpsing the world a little differently. So, too, the daily walk is not for my physiological metabolism alone. There is an emotional or even existential metabolism that gets tuned up with my walks. In contrast to my status in the office, on the sidewalk I’m more-or-less like everyone else; getting where I’m going to by putting one foot in front of the other; always keeping half-an-eye to the ground to avoid the dog droppings; trying to catch a smile from the pretty shopkeeper at the Cheese shop; trying to stay out of the bus’s diesel fume eruptions. When I walk I’m nobody and everybody but definitely not “a somebody.” It’s a daily dose of grounding, both literally and figuratively. And perhaps even a daily dose of humility, as that word comes from the word “humus”—the soil from which I’ve come, the soil to which I’ll return, and the soil on which, while I am able, I will walk to where I’m going.