Hippocrates Prize for Poetry and Medicine: Call For Applications

The “Hippocrates Prize for Poetry and Medicine”, is now accepting applications for the 2011 entry and invites both national and international submissions.
Established in 2009, the competition represents the growing body of poetry that is being included in a variety of prestigious medical journals. An article published in the Lancet this year discusses the relevance of poetry for the physician and as a medium for recording our reflections on Medicine.
The role of medicine through societies and histories has always been integral to respective meanings of life and human experience. Contemporary medicine, however, is of an unprecedented nature. Technological advancements coupled with the development of different languages about the human body, such as molecular biology or neuroscience, have embraced the metaphysical aspects of the beginning and ending of our individual human existences more closely than ever before. The boundaries and definitions of the beginning and ending of life are fluctuating alongside our insights about the nature of the human body.
Thus, a poetic soundboard for such philosophising of medicine is very relevant and as many of us would argue, necessary, for the growth of a sophisticated medical practice.
The link for the poetry competition is :
http://www.hippocrates-poetry.org/
The article, “Poetry, Medicine, and the Hippocrates Prize” by Donald RJ Singer and Michael Hulse” :
The Lancet, Volume 375, Issue 9719, Pages 976 – 977, 20 March 2010; can be found at :
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60427-8/fulltext

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In Sickness and In Health : The Sharing of Pain in Namibia

Between a doctor and a patient, there is a very special and unique relationship contained in an exclusive realm. The connection is formed from the presenting of an illness and the sick are drawn to the healing. The healer in turn aspires to release the sick from their symptoms and pain. Our wonder of medicine sometimes overlooks the elements that symbolize the very nature of our human condition of this shared relationship – recognition, empathy, compassion of the Other. One example of the act of healing from Namibia however reveals the true essence of the human to human connection and the role of medicine in how we experience our world.
In the desert, distances away from the familiarities of the West, two women sit opposite each other on the bare earth. One of the women, an elder, is experiencing acute pain. She can locate the pain to her heart but the pain is all encompassing. It conducts through the whole of her body and smashes through one cell to another, carrying destruction to reach all of her being. The energy from the pain, its heat and the awareness of the body’s aliveness, transpires into a particular state. In this state, the woman focuses on expelling the pain that she believes is a curse.
The pain’s momentum is experienced as the speed of a spirit that has possessed her body. The body and the spirit are two separate entities that on this occasion have become entangled in her life force. The woman is not powerful enough to kill the curse. She can only direct it towards the woman, a healer, sitting opposite her.
The pain, or curse, is propelled from the body and it is invited to be absorbed into the body of the healer. The healer becomes possessed by the curse, and the elder woman is born back into life. The healer labors through the curse. The curse has entered her body but her powers of healing prevent it from identifying with her physicality. In a heightened trance the curse is combated. Slowly the healer begins to relax and the curse is dissipated.
As the cultural relativists would describe, a culture is a natural entity of which individuals are part of. The medicinal world that the woman elder and the healer belong to are as real and ingrained in experience as our hospital setting is in our experience. Yet, the narratives of each show a common illumination of our human discrepancy. Through embarking in a relationship of kindness – perhaps adopting the words of Hippocrates of “doing no harm” – medicine is the ultimate tenderness of care other than when a mother gives life to her child.
Whilst we in the West prescribe a third party into our medical relationships, namely that of chemical (pills)  or physicist (radiotherapy/ imaging) or biological (transplants) to embody the pain that illness curses, we still embark on a journey to remain with life.
The presence of pain, ironically, enables one to develop the skills to reach and help another person.
And , pain can strike in the deserts, on islands in the wide oceans, within the majesty of mountains or in the hospitals that are sterile and armed with technological apparatus to battle any invasion of suffering.
So, I believe that the lesson to carry in our minds, and let fly in our perspective is that of remembering that no matter how deep our knowledge may travel in the researcher’s laboratory, or the doctor’s clinical room, the essence of medicine is in the joining of one person’s experience to another.
How that experience is conveyed – whether through ritual or narrative or diagnostic charting – is only ever a symptom of what belies the curse of illness – namely, the gift of the relationship between the sick and the healing.

