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Stanford University welcome to tonight’s cafe scientifique at Stanford Blood Center my name is Kevin O’Neill in the marketing and communications department Stanford Blood Center is part of the pathology department within the Stanford University School of Medicine it is the primary supplier of blood products to Stanford Medical Center which is the second largest user of blood products in our nation as well as 24 other major hospitals in our community of the 85 blood centers in the United States to our community blood product providers and have a blood research mission Stanford Blood Center being one of them our success would not have been possible without the faithful blood donors many of whom are here this evening thank you all this evening we are privileged to have to introduce our physician writers and dr hon steiner will be doing the introductions dr. Steiner earned his MD at the University of Vienna in Austria he completed psychiatry residences at both the state university of new york upstate medical center and at the University of Michigan in Ann Arbor he is currently an active professor emeritus of psychiatry here at Stanford he is an expert on treating adolescents as well as eating disorders he is a founding member of the Pegasus physician writers and will introduce our readers please welcome dr. Hans Steiner good evening and welcome to our reading of the Pegasus physician writers before we get going I just want to tell you a little bit about the group and how it came about what its purpose is we are a group of some 65 physicians at Stanford that fulfill two criteria where doctors practicing doctors of variety of specialties and we also active writers we write poetry creative fiction and non creative piece tonight we’re going to hear pieces that have not been read before some of them are published now we’ll sort of indicate when that happens our main mission is to sort of bring the humanities to medicine and integrated into medical training because we all believe that to be a really good doctor you have to know how to write about new experiences because what that does is essentially train your capacity for empathy and we have about five or six readings a year they are advertised on our website but you easily find by putting in Pegasus to the issues of Stanford and they usually happen in museums on campus here they’re free of charge and easily accessible we also have with us Audrey schaeffer’s a professor of anesthesiology as you practice is right next door at the VA mostly but most importantly she is the director of the medicine muse program which is the umbrella program under which we all operate and I’m sure at the end of the presentation you will see a little bit about medicine and the views tonight we have a series of readings on the stuff of life hope when you need it most that was the sort of title that came to mind when we were thinking about blood that’s the way we usually do these things we tell all the groups okay here’s the medical topic who’s writing something about ago who has written something about it then people submit and then we select and is my baby a great pleasure to welcome our panel for tonight starting where’s dr. William Mefford through the surgeon and as you will see we call him a Hemingway for sure his prose is being much modeled after that particular writer he’s tirsan to the point and he brings a tremendous amount of humanity to his craft which you will see practice under be adverse circumstances our second reader is going to be Audrey Schaefer as I said she’s a

professor of anesthesiology and she’s an award-winning poet she’s going to read two or three of a poet poems that actually have one a variety of awards as you can see in the reference is provided in the handout the way I was like to think of Audrey is she has an unbelievable talent for bringing beauty and grace to the most disgusting subjects of medicine and then we hear from Randall Weingarten who we call poet laureate in the group he’s read on many of our previous readings and his contribution tonight either is the River of Life which as you can tell as a poem about blood and its function he’s an expert in tea ceremony and a practicing psychiatrist and a lot faculty at Stanford for many many years and finally we will hear from ward true blood also a surgeon who spent a significant amount of time as a very young man as a medical student in fact in Vietnam on the front lines and he think I think he’s going to tell us a little bit about that and the story tonight along with that wonderful picture that comes with the story word is currently completing a somewhat fictionalized biography would you say or just straight back straight back okay he thinks it’s straight psychiatrists of course know that that’s not true but that’s okay and it is forthcoming when do we know yet publication that soon based on the under your in the in the end run and so what we’re going to do is each one of these wonderful people is going to step up you have their BIOS in the handout you’re going to step up start their reading you may hold your questions until the very end don’t hold your applause after they read and when we’re done we have a little Q&A and hear from Audrey please welcome the panel of the Pegasus positions thank you for the privilege of the floor government arms tonight I thought I would present a case as I’ve hadn’t seen exactly but I’ve seen many partial histories with the same type of injury I did I went to did hang about less than a month after i finished my surgical residency and over the ensuing year operate on hundreds of of casualties most i would guess six hundred though i didn’t keep count and sometimes in our a and D or emergency room we had over