Poetry about Aging: Marilyn McEntyre and Guy Micco

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, we’re going to be talking about poems today, right?

Alex: We are talking poetry, which I’m delighted about. I’ve been after Eric to do this podcast for years.

Eric: I’ve kept on saying no, no. No, no.

Alex: And he has held the line. He’s finally relented. So we are delighted today to welcome Marilyn McEntyre, who’s a longtime teacher of literature and medical humanities. She is written a number of books, including one that’s probably most relevant to today. I think it’s titled Patient Poets Illness. Is that right, Marilyn?

Marilyn: Patient Poets: Illness From Inside Out.

Alex: Patient Poets: Illness From Inside Out. She also teaches people who are interested in writing their own books. And she’s a poet herself. She’s authored an essay, I think, titled Why Read a Poem at a Time Like This? And we’ll try to include links to that in our show notes, available with this podcast. Marilyn, welcome to the GeriPal podcast.

Marilyn: Thank you. What a pleasure to be here.

Alex: We also have Guy Micco or Micco, depending on whether you’re in Italy or in America.

Alex: We also have Guy Micco or Micco, depending on whether you’re in Italy or in America. Who is a long time teacher in the joint medical program, now Emeritus. Joint medical program is between UC Berkeley and UCSF. I was a medical student there some 25 years ago or so. And I learned at the feet of Guy, classes, such as death, aging, suffering, poetry. Those were great days and he is no longer growing old. He had a birthday this week. He’s also a part-time hospice and palliative care clinician. And he’s at a long time interest in medical humanities. He’s one of my favorite teachers. Welcome back to the GeriPal podcast, Guy.

Guy: Thank you. Thank you, Alex. And Eric. Good to be here.

Eric: And Guy, since you have been a longstanding mentor for Alex and teacher, I think you are going to supersede Alex here and actually do a song for us. What song are you going to play?

Guy: So this is a song called, Hello in There by John Prine. It was released on his first album in 1971. I think he was about 25 at that time. But I’ve been told that he wrote this as a teenager, which is pretty incredible. (singing)

Eric: That’s great Guy.

Alex: That was absolutely wonderful Guy.

Eric: Thank you Guy.

Guy: Yeah, I really… I love that song.

Alex: I love it too.

Eric: Why do you love it so much?

Guy: Well, first off, John Prine loved it too. He played it, I think every time he had a concert. And he just died a couple years ago of COVID, sadly at 73 or something. He’s my age. Why? First off, I’m amazed that a young man could put himself into the place of an old man in such a poignant way. It’s you can just see his story unfolding in a way that makes you realize John Prine knew something about aging. He used to deliver papers, I read, in a nursing facility. And he would talk with people there as he delivered the paper on the paper route. And they’d sometimes think he was their son or a relative and they’d have conversations. So he got some exposure, but he’s just an amazing songwriter to be able to do something like that.

Guy: And I personally like it because, well, it reminds me of a time when I was a young physician, like you two, and could have used this song in my mind when I went into nursing homes to care for people. And I saw them lined up in their wheelchairs along the corridors and too many nursing homes are still like this. Many are changing, but people would be lined up sitting on often strapped into their wheelchair, head bowed, not talking just a terrible scene, knowing around. And I’m reminded of Bill Thomas’ Eden Alternative, Three Plagues of Nursing Homes: boredom, helplessness, and loneliness. Nursing homes, places where people are over medicated and undertreated for these three plagues. All of which are treatable.

Eric: Likely have gotten a lot worse in the last two years, especially with COVID restrictions.

Alex: We could unpack that song for the next hour, but we do need to move on to topic of today.

Eric: Poetry and Aging.

Alex: Yeah. Poetry and aging. Eric, you want to ask the first question here?

Eric: Yeah. And my question is, I’m going to go to Marilyn first. Have you always been interested in poetry? Since a kid? Tell me how you got interested and/or when?

Marilyn: Well, I lived in a three generation family and my grandmother was an English teacher, and my mother was a teacher and everybody read. And so poetry was just part of the family discourse. People would come up with lines from things. And I loved that. It felt as though there was this big trove of words that we could pull up when we needed them, like having a big bowl of candy in the middle of the table. So I learned to love it very early.

