Healing with words: a physician's lament

The practice of medicine has always posed significant challenges, alongside its many rewards.

Sadly, doctor burnout is not a new phenomenon. And the added strain heaped on medical systems by the pandemic and its fallout have dialled the pressure cooker settings to extreme.

Now, more than ever, it is vitally important to talk about this very real issue for doctors and the healthcare system as a whole.

This is the second in a series of articles examining aspects of doctor burnout. The first outlined four strategies for tackling burnout.

This feature explores the question, “What can I do to better manage the emotional impact of the work I do?”

Written by a GP and author, it details how reflective writing became a tool for transforming some of the messy, less pleasant aspects of the job into something creative.

It is an extract from One Curious Doctor. A Memoir of Medicine, Migration and Mortality by Dr Hilton Koppe.

The Red, or the Pen?
“The poems flow from the hand unbidden and the hidden source is the watchful heart”.
— Derek Mahon

It was late. I was all alone. Everyone else in my family was in bed.

I was tired, but happy. I reached for my glass of wine. Reward for completion of my accounts for another month.

And there they were. The pile of poems. In the bottom of my in-tray. Unread.

They had been sitting there for how long — three months, six months, nine months? Too many poems. Too thick a pile. Too scary. I was intimidated by the weight of the words.

Intimidated, yet curious. I reached for the pile. Poems of a journey through illness and recovery.

Where should I start? Will I? Won’t I?

The poems had been written by a patient. Not just any patient. The patient who had caused me the greatest anguish in my 20 years of family practice. Depression, despair, desolation — we had shared those experiences for months. Nearly a year. Patient and doctor. Sufferer and sufferee.

None of the treatments I suggested worked. Antidepressants made her worse. They stopped her feeling. And when she couldn’t feel, she couldn’t write. And when she couldn’t write, she couldn’t see the point in living. How can a poet live without writing?

The psychologist was too mechanical.

The CBT was boring and predictable.

The psychiatrist kept putting up the drug doses.

Nothing worked.

It was late. I was all alone. Everyone else in my family was in bed.

And there they were. The pile of poems. On the table.

I reached for them. “The Tractor Poems”, typed on the front page.

What does that mean? Something to do with ploughing? With turning of the earth? I don’t know. I’m no good at this poetry stuff. Might be better to let sleeping dogs lie, I reckon.

Below the title, a handwritten note in red ink. “Remember, poetry can be a fiction too. Happy reading. S.” And a simple smiley face. Two dots above a dash, above a curved line. The smiley face disturbed me.

What does that mean? That you are happy now? That you are going to get the last laugh? I don’t know. I’m no good at this poetry stuff. Might be better to let sleeping dogs lie, I reckon.

She had written the poems during her recovery. No, she had written the poems as her recovery. Once she had stopped taking the drugs and started to feel. Once she stopped doing what everyone else suggested. Once she stopped trying to be a good patient. Once she stopped pretending. She started to write again. And she started to get better.

It was late. I was all alone. Everyone else in my family was in bed.

And there they were. The pile of poems. In my hands.

I flicked through them. The titles made no sense. “Cricket”, “To the Headland”, “Test, Test, Testing”, “God is a Potter”. She had told me the poems were about her illness. I couldn’t recognize illness anywhere in these.

And then there it was, towards the bottom of the pile. “And You”, it was called.

Could that You be referring to me?

I was not so different to other doctors. I wanted my patients to like me. No, I wanted my patients to love me. To think that I am a great doctor. To appreciate my desire to help. My desire to heal.

So, what did “And You” have to say about me? I expected to read about how I had been the one to make the difference. The knight in shining armour. That without me, she would not have got better. That I had been the one, the only one, who had been there for her through all the blackness.

I scanned the poem, too scared to dive right in. Then I saw the letters ECT and knew what this poem was going to be about.

It was going to be about the darkest hour of our journey together. None of the treatments were working. She refused to see anyone else. I didn’t know what else to do. I felt so alone. So responsible.

From out of this black hole came a clutching offer. “I’m not sure if you are aware of it, but in cases of severe depression like yours, when no other treatments help, ECT or shock treatment is sometimes still used. It can be very effective.”