fifty casualties at a time we were in evacuation hospital with 300 beds in Danang and most of my work was with large blood vessels or torso or chest injuries most chest injuries were fatal so was mostly of vascular work and abdominal work and I saw two two kinds of patients one the physically wounded and no matter how Grievous most the time they would survive and and they could carry on with the successful surgery and physical therapy and rehabilitation they could carry on useful lives but then that’s quite different to have a severe physical and mental injury and we saw lots of those two unfortunately lots of head wounds open head wound and closed head wounds were some cerebral tissue would be coming out of the auditory canal and the patient obviously unconscious and although I didn’t treat those patients I decided to write a story about one of them because I was interested in our long-term outcome and how far the recovery would go this is a title of the class of 65 karl was unconscious his head legs and right arm wrapped in dense white bandages he had been in that hospital for months when Carl’s letter to letter so Margie his high school sweetheart no longer arrived when he found out what had happened how he has been badly wounded in a grenade attack she went to see him many times she would caress his face and whisper she loved him Margie

saw the deep head gashes the drifting of his opened eyes the heeling arm and leg wounds grasping his hands squeezing them and gently she bent closer Carl Carl was there a response perhaps but no one could arouse him from a coma as months passed the doctors offered no hope because of severe brain damage finally she no longer visited that wrote to him hoping someone would read to him and he could somehow understand he could still smell her soft blossoming perfume her soul her clothing even her sweat it all blended together in his damaged mind she had washed over him on their feet on her family’s farm who he had worked as a higher at hand if you need to fix a tractor or a harvester remember to take your gloves off she would say they can get caught shut off the engine honey you’ll be working late tonight why not stay for dinner lying there he could see Margie driving the old for pickup shopping in a field where in the fading light of late afternoon he plowed the soft black earth so moist from winter snows brought you coffee and some fresh bread and jam she had said smiling he opened the passenger door and got in beside her pushing the gearshift out of the way there are lean bodies intertwined leaving us the snack untouched my god she’s hot just beautiful he thought pulling his shirt on us he drove slowly away steering with her knees she blood and her button her blouse and looked back through the rear view window with a teasing smile something touched his face softly he turned his head away was it at the jungle a thin wire trigger of a booby trap then again more of a caress a woman’s voice Carl Carl can you hear me move your right arm squeeze my hand with your fingers was it his Vietnamese lover liteon no he had seen her body after the rocket attack and the ritual of placing money and rice in her mouth her thin graceful body wrapped in white gently laid in her casket the blood and dusk cleans cleansed away a nurse a comforting voice he heard before Maggie mark maybe margu was there maybe it was her voice my god he’s responding the voice again look at us Carl white coast blurred faces he could see for months he couldn’t remember the past before the fog began to clear and his memory improved that head injury the long unconsciousness the slow painful physical therapy psychotherapy and regaining his speech seven years had passed since he had left home Margie had recently written but Karl had been too confused to respond she had mentioned the class reunion he didn’t call or write but now he felt better and decided to return unannounced driving through the rolling iowa countryside he saw farmers working in nearby fields it was harvest time combines worse and up clouds of dust as they gathered the soybeans and corn Margie again drifted through his mind slender tall graceful or long blond hair bouncing slightly as she walked not a cheap Hollywood beauty pretty in a useful rather than decorative way and he remembered ploughing with the old doesn’t rusty John Deere turning his head from the icy wind to watch the thick black dirt role in two straight lines behind him planting seeds a few weeks later then harvested in the fall keeping the corn picker straight as it ripped off ears and mowed down stalks with choking clouds of white dust the closely following wagons filling with golden harvest Margie had been there behind him on the tractor her breasts pressing holding him tightly the car wanted across the yellow line you have to concentrate but he no longer was bound to the sharp seasonal changes and working the land the Midwest seemed another country another assignment he was returning the group the girl he had really loved the only one who had really cared for him maybe he should have taken the advice of teachers like timid mr Howard a high school teacher the little bastard would peek over his bifocals and say don’t get in over your heads stay here this is a good honest place you’ll be a lot happier than venturing out into the unknown get married to a good person and stay here he pulled into the gravel school parking lot and saw the party