Eric: How about in particular around this theme of aging in poetry?

Marilyn: I think, I’m trying to think about when I first connected them. But years ago when I started to be interested in medical humanities, medicine was always a road not taken for me. When I was younger, I really felt as though one of the things I might want to do is be a doctor. And for various reasons I didn’t do that. And so I was really happy when I found a way to come into medicine through the back door. And I do think that writing isn’t always, but it can be a healing art. And that poetry has helped in the process of both psychological and even sometimes physical healing.

Marilyn: I was teaching TS Elliott’s Four Quartets at Mills College one year. And I started a class in poetry by just asking this big group of young women. Why read a poem at a time like this? Which is a question I like to pose myself and others. Then immediately a hand went up in the back. And this woman who was probably around 23, said, “Poetry saved my life.” And she was dead serious about that. And went on to talk about that. But I think have had many real world encounters with people who feel like that. That there’s a particular passage from a poem or a particular image or way of putting something that has given them a way of imagining their way back into health or sanity or peace. So I think it’s pretty powerful.

Eric: How about you Guy?

Guy: I probably came to it because in my youth, because I liked the kind of poetry that’s sort of smarty pants, poetry. Like candy is dandy, but liquor is quicker. That kind of poetry, Ogden Nash, and limericks, and the like. And then there was probably, I don’t know, a few poems that just hit me. Which I think is the particular ability that poetry has that transcends in a way prose. I mean, there are prose pieces that are like poetry.

Guy: There are prose poems where you suddenly have an insight that knocks you over a little bit. Doesn’t have to be a great a lightning strike. But something that makes you go, “Oh. Wow. Yeah, I get it.” I see an opening of the some sort, but you don’t get in daily life, it’s just a punch of sorts. I’m sure there are other words for that Marilyn can describe, but yeah. And then in medicine, it opens up what I imagine could be called the empathic imagination. Like you get to see what it’s like to be someone else in the case of medicine, someone else who’s suffering in a way that transcends the biological. Our bio pathology is the forte of medicine, and I’m reminded of Eric Cassell. Eric Cassell, who I don’t know, you may remember was a… He died recently, was a bioethicist internist, I think at NYU. Alex, you probably know.

Alex: I think it was either Columbia or Cornell, but-

Guy: Yeah, somewhere there.

Alex: Somewhere in New York.

Guy: Maybe Cornell. And he said, one time, “Look, when there’s a problem with your heart, you don’t get to just take it to the heart mechanic and leave it off and go away.” Unfortunately, he said, there’s a person attached to the heart. And as a physician, it’s incumbent upon you to understand that. That’s not just the heart, that’s got a bad rhythm or that’s impacted, there’s a person with all the other bio, but psychosocial, spiritual part of themselves to work with. So poetry can open that up for one. And John Prine’s song is poetry.

Alex: Yeah, sure is.

Guy: That does. That’s exactly what that does.

Alex: We want to get to the poetry here, and we’d love to hear a poem. Before that, I just want to read something that Marilyn you wrote. This is about what poetry does. “Poetry stops us short. It recalls us to contemplation in a world of action, unlike narrative, which moves us through time and plot, poetry makes us pause. Look again, go back and reconsider what we thought we saw or knew the first time.” I love that. That was in an essay that Steve McPhee wrote about his experiences with patients and reading poetry to patients, which maybe we’ll talk more about later. And see, for example, whether Guy you’ve done that. Marilyn or Guy, do you want to start? Please read us a poem.

Guy: Go Marilyn.

Marilyn: Well, I was going to start with Shakespeare’s Son at 73, which most people know. But actually when you asked about why poetry and I was thinking about how certain lines come back to you, a line came back to me. And I thought I would read you just a little part of Robert Frost’s well known poem, After Apple Picking. Because the whole poem is really about picking apples in the fall in New England, but it’s also about many other things. And here are the lines that have come to me when I think about these transitions into the next season of life. He’s talking about the load on load of apples coming in, and these lines are, “For I have had too much of apple picking. I am over tired of the great harvest I myself desired. There were ten thousand thousand fruits to touch, cherish in hand, lift down and not let fall. For all that struck the earth. No matter if not bruised or spiked with stubble went surely to the cider-apple heap, as of no worth. One can see what will trouble this sleep of mine, whatever sleep it is.”