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The Genie in the Syringe

Throughout the Christmas season, pantomime performances are one of the UK’s most favoured traditions. The pantomime has a long history with a genesis in Ancient Greek times. In our modern era, pantomimes are often adapted to feature contemporary twists and understandings about the unique and special meanings which have structured certain folk tales with a strength to survive the centuries.
In parallel, modern medicine has its roots in Ancient Greece and has seen many transitions and contemporary adaptations in the knowledge we possess about the human body.
Separated by worlds of fantasy and of reality, I have been struck by how the fables of pantomimes and the facts of medicine collide much closely than one would initially imagine.
“Aladdin” and “Ali Baba and the Forty Thieves” are some of the most famous tales taken from the “Book of One Thousand and One Arabian Nights”. Both of these are underpinned by the magic of transformation. The human body is suddenly enabled to perform the impossible and change the fate of our earthly physical determinants. Magic is also used in reverse to cast illnesses.
In Arabic folklore, the powers of changing fate and the body are called “djinn”, or the infamous “genie” in “Aladdin”. These are narratives reflecting some of the basic teachings in Islamic philosophy about our human condition. Djinns or genies, humans and angels are the three sentient creations of Allah. Like humans, djinns can be good or evil. In medicine, health is good and disease is the invasion of evil djinns.
The divide between creation and destruction, fate and transformation and good and evil is a common theme structuring the opposing worlds of fantasy and reality, pantomime and medicine. Modern medicine, however, does make me wonder. If medicine was not real, what would it be?
Another famous pantomime story is “Sleeping Beauty”, originating from the 16^th century. During this story, a princess is felled to sleep for hundreds of years and then awakened with the touch of another human being. Is this so different to modern medical metaphors? It is a practice in intensive care units to induce a coma and then to return consciousness to a patient.
Medicine is writing its own pantomime with fantasy of restoring life to a person through transforming the sick to the healthy.
There are many interventions akin to Aladdin’s lamp, hence the title of this blog “The Genie in the Syringe”. We insert substances, produce images from radio and sonar waves, manipulate the causal relationship between molecular processes to produce a transformation and create our own audiences in the operating theatre to the inner secrets of the body’s anatomy.
Medicine is a central character in our personal narration, sometimes featuring as a tragedy and at other times, as a miracle. As the meanings of folktales have changed over the centuries and changed from representing an integral part of life to forming entertainment, I wonder how the meaning of medicine will be perceived in future years. Medicine is already showing us performances between the doctor and patient that would have been beyond the imagination of the writers of “Aladdin” or “Sleeping Beauty” in the same way as their relevance exists in a different domain to the place from where it was written.
Thus, as the fantasy and reality of medicine grows in an evermore interweaved nature, it will be increasingly important to ground the roots of medicine’s own narrative in the stories that have stemmed from our curiosity and wonder about our own existence; how much we can change and how much is subject to an inevitable fate is the rule guiding the possible versus the impossible in medicine’s fight between good and evil, health and disease.

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Oncologist Sam Guglani wonders what medical care really means