through the gymnasium windows he was an observer with facial scars and gunshot hearing who didn’t couldn’t belong to the cheerful classmates gather that serving tables heaped with food their voices blurred and distant smiling and hugging class beauties grouped together and laughter the women athletes still looking muscular and quick the scholars sharing their new thoughts most of the men hands around each other supporting shoulders talking and guffawing loudly wearing boot jeans and work shirts looking almost alike Fats Domino glared from the ceiling where the mayor globe slowly rotated along rippling orange and blue streamers flashing ceiling strokes resembled enemy rifle firings Oh Cortez barbecued Pig reminded him of incinerated soldiers along scorched jungle trails he started to sweat I found my thrill on Blueberry Hill on Blueberry Hill when I found you the moon stood still it lingered until but all those bowels we made were never to be most of his schoolmates had chosen to remain in town are nearby they of course had remained friends or at least had seen each other through the years and we’re not outsiders where was margin he’s in seer with others gathered at tables or standing in small groups an old buddy shuffled over and put his arms around Carl’s chest giving him a bear hug was a charlie chess or Chuck my god Carl you look great for what happened nobody heard anything for months after you were hurt he stepped back glancing at Carl’s damaged face fumbling for words you can be very proud of what you did for your country for us your old girlfriends working late at the family farm so deal here before long I guess the Carl stood erect his relic this relic from the past body’s still hard and firm scarred face and head a few others recognize him one of the beauties Sharon gave him a perfume hug pressing unsteadily against him in her gauzy red dress breaths ball xenon earring brushing his face she murmured into his ear goddamn Carl I heard about your injuries I was so worried but you look great you’re a hero let’s get away from this party go somewhere quiet alone the bright flashing lights loud music the loud unguarded talking Carl was disoriented and confused his header is an entire body ached sweating he leaned against a wall in a dim corner and they’ve got the exit into the soft light of the dusty harvest sunset the kitchen lights were on when Carl drove into the farmyard it was almost dark but he could see the old John Deer Park near the barn it’s Canada front wheels now restrained by unser clean weeds no longer used he thought obsolete the old hip roof barn was still there but quiet and Doc and dark perhaps it too had been abandoned most of the barb wire was gone he heard no animals south of the faded red barn several tall concrete silos stood next to buildings that might be used to protect the large harvest machines and the newer tractors he walked across the gravel farmer and along the straight side walk to the house front door the evening was still quite warm only the screen door was closed she was working at the round oak table where they had shared evening meals putting food and coffee into large metal boxes to take to the fields where the large machines were still rolling slowly through the darkness gathering the crops before the first snows he knocked on the door and called her name softly tentatively his head throb with each heartbeat she looked up but couldn’t see who was there just a minute she answered put in several boxes done and then walking to the door switching on the lights then throwing open the screen door my god oh my god Carl Carl she saw scars across his face and head his alert thinness the way he favored his right leg he smelled the old perfume faintly and noticed a few gray hairs new wrinkles around her eyes she was a little thinner now too well I’m certainly no damn prize he thought Vietnam did me no favors watchful he was looking beyond or guarded and careful they embraced and kissed hesitantly it wasn’t the same as before he wrote in

the pickup with her out to the fields where the gigantic harvesters lumbered along trailing clouds of dust thrashing and roaring until suddenly shut down when the driver saw them approaching Carl stayed in the darkened truck leaned in his aching head against the cab the family was still together the machines were new but the pattern of working together a loving dependent on each other was the same as when he first drove that old John Deere in Vietnam he and his platoon have learned understanding saw there was silent gestures in a few whispers careful to avoid clumsy movements are noises living in the safety of quiet shadows they also had been a team he thought dependent on each other for our lives he belonged to something then later Carl and Margie drove out of the fields and onto the blacktop leading to town his old house was gone the gas station was now a quick trip a dim bowling alley in place of Doug’s tavern the school’s gymnasium was still brightly lit and noisy with celebrating classmates but they didn’t stop he held his aching head and looked at Margie as she drove slowly out of town he moved closer to her softly caressing her neck with his left hand we had something special he said I never stopped loving you even during the most dangerous times I could see you smell your perfume almost touch you she looked at Carl his head marked with healed injuries is thinking scared her his new fears the the flat robotic talking she had loved him but now he was almost a stranger searching not yet at peace still wounded she knew it was too late too much it happened Margie’s left hand and wiped away her tears he slit his arm away from her shoulder and serves silently at the dim road ahead thank well thank you very much to Kevin and the Stanford Blood Center for hosting Pegasus physician writers and to haunt Steiner for his amazing leadership of this ever growing group of writer physicians i’m going to read three poems and i’d be happy to answer questions during our Q&A afterwards incompatibility dr. blood for your patient was just returned from another operating