Marilyn: And then the poem goes on from there. But I wanted to mention it, because that line, “I am over tired of the great harvest I myself desired.” So precisely talks about a moment when you think I’m done, I’m done with that season. I’m done with this work. I’m done with this thing that I’ve done with so much energy for so many years, and now I need a new thing. And my favorite line is, “There were ten thousand thousand fruit to touch, cherish in hand, lift down and not let fall.” And I thought about all of the student that have gone through my office hours for decades and trying to cherish each one of them, not let them fall. Foster and mentor them and move them on. But there’s a time when you reclaim something of your life and you leave a lot of that ministering to other people. And so I think that moment of transition is just beautifully captured in that poem.

Marilyn: What I wanted to say about the sonnet, Shakespeare’s Son at 73, it’s short. I can read it or I can just say it-

Eric: Oh, please do.

Marilyn: Okay. I will read it. Sonnets are 14 lines. They’re not that long. Notice as we read it that, it’s the first four lines offer one image of aging. The next four lines offer a different image. The next four lines offer a different image. And then he closes with a couplet. “That time of year thou mayst in me behold, when yellow leaves or none or few, do hang upon those boughs, which shake against the cold, bare ruin’d choirs where late the sweet birds sang. In me thou see’st the twilight of such day as after sunset fadeth in the west, which by and by black night doth take away, death’s second self that seals up all in rest. In me, thou see’st the glowing of such fire, that on the ashes of his youth doth lie as the death-bed, whereon it must expire, consum’d with that, which it was nourish’d by. This thou perceiv’st, which makes thy love more strong, to love that well, which thou must leave ere long.”

Marilyn: And so all it is really is a little reflection on this is what he’s speaking clearly to a younger person. This is to be entering the last season of life. And one line I love in here is, that you may behold, That time of year, in me when yellow leaves or none or few do hang. And it isn’t… The logic is yellow leaves or few or none. Right. But to go or none, or maybe there are few left. There might be some leaves left. We’re not sure. So there’s a little flickering of humor or even pleasure in this poem, that’s very sober about aging. And that makes me think of a lovely essay by the poet Howard Nemerov, on this similarity between poems and jokes. He says that a good poem always has something akin to a punchline where it surprises you into reframing something and seeing it in a new way. But even just what this poem does in trying out three different images of age is an invitation to say, play with this. What is old age like?

Marilyn: Is it like a river that’s dwindling to a stream? Or is it like a tornado that’s coming down the path? Or just trying out images for that can get at different dimensions of the experience. And that’s what I love about this poem. And so many others.

Alex: Thank yeah. Personal reflections as you were reading the Robert Frost poem, I was thinking about, boy, there’s so many patients I’ve seen. Hundreds, thousands like apples from a tree. And you can just think about them as this… Often in medicine these days we’re come to think of our work, for some people as a conveyor belt, just one after another. But then when you think about each one and their individual selves and how some are bruised, some are broken and what we do with them and how we can take the time to cherish each one and for what it is. And I love the image of uncertainty there with the, Some, with yellow leaves, some with none, and the work that we’ve done in thinking about prognosis and how uncertain that is. Even for older adults, though we make great efforts to try and quantify it.

Eric: Guy, we hear it a little bit of potentially what makes a good poem? What makes a good poem for you?

Guy: Well, I think it’s that punch that Marilyn spoke of that maybe I spoke of it too. A little insight that happens in such a short period of time, such a short read often, often a… I just learned in Italian, there are two words you can use for poetry, poesia. And poema is long, like Dante’s divine comedy. It’s a long, long piece, but [foreign language poesia is short, a short, shorter version, like Shakespeare’s sonnet or Hello in There. And on reading it there are two… I don’t know, Marilyn’s so much more adept at this than I am, but on reading poetry for me, occasionally I’ll get it. I’m first reading, it’s just like, wow, there it is. I see. I understand. And maybe it doesn’t, I can’t say it changes my life, but it gives me a little view that maybe will last into another encounter with another person perhaps, or just an understanding myself.

