................................. Writing the Caring Experience

“Various forms of structured language, and especially what we recognize as poetry,” writes the poet-physician Raphael Campo, “have been important and even principal means of healing through history and in many different cultures.” In the late Eighties I was invited to be Artist in Residence at Jean Watson’s Center for Human Caring and to write poetry about the nursing profession. Poems, in Jean’s view, were not arty entertainment but a perceptive tool crucial to portraying nursing’s complex fullness. As the year unfolded I discovered that the commission was a gift that would profoundly transform my writing and my life.

Collaboration: Theme and Variations
by Marilyn Krysl

Hasina: veil of skin, draped over bone. So thin she can't walk, sit up, hold a cup. Eyes a single beam, scanning for food, even when she's full. If I cover the woman next to Hasina with a sheet, Hasina wants to be covered. If I bring another woman a biscuit between meals, Hasina demands a biscuit, hides it under her mattress. If another calls for water, Hasina too signals, waving her hand.

Calcutta, summer, 1994. How did I get here, I who am not Catholic, who wasn't even a candy stripper? It began in 1986 with a phone call from Jean Watson, Dean of the School of Nursing in Denver and Director of the school's Center for Human Caring. I didn't know her.

"We'd like you to serve as Artist in Residence at the Center and to write a book of poems about nurses," she said. "Health care's become dominated by technology, and we need the humanities to show the human side." She spoke of the medical profession's emphasis on cure, the nursing profession's emphasis on care. A good nurse, she explained, had to be educated in anatomy and physiology, but a good nurse also had to be psychologically acute, emotionally perceptive, sensitive to nuance. She wanted a poet to describe the work nurses do in a vivid and compelling way. "You can do this for us," she said.

I was intrigued. "Why not an article? Why not a journalist?"
"Even a good article won't fully capture what we do," Jean Watson said. Then she quoted Heidegger. Heidegger distrusted the way science studies bits and pieces in isolation from each other. He believed that being resides in wholeness. "Truth happens," he wrote, "when that which is as a whole is brought into unconcealedness and held there." He also believed that only poetry could articulate "the saying of the unconcealedness of beings."

Jean Watson referred to poetry as "mortal language," by which she meant not conversation, journalism or scholarship, but speech spoken by human beings at the moment of unconcealedness. She wanted a poet to describe nurses' work: not what was visible, such as the emptying of a bedpan, though that was part of it, but what was invisible: the gestalt of knowledge, feeling, sensitivity and attentiveness of those who care for the sick.

Jean, I would learn, is a sunny, enthusiastic personality, open and generous, known for her pioneering vision not just by nurses in the U.S. but around the planet. She brings musicians, philosophers and alternative healers to the Center, and promotes conferences on the healing arts. She envisions sweeping changes in the nursing profession, then goes about implementing her plans on a grand scale. When Emma Goldman said "Pettiness separates, breadth unites: let us be broad and big," she might have been describing this visionary nurse--theorist.

Jean pointed out that nursing, like public school teaching, is an undervalued profession. Though nurses are vital to everyone who spends time in a hospital, they're rewarded with minimum pay and low prestige. Jean believed I could help change this. I was excited, but anxious. Would I feel compelled to censor my feelings? Would writing to order like a journalist make the poems seem contrived? Would nurses like what I wrote about them? Surely Jean Watson knew what she wanted. What if I didn't meet her expectations?

"We need the perspective of someone perceptive from outside the profession," she said, "someone who'll see us in ways we can't see ourselves. Whatever you see will be useful to us."

As payment, the Center would provide a $6,000 commission. Jean would introduce me to midwives, psychiatric nurses, community health nurses who made home calls, hospital nurses working on ICUs, Burn Units, cancer wards, in surgery. Would I be willing to spend one day a week for the academic year doing the research? Would I give a public reading at the Center at the end of the year? And would I then consider submitting the manuscript to the National League for Nursing Press?

I felt like the sky had opened and I stood in the proverbial shower of gold. Here was someone outside the literary world who honored my work, wanted to pay me to write poems, and offered entre into the workings of a life--sustaining profession. This extraordinary woman perceived poetry not as arty entertainment but as perceptive tool, crucial to portraying nursing in its complex fullness. She was convinced poetry could change the public perception of nurses, that it could help transform the profession itself by acting as a mirror, reflecting back in lyric and narrative form what was there. And she seemed to trust me unequivocally. What more could a poet want?