room the words mean this my patient received blood incompatible with his own time expands as before a storm leaves flutter helplessly expose their veined undersides I see the bag drained of color still attached to the blood set sine wave saw their way across the screen time contracts into jagged heraldic lightning blood pressure you’re a name on bag urine wound pressure yet the pulse oximeter beats steadily like freight cars passing now now now now the words mean this poison I think at any moment the end of the train will appear around the bend I tell surgeons bent to the dissection nurses eyes above masks the winds begin to gather trees talk a whipping language any moment now blood cells will lice I steady myself in the thickening dark feel Huff’s of air from the passing train fluids mannitol send labs check crusher empty the urine tube again and wait for the moment I lose him in the storm the anesthesiologist sees pink moon rise in a pink in a curved pink sky a perfect fingernail for my oximeter a screen of pink pink pink obliterates the shoehorn edge of epiglottis fiber optic frustration carbon dioxide pooches the umbilical hernia a cupola between worlds above a pink peritoneal dome spectra of effluvia ascites the color of birchwood urine blued by indigo carmine flecks of gold and malachite bile but one color demands intensive care the thin pink froth of pulmonary edema flooding the

accordion circuit inside all of us life blushes pink and moist our passage to black and white hardens dry gangrene bleached bone yet even as winter chills there just beyond my porch November camellias bloom pulsing pink third one is the off-duty and East the chest the woman on the bus twists her arm away as if I coveted her jangly bracelet I smile at her veins plump Rivi let’s slate blue pleasingly straight she worries about gold but I delight in the red flash and slide gently into the stream well a real poet laureate wants you to get up and dance on the page and try your hand at writing poems whatever your hand may be one of the great things about Pegasus is that we have a chance to try our hand at writing poems prose short novels long novels and we get together at least once a month and we chime in on each other’s efforts and so what I liked and so every everything we write is essentially something in evolution something that’s ripening in this poem that I’d like to read is about four or five drafts before the current one that I’ve written so what I’d like to do to ask for your patience and read this poem that you have here and then read the current draft that was done this afternoon this of the same poem and see what you feel might be worthwhile for the next draft okay so this is called the river of life whoever said bread is the stuff of life had only a dim notion of a river of blood flowing through us all only when the boundaries of skin and bone are broken will that primordial river flow outward pulling into Eddie’s on the floor in the bed through the pants and dresses of our daily lives only then will that metaphorical staff come into play a crooked branch to Ford a rushing river we have seen legions of children scream with fright at sight of needles have tended warriors on battlefields or men and women in the surgeries as blood flows outward from their wounds or from the necessary incisions from whence cometh the coagulative energy within our arteries and veins the gravity’s of stars turned into cells that staunch the bleeding or set the body on alarm how different now the lines for blood mobiles the precision ways for typing cells and other factors the intricate economy of blood banking for all the tributaries of our human blood and finally what Marvel that parade of athletes those red-faced reticulocytes summoned from the marrow of our bones so young these sons and daughters of our heritage and future so ready to make their mark within the laughing river inside us all so quickly wisin before returning to that cosmic see around us all so the when I read this a month or so ago at one of the Pegasus there was it was like I had read a comic opera and so this is the revision of it and you’ll see it has some bearing from the original it’s called the river of life I rode the Merced River in a raft till it capsized almost lost my life with others in that churning whitewater the river simply carried on unfazed from granite peaks to endless seas of the three great circulations in our lives history fate

and time itself our very life depends upon another circulation that ancient invisible river of blood pulsing through the Heartland in each of us only when the boundaries of skin and bone are broken will this primordial river flow outward pulling into Eddie’s on the floor in the bed through pants and skirts of daily lives we have heard the cries of children when blood is taken from them with a needle have tended warriors on battlefields or men and women in the surgeries as blood flows outward from their wounds or from the necessary incisions who would have known from birth to birth the unseen channels of our river beds or name the names for gravity of stars turned into cells that carry energy staunch bleeding transport the freight of minerals and microbes within us who could not marvel at that parade of young athletes all those red-faced reticulocytes summoned from the marrow in our bones to renew our life inside each outer life we live and share so precious in particular thank you well my colleagues have introduced themselves with some honesty and I must tell you that I was a chemistry major and I didn’t read poetry in college but I had this incredible experience of being drafted to Vietnam and about 35 years later I started having more and more outbursts and would see a picture that would just make me weep and