Guy: And sometimes the other kind of poem is one that is at least at first barely scrutable like TS Elliott’s Quartets. I mean you got to study it, I think, and really dig and take some close reading to come to some better understanding. And then there’s some that are just obscure. It’s just obscurantism to the max that I can’t stand it. I think you asked Eric, or maybe Alex, before we started about a poem that we didn’t like, that would be the obscure poetry of say, John, forgive me, Marilyn. – one of the greatest American poets who died recently, John Ashbury.

Guy: I just don’t understand any of his poetry. I don’t get it. And I’m not… I don’t have the patience to dig, I guess, or I would need help. On the other hand, Rooka is sometimes difficult, but I find it worth digging to come to an understanding of what he’s trying to tell us. And, and often it’s really worthwhile, but I don’t get it right away necessarily.

Eric: Well, when we think about kind of the favorite aging theme poems, what came to mind and can you give us an example?

Guy: Oh yes.

Eric: Read it for us.

Guy: Currently. My favorite is a little frivol. I like humor in poetry. It doesn’t have to be there and often it isn’t, but I’m going to read to you. I’ll try to read it relatively quickly and you can make it available to people. It’s called Jane by a fine poet by the name of George Bilgere. Jane. “Jane, the old woman across the street, is lugging big black trash bags to the curb. It’s snowing hard and the bags are turning white, gradually disappearing in the storm. Jane is getting ready to put her house on the market and move into a home of some sort. A facility. She’s just too old to keep the place going anymore, and as we chat about this on the sidewalk, I’m thinking I’m so glad this isn’t going to happen to me.

Guy: It seems like a terrible fate to drag out your trash bags and then head for a facility somewhere. And all the worst to be old in a facility. But then, that’s the whole reason you go there in the first place. But the great thing about being me, I’m thinking, as I continue my morning walk around the block is that I’m not going to a facility of any sort. That’s for the other people. I intend to go on pretty much as always, I have enjoying life taking my morning walk, then coffee, then the newspaper, music and a good book, Europe, vaguely in the summers. Then another year, just like this one and on and on ad infinitum. Why change this? I have no intention of doing so what Jane is doing grow old, taking out her ominous black trash bags to vanish terribly in the snow, getting ready for someone to drive her to the facility. That may be her idea of the future, (which I totally respect), but it certainly isn’t mine.”

Guy: Okay. So this is for us. This is for the people like us who think the people we’re caring for don’t have anything to do with us. It’s like, they’re sick, they’re old, I’m not. I mean, we don’t even consciously think, I’m not. We just act like it and Bilgere’s making it explicit. I really love it. I use this… I hate to say I use poetry, Marilyn, forgive me, utilitarian view here of a poem. But I like to read this in nursing facility with the administrators. Which I’ve done a couple times-

Alex: Oh, what is their reaction?

Guy: … And see how they react. Well, there is silence. Or maybe a nod, like, “Oh, all right.” Yeah. So that’s the first poem that actually came to mind when asked about poetry and aging, even though it isn’t necessarily the best, it’s still is powerful.

Alex: Marilyn. When you think about, I’m going to read another piece from your essay, I think this is from your essay title. What poetry does? This is Steve McPhee incorporated a number of these quotes into his essay, which he read at the memorial service. This is second quote, “Poetry, trains us in a metaphorical habit of mind, so that a world of flat surfaces becomes charged with meaning. At what seems discreet may be perceived, is connected.” And that speaks to me about the ways in which poetry connects you to a key going into a lock. And it just sort of fits in there. And it unlocks something which might have been inaccessible to you. And whether that’s emotions that many of us in the health professions have packed away, whether that’s ability to relate to our patients and their experiences moving beyond, as in Guys’ poem, the othering of the person they are going to a facility, but not me. The way it makes three dimensional surfaces out of two dimensional surfaces. I like that expression.

Alex: So I want to tutor you Marilyn, see if you have any reflections there and then if you have another poem for us.