As I began to accompany nurses at University Hospital on rounds, imagining their inner lives and those of their patients, I began to understand why Jean had sought out a poet. Nurses are present at many of life's quintessential occasions: birth and death, the experience of pain and helplessness, of irrevocable loss and mourning, and the experience of recovery and the bliss of well being. These occasions comprise poetry's quintessential subjects. Poetry was an ideal medium in which to do these moments justice.

During my residency at the Center, I lived the writing life I'd lived before, but with several new twists. I was in a place where those moments were concentrated. I might be present at both a birth and a death on the same day. In the space of a few hours I'd witness people in severe pain and others happily preparing to leave the hospital. These moments came thick and fast, they were intense, and I felt myself pulled into their vortex. The effect of this was that the situation in which I was writing felt distinctly collaborative.

Dictionaries define collaboration as two or more people working jointly, usually in the arts. Olga Broumas and T. Bagley co-authoring Sappho's Gymnasium comes to mind. But my collaboration wasn't a two person partnership. The Dinner Party, an art piece conceived and produced by Judy Chicago and the many artists who gathered to work in partnership with her comes to mind. But my collaboration resembled this only in scope. Jean Watson, her faculty, the nurses, patients and I were in league, working jointly on a common project, and this project was tied to collaboration in a crucial way. Nursing is a milieu which graphically embodies our human interconnection. Patients depend on someone to take care of them, and nurses respond to this need. I was witnessing the give and take of our interdependence acted out in a health care setting, an interdependence emblematic of what Merleau Ponty calls our intersubjectivity. I was observing, in a literal way, how we are one "flesh."

My approach to writing about this interconnection wasn't so different from what I normally did for a given poem: read some history on the subject under scrutiny, find out what triage means, keep a journal of relevant quotations. Notice the atmosphere around whatever scene is unfolding: cold clinical institutional, sunny with a breezy pace, the hush in a room where someone's dying, the feeling in the delivery room that the room itself is slowly expanding, rising into the air.

Now this "researching" also felt collective. Partly it was the fact that there were always people around me. But the collaborative feel also came from my sense of connection to both nurses and patients. Take Katie and Wiona. While Wiona recovers from surgery, she's doing hand sewing on a dress for her daughter. She asks the nurse, Katie, to buy her some thread, and while Katie's gone, Wiona and I talk. Wiona knows she's dying. Still she wants to sew the dress, and we talk about why this is important to her. Later when Katie and I are alone, she confirms that indeed Wiona won't live much longer. She has a particularly idiosyncratic connection with Wiona because Wiona reminds her very much of her own mother. By this time I am involved in the lives of both Katie and Wiona rather more deeply than as a mere observer. A few days later, I am on the floor when Wiona dies. I cannot simply observe this experience of death. By being present I am part of it.

This intricate engagement was typical of my interconnection with patients and nurses. I was an observer, but in a larger way I felt that what I observed wasn't apart from me. And indeed I was experiencing a universal truth. For Heisenberg's Uncertainty Principle implies that an observer and the subject she observes are not separate, that she is part of a system she cannot step outside of. I was willy nilly engaged by and engaging those I was to observe. My poems would reflect a subjective reality as I perceived it while being a part of it. My so called "subjects" and I were literally in this together.

The sense of collaboration was especially notable amidst the expensive, intimidating technology and the press of efficiency which seems a given in hospitals. When we're sick, we don't care about the latest improvement on the laparoscope. We're hurt animals, and we want to be recognized, touched, reassured. Amidst the intimidating presence of steel bed rails, drips, tubes, charts and humming machinery, exchanges between nurses and patients kept things grounded. The urgency of patients' needs tends to be keep nurses down to earth in the sense of being at once sensitive and pragmatic. On one occasion I was with a nurse who was supposed to bathe a quadriplegic man. The orderlies had lifted him into the water. But this man wasn't having any of it. He told the nurse he didn't want a bath. She agreed to leave, smiling, indicating by gesture and attitude that his refusal was no big deal. But as we began to walk away, he called her back. By honoring his desire, she'd given him room to make his own decisions, and he'd changed his mind. "You have to let them keep their dignity," she told me later, "however they define it."