my wife advised me that I needed to start writing and giving taking care of my old man old thoughts and so this book is called blood of the common sky a young surgeon in Vietnam I was drafted in my second year of surgical residency University of Pennsylvania I went to a very primitive hospital tent hospital the first house and Vietnam this story is about a case that came to our hospital and some months later it was much more up to date in fact we had the first place anywhere that frozen blood had been used in in the field title of this chapter is saving lance corporal cinnamon on the day in early April 1966 that Lance Corporal parent gentleman came to the Naval Hospital in Danang I was assisting Jerry Moss on a repair of a multi organ abdominal case this was the last patient to be treated out of a squad of 12 men have been shelled the evening before just before they had had been preparing their foxholes it had been on a mission in a river plane ten miles northwest of ninang known as elephant valley valley was a heartbreaking regular source of our casualties the 40 ours had run all night and the names and the cases became another long list we were finishing the attachment of the colon to stoma to the skin of this last patient when mas was urgently called to triage he found in corporal gentleman in a state of shock from massive blood loss he stepped on a land mine which had amputated his left leg at the thigh injury was so high there was no stump around which to place a tourniquet bleeding was being controlled by a corpsman was putting pressure manually on a spurting vessel deep in the thigh we had to empty the who had an empty o are fortunately an awaiting anesthesiologist who could take the case i finished the building closure of the case we were doing and then entered the adjacent room where

gentleman was being prepared for surgery he had two large IVs running and that had brought his blood pressure up to 90 a low but safe level I took over for the course corpsman who had been compressing the bleeding vessel as the mangled stump was prepared loss had to work close to my hand tie off the artery repair the artery was not needed because there was no lower leg to save so we simply suture to suture to close to stop the bleeding we were faced with multiple bleeding sites in the enormous wound I went back and forth ultra alternating packing the wound with gauze to allow anesthesia to catch up on blood replacement and then suturing the various bleeding points after an hour his situation changed and we recognized that we were dealing with bleeding from new sites in his hip that had not been bleeding formally there was also recurrent bleeding from the places we had previously controlled his blood had lost the ability to clot he had at that point received 20 units of blood over twice twice his normal blood volume available blood on hand was bank blood and frozen blood neither containing the missing factors essentials for plotting our only solution was to call for fresh blood from donors on base but that process would take more than an hour would take 10 years before a process was developed for making available the necessary clotting factors IE platelets and fresh frozen plasma known as FFP for just this situation at the same cinnamons core body temperature was dropping a sign of his worsening state due to the extent of his wound and the loss of blood we made the hard choice of ligating the femoral artery higher in the groin which had the risk of possibly d vitalizing some of the stump tissue by doing so we stopped the ongoing bleeding but added the risk of poor wound healing due to the lack of circulation next we place a dressing on the short fat stump with a hope that pressure would staunch the many using vessels and also help the heat loss blood warmers and bed warmers were not available in Vietnam so we use blankets that have been warmed in the autoclave would take time for fresh flows and blood to arrive and warming blankets to work I stayed in the ICU several nights oversee the massive fluid replacement he needed his body was behaving like that of a burn patient with a large area of skin loss and leaking serous fluid from the open wounds his loss of serous fluid along with the massive bleeding fortunately did not lead to irreversible multi-organ failure yet his condition was so unstable and we need to recalibrate his fluid replacement every two hours gentleman was too sick to be aware that he was close to death but on the third night between morphine shots and blood transfusion he asked me in a lucid interval well I die doc I knew I had to give him a thoughtful answer not just a quick reassurance that he would be fine he knew better than that the situation was precarious and the outcome unknown I knew that interval interval between morphine injections was not the time for heart-to-heart talk so I told gentleman the limited truth that he had proved amazingly resilient and we had no intention of letting up or giving up without insurance she went back to sleep we took him back to the or each morning for dressing change under anesthesia and to stitch any remaining bleeding points on the fourth night after the bleeding had been controlled his blood pressure dropped and he had a spike in his temperature his heart rate was also