Care infuses medicine. Well, the word ‘care’ infuses the language of medicine – Healthcare, Intensive Care, Palliative Care, Standard care, Standard of care, Best supportive care, Care Quality Commission. But what actually is medical care?Good medical care perhaps primarily describes the quality delivery of evidence-based therapeutic interventions, for example drugs, operations, scans, anaesthetics, and the organisation of services to permit these. It must also necessarily refer to the judgments around such interventions, that is to say the ethical consideration towards appropriate medicine. A skilfully performed pneumonectomy may not reflect good medical care in a patient dying from advanced lung cancer, for example. It seems reasonable then, to suggest that good medical care demands quality clinical medicine and ethical judgment. That the former requires rational thought may not come as a surprise, but the latter? In fact, contemporary ethics and moral philosophy place reason and rational thought at the core of what it is to make moral judgments and act ethically.
However, schools of ethical thought don’t always agree on what it is that constitutes the basis for moral action in medicine. For example, lying to patients may be considered to be bad because lying is bad in principle, or good if the lying perpetuates good outcomes such as hope, or bad again if the consequences, despite the good outcome of hope, generalise towards the negative, such as an erosion of trust.  Further to disagreeing on the basis for moral arbitration, the centrality of ‘reason’ may be questioned. ‘Care ethics’ gives weight, beyond rational thought, to the place of sympathy, emotional understanding and relationships in informing ethical judgments (Beauchamp and Childress 2001, p. 369)
Jonah Lehrer, in his book ‘The Decisive Moment’, describes the place of emotional understanding in morality:  ‘At its core, moral decision-making is about sympathy. We abhor violence because we know violence hurts. We treat others fairly because we know what it feels like to be treated unfairly. We reject suffering because we can imagine what it’s like to suffer.’ (Lehrer 2009, p 174) He goes on to elaborate on the evidence for emotion having a central role in ethical judgment and paints a very interesting picture in aligning often very rational thinking with clear acts of immorality. Even so, what about this, the idea of sympathetic and compassionate care in medicine?
Well, firstly, it seems as though, unlike the parameters of clinical/ technical care in medicine, compassionate care is harder to measure. Technical care is relatively easily measured and to a certain extent such data form the basis of the new outcomes framework for the NHS.  Healthcare staff in general and doctors in particular recognise this and to a certain extent aspire towards it. For patients and relatives, these data may be more opaque, unless significantly removed from the mean. As such, responsibility for judging, monitoring and delivering technically good care may be readily handed over to the profession.
Compassionate and empathetic care is harder to measure and in many respects therefore it just isn’t. Where currently is the section in our appraisal folders entitled compassion?  Doctors seem to value it much less and indeed we almost feel uncomfortable when discussing it.  Patients and families though, recognise this much more readily and indeed are generally very sensitive barometers of it.  Their assessment is probably more reliable, consistent and reproducible than any parametric measure we might use.  We all know (and can recognise ourselves when we become patients) the health worker who cares.
Such care can be a simple and empirical prompt towards good medicine, through sympathetic imagination: how would we want our family or indeed ourselves to be managed in such a situation? Of course this isn’t enough and is potentially open to abuse. But so is a version of medicine informed simply by good technical skills or good ethical judgment.
Compassionate and sympathetic care is arguably a primary prompt and governing steer for the entirety of good medical care. And it is the platform for engaging patients at times of often profound vulnerability. It might motivate finding the bed, asserting the need, chasing the results, over-booking the clinic, calling the family, developing the service, asking for opinions, clarifying all the evidence, seeking consensus, admitting the uncertainty and withdrawing the treatment. It is antithetical to hubris and necessarily connected to a proper medical professionalism, one founded upon a duty to patients rather than the rights of a privileged set.
How do we teach and foster this care? By recognising its importance – now more than ever in a resource -constrained, exponentially more technical NHS with increasing demand and possibility. By selecting students, training doctors and consultant appointments with this in mind. And, perhaps most challenging, but also most pressing, by decanting it through professional example.

References
Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, Oxford, Oxford University Press
Lehrer, J. (2009) The Decisive Moment, Edinburgh, Canongate

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2011 International Symposium on Poetry and Medicine

May. It will be held at the Medical Teaching Centre, Building 37, University of Warwick Gibbet Hall Campus.
The symposium looks set to be a wonderful day, with fantastic speakers and will conclude by announcing the winning poems for the International Hippocrates Prize for Poetry and Medicine Award. Please see the attached website link for further details.
http://www2.warwick.ac.uk/fac/med/research/csri/research/cpt/poetry/symp

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