As a writer, I was especially tuned to nurses' role as interpreters of medicalese. The euphemistic quality of medical language is ubiquitous in hospitals. It creates a domain of expertise that renders patients less powerful than doctors and interns and cuts them out of the process of their own treatment. Some physicians of course are sensitive to this, and talk to patients in language they can understand. Many aren't, and the nurses present necessarily become translators, interpreters and patients' advocates.

Browsing a medical textbook one day, I learned that our human skin is classified as an organ; that an adult's skin, if you were to flay it, would weigh six pounds and cover eighteen square feet. I was stunned by the text's cold matter of fact delivery. My response was to try to counteract the sense of disembodiment by weaving this data into something that might contain and mitigate its damage: the warp and weft of a poem.

As the year progressed, I kept writing, revising, fine tuning. Some situations I cast in third person, hoping to capture the "invisible" work nurses do by sketching nurse and patient at a distance as a single gestalt. I also taught myself to write monologues, to construct an epos that would convey in first person a particular nurse's inner world. The poems were in some ways recognizably mine, in some ways a departure. Often poems I've written feel so individually quirky that it's difficult to envision how they'll cohere as a book. But these poems were in collaboration with each other. They felt of a piece. In May I read the cycle at the Center to an attentive audience. When we gave each other a standing ovation, I knew my sense of communal effort had been accurate.

Publication of the manuscript turned out to be another version of collaboration. My editor suggested I group the poems by theme and write a prose introduction to each section. He knew the audience for NLN books was intelligent and highly educated, but he also knew how easily even the intelligent and highly educated can be intimidated by poetry. I decided these introductions were very much to the point. In them I tried to give each poem a context the way I'd do at a reading, telling my audience bits of data about myself and the circumstances which had inspired each piece. Jean Watson's introduction to Midwife provided another context for the poems, and stood as symbol of her collaborative contribution to the project. The finished book was a kind of printed poetry reading. Providing those prose contexts and seeing them in print beside the poems reinforced my sense of the shared experience in which the poems had been conceived.

In 1989 NLN Press did a print run of 1,000. When this first print run sold out, the NLN printed a run of 2,000. When that run sold out, the press printed 1,000 more. For the first time I felt I had a built in audience. Nursing schools began to use Midwife as a text, and I began to be invited to read at health care conferences. At readings I generally feel myself in collaboration with the audience. Both the listeners and I are hearing the poems together, and while they watch me, I'm noting responsive faces and changing expressions. Now, because the majority of participants at health care conferences were nurses, collaboration went on at an even more intimate level. Reading to them resembled reading to a lover the poem you've written for that person.

And there was another far reaching reverberation to our collaboration. Within the nursing profession, nurses were beginning to recognize the value of narrative. It was becoming clear that a story was not only a more vivid way of charting a patient's data, but also a more comprehensive, humane and accurate method. Thus I was invited to conduct writing workshops at these conferences. I was not only reflecting nursing back to nurses in poems, but also helping nurses learn to tell the stories of their collaborative interactions with patients.

Jean Watson and her faculty imagined I'd done them a service. I knew I'd received a gift. Collaboration had nourished me in unexpected ways. I'd seen patients in the hospital humbled by their faltering bodies and been humbled in turn. I was reminded that life is not a right but a privilege, that I do not know when my death will come, that I am an animal creature dependent on the generosity of others. I'd also witnessed that generosity in action, freely offered by people working for minimal pay because what they were doing was needed--not needed to turn a profit, to please a supervisor, to enhance a resume, but needed by others, by people in need.