quickened the following morning his white blood count was higher and his blood pressure remained low in spite of receiving more fluids when mas arrived in the morning we had reviewed and we reviewed the situation we both both knew that gentleman had an infected wound despite his receiving antibiotics and we need another surgery this would be a risky amputation to the hip joint Moss went to talk to captain Adams our most experienced surgeon and asked me to schedule the surgery he do not say so but I assumed from the unusual nature of the wound it of the wound itself that he had never done such a case I reviewed the anatomy of the head joint and pelvis so that I could be more helpful we were methodical so folk and focused so completely upon this man’s survival that it actually became an away synonymous with our own personal survival each intramuscular vessel was sutured with fine vascular stitches while the anesthesia staff rotated warm blankets on his torso to ward off hypothermia following his surgery gentleman’s infection cleared and we were able to have evacuate him to Clark Air Base Hospital 10 days after his admission he was the first our first patient to receive more than 100 units of blood a new record in Danang except for an occasional direct encounter at Clark when one of us transported unstable patient there we rarely learned anything of our patients fate but this case was an exception cinnamon went to more surgery and rehabilitation at Great Lakes Naval Hospital in Chicago of course we wondered what had happened to him ultimately and were to find out in a very special way the dacian amin returned to his home in south dakota the photo was taken of him by ray muse a photographer for Sioux Falls daily newspaper The Argus Leader in that picture picture shin Amanda standing on one leg clutching his wife in an embrace his crutch having fallen to the ground the picture was syndicated and published in Sunday newspapers in August 1966 and received national attention when we receive copies of the photo and the mail from home everyone in our little Hospital unit glowed with pride for having save this marine hersham and lived a full life on one leg as a correctional officer and a volunteer at Veterans Center in Sioux Falls he died in Sioux Falls at age 70 2005 having survived his wife Shirley the photographer reimu news won many awards including a nomination for the Pulitzer Prize for his photograph cinnamons returned home the photo came to symbolize for the country the whole experience of Vietnam but for us it symbolized the unwritten story of the Battlefield medicine that it allowed him and so many others to return to productive and happy civilian life one of the fine corpsman on duty those nights checked me down in an email search 30 years later to revel and are having save gentleman in 2001 when Jerry moss and I met for the first time since the war we both recalled this case the hurried thoughtful and complicated decisions that we had made in 1965 or as clear and our memories then as they had been when we made them 36 years earlier you you okay we’ll move on to the Q&A part of our presentation this evening so we’ll

pass around this microphone and ask your questions will run this tool approximately 8 30 and our writers have graciously agreed to answer any questions that you may have one on one after eight-thirty okay thank you well first thank you for sharing everybody on that I thought it was great I didn’t want ask a question about just the group in general do you guys has anyone ever ventured into writing like for theatre for performance is that in a format you guys have gone into and I know your psychiatrist so it’s like drama therapy is that something that interests you and is that something that would interest a group and I didn’t want to say well I thought they were all great i wanted to just shout out 12 dr. Meffert the that your line was it that she was beautiful and a useful where rather than a decorative one I thought that was great line so I just wanted to say that before I forgotten so that’s that’s my question so theatre drama therapy um I can respond to the theater question we do have at least one writer who has written for theatre and that’s Jim lock wrote a piece that was produced in San Francisco and taunts do know of others where’s the language on them no I think it’s a very good point and actually I was going to ask ward in your description of the whole event in India of the Assam aftermath you essentially give us one of the criteria for PTSD in other words the decisions you made and in that situation I sort of etched in your mind and do you want to say a little more what writing about these things does for you because I think this is one of the functions writing has in all of our lives as we’re all going through these may be difficult situations to sit down and sort of encapsulate it in either fictional and non-fictional for more poetry helps you well I had this box of letters i wrote my girlfriend every day proposed to her over over shortwave radio wrote my dad who was a World War two army army doctor once a week and these letters were just laughlin that I couldn’t couldn’t open them for about 45 years but I think the answer is yes it’s been very helpful for my mental health to do that and write it it’s been I’ve cried many times just what I said we’re just going to ask you dr. blood that the story is stayed with you and etched in your memory but the fact that you were able to write about it it was much later and and so it had kind of its own traumatic effect than you but at what point was it that you felt like you could actually put the words in writing