Marilyn: Well, I think that there’s a difference between what does a poem say and what does it do? And what does it do? Is the much more into interesting question. And beyond that, what I have learned to ask in classes and conversations about poetry is what does this poem invite you to do? Any good poem, even a long one, like the Iliad, is going to invite you to stop. So it seems to me that there’s always an undertow in a good poem. And even as you move forward, what you see will connect with something you just heard. Repetition is one of the basic poetic devices. And each time you see the word or the image, again, it has a kind of… It acquires the density that makes it more interesting. And I think a good poem can invite you to think in phrases rather than sentences, especially contemporary poetry, where a lot of younger students don’t get immediately, why a poet would end the line right in the middle of a sentence. But there’s a tension between a phrase and a sentence.

Marilyn: Sentences do something all by themselves. And there’s a chemistry of words sitting next to each other on the line, where you get an effect before you get a whole statement. And so I think poetry gets us to that level of language that is at its deepest level is a kind of melody. We communicate at the level of musical exchange. We communicate by tonality. And so I think poetry really helps us to be attentive to language in its subtler dimensions. And I love that. And sometimes there’s an exercise I would recommend to anybody, which is take three sentences you’ve written that you like, and just lay them out on the page, like a poem. Cut the lines where you want, make stanza breaks and see what happens. Something will happen to them. It might not be a great poem, but something interesting is going to happen.

Marilyn: And I’m going to give you this really quick example because I tried it with the JMP students a few times, but medical program. I said, write three sentences about an encounter with the patient. The first sentence needs to be, I didn’t know what to say, add a couple of sentences. So they did that. And then I said, “Okay, lay them out like a poem, just make them look like a poem. Do anything you want.” Here’s what was interesting. This is really true. I had them all put their little poems on the board. And one person wrote, “I didn’t know what to say,” as the whole first line of the poem. One person broke the line at, I didn’t know what. And another person broke the line after, I didn’t know. And another person broke the first line after, I didn’t. Each one of those was a very different point of departure for entering into the rest of the thought of the poem.

Marilyn: So I think poems are inherently playful, even poems about… Even laments, even allergies. There’s a playfulness about poetry that seems to me to be at spiritual dimension, which is, I mean, I really think a mark of the spirit. However, you think of that is a kind of playfulness that just says, like improv theater. Yeah. Okay. Let’s play with that. Let’s go there. Let’s imagine it this way. So I can’t remember the rest of your question.

Alex: Oh, do you have another poem for us?

Marilyn: Yeah, I had two more, but I think we don’t have time for both. So I’m going to read you one called, Long Life by Elaine Feinstein, “Late summer. Sunshine. The eucalyptus tree. It is a fortune beyond any deserving to be still here, with no more than everyday worries. Placidly arranging lines of poetry. I consider a stick of cinnamon bound in raffia, finches in the grass and a stubby bush, which this year mothered a lemon. These days I speak less of death than the mysteries of survival. I am no longer lonely, not yet frail. And after surgery recognize each breath as a miracle. My generation may not be nimble, but forgive us. We’d like to hold on stubbornly content even while aging.” One of my favorite phrases in that poem is, stubbornly content. That’s what I plan to be.

Eric: I got a question for you, Marilyn. So doing with JMP students and… How important do you think poetry is for the medical profession?

Marilyn: Well, I think the easiest answer to why read a poem in a place like this, which I talked about that at the medical program one time, is that if you really practice, if you have a practice of poetry, just like if you have a practice of meditation, it can make you more attentive to words. It makes you a better listener. And I believe, and I’ve heard doctors talk about this, that you begin to listen for how people put things. And for the metaphors that a patient will reach for to describe what they are experiencing, and for the patterns of repetition and for the pleasure they take in retelling their story and how they put it together. So all of that, the language dimension of clinical work is, it seems to me very much more fine tuned or refined. It’s more of a precision instrument. Your ear is a better instrument, if you listen for how, and not just what.

Guy: We should have a cadre of poet physicians. In fact, all physicians should be poets. In fact, all politicians should be poets. In fact, who shouldn’t be a poet? I mean, who couldn’t learn from the poets sensibilities?

Alex: Guy, Steve McPhee would read poetry with patients. And that’s what this essay is about that I was exerting Marilyn’s quotes from. Have you ever done that?

Guy: Rarely. I’ve thought about it many times. I’ve thought Steve can do it. Steve had a very special ability in that.

