I don't use military metaphors in medicine lightly

#PittMedPedsRox MP-3 resident reading from her just published poem in @AnnalsofIM. Congrats!! #medpedsrox #narrativemedicine #humanism pic.twitter.com/J1looK5EhE

— Alda Maria Gonzaga (@MedPedsRox) May 29, 2019

"In the Trenches"
A poem published in the Ad Libitum section of the Annals of Internal Medicine

Feel for the teenaged girl who cuts
herself so she can control some-
thing in a divided household
but cannot bear the dozen pricks
of the thin lidocaine needle
so she will not feel any of
the one hundred twenty stitches
needed to lace her wrists back up.
Sutures march like rows of barbed wire
across this no-man's land of skin.
Her mother whispers in her hair,
while her father stands guard, arms crossed,
watching from the foot of the bed.
My hand cramps around the forceps
as I bend down to sew again.


I don't use military metaphors in medicine lightly, despite their ubiquity: we talk constantly about "fighting cancer" and "beating the disease." In graduate school I did a research project on the use of contemporary geopolitical language in the earliest days of bacteriology (~1880s). Because non-white, non-Western bodies seemed to bring diseases with them (especially cholera), terms such as "invasion" and "colonization" reflected both fear and the vacuum of an entirely new field that needed a vocabulary. What this sometimes overwrought language did, however, was pretend like nineteenth-century European and North American cities weren't also already filthy places to live.

While military metaphors seem normal now due to their longevity, the anthropomorphization of unthinking malignant or infectious cells is not inevitable, as Susan Sontag wrote in Illness as Metaphor (1978). She described how being encouraged to "fight" her breast cancer made it seem like her clinical outcome depended more on her state of mind than on the biology of the cancer or the efficacy of the available therapies.

In this poem I invoke "the trenches"--of World War I, of a family at war with itself, of front-line healthcare workers threatened with burnout. I think it's important to point out that burnout can happen if a nurse or doctor becomes overwhelmed with all the tragedy around them--essentially if they feel too much for their patients--and it can also happen if the long hours and bureaucratic red tape prevent them from feeling anything for the vast majority patients who come seeking aid without ulterior motives like pain medications or a free turkey sandwich.

One last note: as I counted up the syllables to make them even in each line, I realized that 15 lines x 8 syllables = 120 beats/stitches.

N.B.--Other poetry you might enjoy include this little Ogden Nash ditty, and this more somber verse about the relationship between the Pacific Ocean and the coastline.