well Rick mammal acha sitting right here in the second row and he was in my original poetry writing group at Stanford almost 20 years ago and so that’s when I really realized i could write poetry and condense it enough but i didn’t totally fall apart and but it began that began the process and i saw value in it from the very beginning so hunts had mentioned at the beginning that there’s an umbrella program called medicine the muse it’s based at the bioethics enter and one of the things that we do are other kinds of events as well as education for medical students and undergraduates outreach music all kinds of things but what has been brought to mind is one of our events that we are planning for April that will be held on the Stanford Campus it’s free and open to the public it’s called honoring the ghosts it’s being organized by Jackie Genovese we have through a grant from the Stanford Arts Institute invited Roman Baca and the exit 12 dance troupe from New York City Roman bacha is a marine veteran and he directs that troop much of their dance is based about war trauma and recovery there will be a poetry reading just before that by Alex nimroth who’s a professor of art in art history and I encourage people to come to that they’ll be also a discussion afterwards again about this incredibly important topic of PTSD Audrey it’s a question for you in your poetry though yeah sometimes you write about the traumatic events but when I’m more struck with whenever I read your poetry is how you sort of digests the daily ins and outs of your job of your profession and cast it into portrait they let that woman in the subway that’s a perfect example of that so what’s the function of that sort of poetry do you think thanks Hans I think for me with that poem I was exploring the idea that one is never separated from one’s role as a physician it becomes part of you the training becomes within you and I think it’s different for different specialists probably but as an anesthesiologist I’m always looking at Airways and vain gains I’m sorry and I was trying to have some fun with that and how that gets misinterpreted but basically I think it’s important for professionals to recognize that identity with their work and career there immersion in that and how that might be affecting the rest of their life and the lives of people around them so it is difficult to turn it off it’s sort of with you all the time Randy what’s that like for a psychiatrist I was actually thinking about an experience I had today I I was with a good friend and colleague who is drifting into his Alzheimer’s disease and we were having lunch together and then going to see the Anderson collection at Stanford and walking around and as we talked it became very clear that one of the most painful and agonizing things about his kind of evaporation is the loss of his identity as a physician in that this has been

such an intimate and intricate part of who he is as a person and it’s it’s not just like retirement but it’s it’s an actual loss and some part of him is just continuously grieving now and so that the what you were saying about the how in our writing and in our living we those of us who’ve been fortunate enough to practice medicine and continue to it’s just so much a part of who we are and and when that begins to disappear we disappear in a way so the other thing is everyday experiences our dreams our imagination they all somehow get transformed and and I think there’s a poet named hirschfeld who says that all of us are writing poems every day but that somehow we don’t always recognize them or remember them in a sense and so each of us have to be sensitive to the poems that are friends and colleagues and family members are writing just in their natural ways of living so thank you all for sharing tonight I’m a pgy 6 psychiatry trainee and just been thinking a lot about the exposure involved in writing and I think in psychiatry in particular by suspect in other fields of medicine there’s sort of a value in the anonymity of the clinician like sort of feel like there’s a hesitation for my story to be in the room before the patient’s story so I’m curious about your writing and what it’s like to kind of put yourselves out there for public consumption for your colleagues to know more about your personal stories for potential your patients to know more about your personal stories and weather there’s hesitation involved in that just pondering bill efforts story and how I didn’t this love didn’t really come back together and and and certainly in my case thinking how unfortunate was those daily letters that while two people separated to be in sync all that time and share something so deeply just striking because it really gets at the the issue of boundaries and the risk that we take to be to be transparent and to allow ourselves to be intimate with others and yet still maintain the integrity of that relationship and I think as you grow in your experience you just honor that that balance between the adventure of being intimate and yet the the holding on to the frame as we would call it and that’s so important I agree that’s wonderful question I think for me in terms of writing getting something outside of myself and then sharing with others there are multiple steps there and overall i believe it’s helped me with my interactions with patients for example i feel that i am far more willing to share an anecdote about my family when we’re talking and particularly in the post-operative period when just checking on a patient to see how they’re doing and I’ve come to believe that that sends a message a very important message the patient that I understand it’s a human human encounter that is what medicine is and that my willingness to be a bit