Alex: And we should say Steve McPhee was a professor. Oh, is emeritus professor at UCSF, internal medicine. Wrote a textbook and among many other things helped start the comfort care suites at UCSF, and also read poetry to patients. So Guy go on.

Guy: Well, I think it’s risky. It can be presumptuous to pull out a poem and say… I mean, I’m not saying Steve would do it this way for sure. But I have the… For me, I have the vision of, well, here’s a poem, this is going to do this good. I just haven’t found that the opportunity where it’s really appropriate… I felt appropriate to me, except on a rare occasion, not in the hospital when someone is sick, like, I think Steve has done, but in a clinic situation with in fact, a couple of elder patients of mine who actually brought me the poems. And one was Sonnet 73, and she just loved this poem and wanted to share it. Another was sent to me when I was very sick in the hospital by a patient of mine.

Guy: In any other setting, you might call it a little drippy. Mary Oliver poem. Occasionally Mary Oliver is too Mary Olivery for me. But it’s that, tell me what will you do with this one wild and… One wild, wonderful life of yours on a summer day, I think it’s called the poem. And so in the proper place, a proper time, I think it’s really wonderful to be able to share poetry. But again, it’s really tricky.

Alex: Yeah. I haven’t either. I have played music for patients or with patients, but I have not yet tried a poetry. We are running out time here, we’ve six minutes left. Guy, do you have another poem that you could read to us before we get a little more John Prine?

Guy: This is called, Sam at 60 by Pat Schneider. Do you know this, Marilyn?

Marilyn: Yeah.

Guy: Yeah. I wonder what you’ll think of it. Well, anyway. “He opens the front door with the force of a minor hurricane. The great bulk of him led by his belly, which is held in only metaphorically by wide red suspenders. His face is bushy with beard. He feels like a warm version of the north wind, all blow, hair going white, beard wild with curl. His cap is blue with a protruding bill and white letters proclaiming, friends don’t let friends drive forwards.

Guy: Hello! He yells. But the last syllable lifting into a question, under the red suspenders and orange tomcat grimaces on his T-shirt above the words, give me coffee, nobody gets hurt. He brings what I’ve lost. Ozark, country, humor, sausage and milk gravy biscuits, cornbread, lightning bugs at dusk, a million grasshoppers at noon. He has left his truck’s motor running parked as far onto my lawn as the Oak tree will allow. Had a delivery in North Adams, he says planning a wet mustache kiss on my mouth. Got any coffee? It’s a busy day. I have plans, but I would make a pot of coffee for my brother, if the world were coming to an end, because the world we knew together is coming to an end. And he’s the only one who remembers the day I roller skated too far down the hill, how I fell, how he picked me up and called me by my childhood name. Really sweet, sweet poem.

Eric: I guess Guy out of all the poems that kind of go through, why’d you pick that one to decide-

Guy: I don’t know. It’s the sweetness of it, the humor.

Eric: Yeah.

Guy: I don’t know. It just came to mind as one poem that I have enjoyed in the past. I used this poem in readers theater with students and elders. I don’t know if Alex, you ever took the course.

Alex: I did. Yeah.

Guy: So we’d go to a nursing facility and read with students and elders together and we’d split poetry or prose or whatever into parts for people to read together. And this was one that I thought was particularly effective with students and elders reading up one part each dividing it up in various and certain ways. Yeah.

Alex: Guy, there’s still a little of that kid in you. You said at the beginning who like those zinger poems, like, candy is dandy, liquor is quicker. Friends don’t let friends drive forwards. Bring me coffee. Nobody gets hurt.

Eric: Well, I would also be mindful of the time, because I do want to hear some John Prine, but I agree with Alex. I think my only book of poems is on Shel Silverstein, Running Babbit.

Eric: Well I want to thank both of you. It makes me think, maybe I should branch out from my Shel Silverstein, Running Babbit book, that maybe some of this… I see a thumbs up. But before we end, let’s hear a little bit more John Prine from Guy.

Guy: Okay. (Singing)

Eric: Guy, Marilyn. Very big thank you for joining us for this podcast. That was absolutely lovely. And Guy wonderful rendition.

Guy: Thanks. Thank you.

Marilyn: Thank you.

Eric: And as always, thank you Archstone Foundation for your continued support and to all of our listeners.