Now I surveyed my work as a teacher of creative writing from the perspective of the collaboration I'd been a part of. At the time teaching did not have the cooperative feel my work at the Center had had. I knew it could have that feeling, and I wanted to figure out how that might happen. To help me learn this new way of being with students in a classroom, I felt intuitively that I needed to be part of another group project. I looked for such a project in the healing arts. I interviewed and spent time with a sound healer, a medicine woman, a curandera. Their stories began to broaden my sense of what constitutes "health care." One evening I chanced on a T.V. documentary about Mother Teresa and the international volunteers at the Kalighat Hospice for the Destitute and Dying in Calcutta. As Artist in Residence at the Center, I'd been in the position of observer. Here was an opportunity to be in the position of care giver. Instinct urged me to go to Kalighat. I expected that taking on the role of volunteer would benefit me in some way.

Calcutta's air is Diesel. Trucks and lorries crowd the thoroughfares, revving their engines, grinding huge gears. Every day thousands of refugees arrive from Bangladesh. People fight over taxis, and on the bus I usually stand--seats reserved for women are already taken. Many of us are sick--coughing, sneezing, feverish, nauseous. It doesn't matter. I get on the bus and I'm happy all the forty minute ride to Kalighat. Though the air is awful and the bus stalls again and again in traffic, I feel I'm on a smooth, continuous trajectory.

The routine at Kalighat centers on bare essentials: meals, baths, the changing of linens, the agape of an embrace. There are vitamins, antibiotics and pain killers, but the most technological procedure is a drip set up for anyone too sick to swallow liquids. If someone needs hospitalization, they're taken, but most people picked up by the van are beyond that stage. Death is a common occurrence, and serving food, giving baths, emptying bedpans, changing soiled clothing and washing fifty-four plastic mattress covers on the women's ward each day is hard work.

I badly need to talk about what's happening. But much of the experience doesn't translate into dinner table conversation. Thankfully there's writing. In the great, ongoing conversation poetry is, I can speak freely and wildly. And it's while I'm writing in my notebook in Calcutta that it hits me: all my writing life there's been this other collaboration going on, the one between the writer and the world. I write alone, in a quiet place, but how separate am I, at those times, from everything else? Not very. In fact, not at all. What some call a visitation by the muse feels to me like the nurturing presence of the world around me as I write. Exchange is creation, Muriel Rukeyser wrote. I have taken part in that exchange by "following," as William Stafford suggested, being "neutral, ready, susceptible to now." I know what he meant: when the right word falls into place, it feels not so much chosen as given. I don't hear voices, but it's as though I've stumbled onto something that was right there: the right word. It was right there because the animate world is right there, offering itself. We can't not be part of what the physicist David Bohm calls That-Which-Is.

Every day in Calcutta I engage in this collaboration called writing. And every day I engage in the collective enterprize called Kalighat. Occasionally I want to be somewhere else, like the day half the women get diarrhoea, and our work is to help them bathe and dress over and over again. At other times, when a woman smiles or squeezes my hand, or we exchange a glance of understanding, I'm in a serene version of bliss.

Then Hasina. When she arrives, I guess she's in her thirties. But starvation is deceptive. In Bengali she tells Sister Luke she's fourteen. Then she stops speaking. Or maybe she can't, maybe she's too overwhelmed, now that she's in a safe place, by her own suffering.

Every day I bathe and feed Hasina. Every day I give her vitamins, hold her hand, stroke her. One day Hasina begins to moan. What's wrong? Sister Luke asks her in Bengali where she hurts. Hasina shakes her head. Luke throws up her hands, goes to see about another woman's drip. Now Hasina looks at me, her eyes anguished.

Her moaning is continuous, rhythmic utterance. I kneel beside her, sit her up. She can't sit alone, so I put my arms around her and we climb onto the rhythm of her moaning and begin to rock. Around us the other women are dozing. Six o'clock comes, and the other volunteers go. The light lowers toward dusk, and the nuns go upstairs to prepare their evening meal. I close my eyes. I have no where to get to. The only sounds are the nearby whir of a fan, Hasina's moan. I have no sense that time is passing, no feeling of urgency, no desire to be anywhere else. I'm content rocking Hasina. Then I become aware in a bodily way that this rocking is also rocking me. We're rocking each other, we're becoming this rocking. We keep on becoming the rocking, and the next thing I know everything is in dissolve. I'm not me, just energy waves, which are also Hasina's energy waves. I can't tell myself from Hasina. And I can't tell us from the murmuring voices, the fan's whir, the encompassing air.

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