vulnerable to share a bit is a way of saying I care about you well I I practiced for years in Iowa and Iowa as the distinction i think is this distinction of having more people over 80 than ever any other state of the union and them and i was called upon to operating on a lot of these elderly people for major procedures like cardiac cases and i never met them before but that would be like seven in the evening and I be making evening rounds and going in to see patients for tomorrow and it helped me to assume that I was part of the family like I was their son and to sit there with the family and the patient not for very long I didn’t have right long but to sit down maybe on the edge of the bed to look at them and it’s on what the risk were and to be part of the family I thought that was it helped me a lot it helped relieve anxiety and I think it helped the patient so also many times and maybe this is true another siege to but I was so impressed by after the explanations the estimate of risks that sort of thing the patient would say well do the best you can dock and I never met the patient before five minutes before and that’s the way it is and you know if medicine is a great profession and I would certainly do it again without question despite all the unsettling changes right now there’s nothing else no other profession I know of that forms such a solid trust between the patient and the doctor any relationship that is anywhere near that and as far as PTSD goes I whatever you call it my art I have a youngest daughter who’s a psychiatrist she says I have PTSD but I’m a surgeon I don’t think I do have PTSD but anyway anyway I I think we were shipped home too fast i mean i was i almost got killed the last two days in vietnam and the next day i was in san francisco and i stood behind people waiting to get on a United Airlines plane and the service wasn’t too good then and it isn’t so good now but they were talking about well they wanted red meat or fish for dinner on the plane and they were upset because they weren’t getting their first preference and I I just come from danang and if I didn’t make that plain I wouldn’t get home and time to see my wife what was still quite close to and so and the first day I was home i guess this first week we had a little earthquake I was at Fort Ord when I went flying off the bed trying to get under the bed and looking for my flak vest the trouble was a mattress was on the floor we didn’t have a bed frame yet and I just think that they could have done a better job with conditioning you before you were suddenly sent home and yeah i think it was easier for people who had been trained in a profession already because we could defuse a lot of our anxieties by just getting to work and developing new entrance but what do you do when you’re 18 years old and you’re missing a leg and you don’t have any specialty you know it’s a whole different situation but for me it was a fascinating experience and it was it’s been difficult to overcome but writing has helped me also the other thing I I thought that the children and the grandchildren would never want to sit while I told him what happened so I thought well I’ll start writing and put it down and writing and then I found I got addicted to writing and now I could really can’t stop I really am I writing addiction some sort it’s a very good question the person that has most struggled with this particular aspect is of not with us tonight he’s part of the group as part of our group actually that’s earth yellow he’s written several stories and when he read his story loves the executioner where he’s new book that’s coming out februari 15 creatures of a day we’re going to have grain rounds on it in march on march fit he’s very transparent with his reactions to the interaction with a patient and then of course you need is sort of trying to

figure out is it helpful is it not what I think here and how the one thing that it amazes me about his writing on I asked him all the time I say how many lawsuits have you had against you because you know all it takes is one lawyer to sit there and be sort of carefully go through these essentially transcripts of treatments and he always says not one which is very encouraging so if you’re contemplating doing what he’s doing I think you’re safe I also concur with what a handset said I write poetry too I find as a psychiatrist I think I find it the format of that is very freeing in other words in terms of not having identifying any particular patient because we share this more more like a universal or communal kind of unconscious issues that if it comes out it doesn’t really pertain to any particular patient that would create any kind of issues around boundary or confidentiality so I think the poetry format it allows even more freedom than prose that’s my opinion thank you very much and a couple thoughts one is I do remember going through hard experiences and sitting down and writing poetry and it was really transformative and I felt very happy to have the poem and then I seem to be able to move on so what you’re saying re i do remember doing that and then the poem that there were there two poems and you were wondering about the what are you know reactions would be and i just want to say i liked the second poem with the boat image because it felt very metaphorical but also kind of i could imagine the boat floating down the stream and lately i’ve been a little bit trying to think about what is actually going on inside of my body with the blood I’m not a physician with the blood and organs and weight and food and nutrition and all of that to think that maybe it make better decisions so I appreciated being able to be part of the the flow of circulation so I want to know if anyone the group I mean you obviously rights what you know but you also use this group or this exercise as a form of escape I mean do you write something that is nothing to do with your profession just as a way to come you know find yourself outside of your your your life you know that your your day-to-day life there and do you share that in the group or is it usually just focused on things are related to to your profession I think I think of myself as a poet and and I write a lot about birds and beautiful places oh sure oh yeah thank you very much for more please visit us at stanford.edu

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