In all my years of medical practice, I had never before needed to utter those words. As they catapulted from the depths of my desperation into the space between us, two images flooded my mind.

The padded cell in the lock-up section of the local psych ward, which I had visited when I had first arrived in town. “Just wanted to check out the local facilities,” I had mumbled to the medical superintendent, as the horror of the cell was etched into my memory.

And at medical school, during my psychiatry term, going with my newly admitted patient for her first shock treatment, her terrified face etched into my heart.

“… ECT or shock treatment is sometimes still used. It can be very effective”.

At the time, I had wondered how she would react to those words. What would she think? It was hard to tell. She was still being a good patient.

“And You” was about to let me know.

And You¹

These are the things
that I could have been
before you knew me,
(please tick which boxes apply):

restaurateur
mother
recruitment consultant
Avon lady
travel writer
f***wit

but now I’m not.

And you,
who knows nothing
sit there and say:
If not

hospital

then perhaps

There’s always ECT.
I’ll just put it out there.
You say.
And I say to you:
Sylviajanetvirginiaernest
and more.

You look abashed or possibly bored
though more likely you are just
a gentleman of science revealing
your ignorance
your stupidity
your naivety
your cruelty
to suggest violence
(incredible)
to cure pain.
And I say to myself:
Black dog’s girlfriend is little kitty heroin.
I should perhaps instead seek a vet.

It was late. I was all alone. Everyone else in my family was in bed.

The poems were no longer in a pile on the bottom of the tray. They were scattered in front of me. The lid was off Pandora’s box.

And you? And you! What about me? What about all this emotion? All this anger, this resentment, this hurt, this shame! What am I supposed to do now? How am I to respond?

My first thought, another glass of wine. It had always helped in the past. But it felt too late for that.

I was all alone. Everyone else in my family was in bed.

And there they were. This pile of emotions. Too much for a glass of wine.

My next thought, to write a poem. Write a poem back. To be understood. To be heard.

No one ever hears the doctor’s story. Bloody patient-centred medicine. I practise it. I teach it. But what about us? What about me? We are not inert punching bags, there to accept without judgement all that is thrown our way. Bugger it, there are two people in this doctor–patient relationship, and I am one of them. If it’s good enough for her to write a poem about me, even though I’m no good at this poetry stuff, I’ll give it a go.

To be with, or to do to?
That is the question.

A start shamelessly stolen from my old mate William, and from my own consulting skills workshop.

A tentative start. A gradual increase in momentum. I found words pouring directly from my heart, brain bypassed. As the words flowed, so did the tears. Unexpected. Uninvited. But welcome. Relieving.

Just keep writing. Just keep writing. Don’t think. Just write.

And I did. I wrote, and I felt better.

A Physician’s Lament

To be with
Or to do to
That is the question.
To do no harm by being with
An other
Separate, yet not
Different, yet not
Flesh and blood, both.

But what when being with is not enough,
When being with only
Does harm?
When there is a need to do to

To do to
And to do no harm.
Now there is a question

To vex the mind, body, spirit
Of this flesh and blood.

Where is the wisdom?
To whom can I turn when my
mind, body, spirit, flesh, blood flounders,
When my inner well is dry,
Except to the thoughts of others,
Past and present
Who have trodden similar paths before me
Or for me
So that I may
Be
and
Do
For You.

Time, they say, heals all wounds. But sometimes, time alone is not enough. For me, as for her, it was writing that triggered my healing. Another shared journey.

Now when it is late, when I am all alone, when the rest of my family is in bed,
I write. Just a little each night. A few more poems. Some short stories. The making of a play.

I don’t care if I’m no good at this poetry stuff, if my writing is crap, because now, I feel better too.

Extract from One Curious Doctor. A Memoir of Medicine, Migration and Mortality.

Dr Hilton Koppe is a GP, medical educator, writer, podcaster and workshop facilitator.

Dr Koppe uses reflective writing both as a personal and educational tool for reducing the risk of burnout, overcoming professional isolation and deepening compassion.

“And You” reproduced with permission of author, Susan Bradley Smith. First published in her collection of poems Marmalade Exile, published by Southern Cross University Press 2006.