Click here to download and read Glenn’s poem “Doctor to patient (on ornithology and the practice of medicine)”
For most of my career medicine has not been so friendly. I have struggled with doubt. I have always felt that at any point I might do the wrong thing. For a long time this meant that consultations were noisy with my own thoughts. Life was lived in two parts. In one I would go to work and be unsure and struggle with the waiting room and paper trails and fires popping up. In the other I would imagine. I would dream that I could fly. I would soar up over the world like a young seagull and look down and be amazed. Moments would open up like a ranch slider. Inside I found they were timeless. Poetry was good and medicine was bad. I joked that poetry was the first girl I ever loved, the one I always wanted but never felt confident enough to ask out, and that medicine was the girl I got pregnant behind the bike shed and thought I had to make an honest woman of.
A few years ago I began to compile a book based on the stories of a group of patients I saw over the course of one day in general practice. For a year I visited as many of them as I could and asked them about their lives leading up to that consultation. I saw them in their homes and among those things they cared about, then afterwards flew up into the sky like a seagull with an old piece of string and looked down. When I came to write about them I saw them with wet eyes — the sort of love that poetry demands of those who write it.
I noticed that in consultations after that my head would calm sometimes and I would see my patients’ faces slow down while they were talking. I was reminded of that day outside the lecture theatre at Auckland University. Now wrinkles began to shimmy on the faces of my patients. Parrots or bellbirds or fantails would appear on their shoulders and dead people shuffle shyly out from behind them. Some would hide beneath their skirts or behind their trousers and others would trail warily after. Some would haunt and others would protect.
I came to understand that the anatomy I had learnt about at medical school was limited. Ache and memory gave human beings other anatomies that were entirely specific, and with increasing confidence I began to palpate these like the quadrants of the abdomen. After a while I realised I had ghosts of my own and that they were present in my consultations as well. I kept stumbling on them red-handed.
Card games would spring up in the corner of the office. My wrecked old dad, my estranged wife, my bright and shining daughter would take the spooks they met on the other side of the room by the hand and do the real medicine while my patient and I were left to talk about more important less important things. Often they would look at me and shake their heads as though I was their ghost, a distraction or apparition from some less real world.
These ghosts are with me still. Their medicine is usually either play, i.e., card games, Ludo, mini-golf or indoor bowls, or conversations over food, i.e., biscuits, tea, potato chips or jet aeroplanes. Even now one or more of them will follow a patient out the door to offer them a cup of tea or slice of cake or game of pool. I am too stubborn and fallen to call this prayer, but perhaps it is. I call it ghost talk. Poetry showed me that a person is the tip of a fabulous iceberg. The shape we see is the line the pen has drawn onto the map but it is determined only by the state of the tide at any given time. Beyond this everyone has a layer of continental shelf.
But I am a GP who has spent his life working with Māori and young people, so I suppose this sort of medicine has become important to me. I don’t often find myself wrist deep in an abdomen or busy correcting acid-base equilibriums. Sometimes we need to be mechanics. People are wheezing or bleeding or in pain. Stuff is dripping out of them that shouldn’t be. Our physiology and our randomised controlled trials hold there like Newton’s laws of physics. But on the magic edge of medicine other wonders play out. Medicine blurs into the spirit and here medicine is as old as the hills. It is black magic and weirdness. It is a type of quantum medicine where illness, happiness and longing tangle and weave, blinking in and out and in and out of existence.
There are times for me in the consultation when the intimacy of two human beings talking rivals the intimacy of the creative moment. In fact, I have come to understand the consultation is a creative moment. It seems after so many years of chasing my childhood sweetheart I have found her hiding in the eyes of that girl behind the bike shed. I have expected for years that medicine should leak into my poetry but never dreamed that poetry might leak into my medicine in such a way. On my best days there is no separation at all between both disciplines. I feel as though I have discovered a late love and, like all of those who have, it is all the more sweet for taking so long to wander by.
A non-randomised uncontrolled trial
It has taken a long time for me to rebel in medicine. It is full of high priests and orthodoxy and impetus to act in the way it does because of impetus to act in the way it does. And there is so much to learn that you might always be distracted learning it and rarely step back and question. My doubt has been busy with self-doubt. And I have always had writing to run to anyway when it gets too much. But for a long time I have grown frustrated by the ten-to-fifteen-minute model of medicine in primary care. It has always seemed to me designed by designers, and without imagination. And I have been slowly frustrated by a medicine that usually expects patients to come to it and rarely reaches out to see people where they are.
I have also been inspired by others — the quiet and gentle rebellion of old teachers like Professor Sir John Scott, who retained their humanity in all the busyness, and the new anger of colleagues in primary care such as Lance O’Sullivan.
Most recently I have come to believe that the stories my young people tell me demand some response from my profession. They are at times a plea to the world of big people to bring some explanation or justice or relief, however naive that might be. Not to respond is a defeat in the natural order of things.
In 2012 I took some time out from medicine. I resigned from the clinic I had worked at for many years because they wanted me to see more patients. My sessions usually ran over time anyway, and I felt too old and stubborn to change. I wrote for much of the year and let medicine tick. By the end of that year the distance had made me want to practise medicine the way I wanted to. I knew I could rely on being employed for two days a week by the local youth health service, but I also knew that, no matter how understanding my funders, this would come with expectations about time and location, and so I took a job for another two days a week as a youth worker in the same area.
From that time on I have been employed by two different organisations under two different contracts with wildly differing pay scales, but in reality I do one job. I see young people. We have clinics in the community and in two of the three high schools where the best of the old model can be retained, but I am also free to leave the clinic each week to follow up young people who need more time to talk or a ride to the hospital or who need to know that they are worth a big person checking on how they are doing.
I get to help out on a local alternative education programme for students who have been excluded from mainstream schools, and I run a creative writing group for those who share a similar wound. I can see young people individually or in groups. I can see them for two minutes, ten minutes, thirty minutes or an hour. I can bake with them, eat burgers with them and watch movies. I can knock on their doors and explain again what they are bound to have forgotten the first time round. I am poorer but richer. Some joy has returned to medicine for me.
I think about patients outside of work now and wonder how to reach them as though I am stuck on a line in the middle of a poem. Medicine has entered my imagination. My room has filled up with toys and models and props that explain the abstract to more concrete minds. My subconscious is figuring out what to do next in cases where I am stuck. This has only ever happened in poetry, answers to problems appearing days later when I thought I had given up on them. I have stockpiled a shelf full of books to give away to young people who might find something they can identify with in a particular story. To be able to hand someone a book instead of a script for fluoxetine or methylphenidate or something to help them sleep and say “this is a story you might like” seems a great freedom.
Many of the young people I work with have my cellphone number. For years I guarded it as though it was some sacred barrier that could not be crossed. I am discovering that it is much more convenient for my patients to have it. No one has abused it. Texted consultations have evolved in which patients are more direct in what they want to say than they are when they are face to face. In the context of being able to see them face to face later, it is a useful adjunct.
I’m not sure if any of this will make a lot of difference to youth health in the Horowhenua. In fact I know that most of it won’t. It will improve some access to primary care for some people, but so many of the young people I see needed to be seen ten years earlier than they were, and their families needed services that engaged with them in caring, constructive and enduring ways.
But it is, I suppose, a personal response to the limits we have allowed to build up around primary care — my own small non-randomised uncontrolled trial. Strengths in young people can sometimes be seen only by being with them outside a clinic. This is important because so often the path to establishing the confidence and engagement of a young person is through growing their strengths rather than concentrating on what is wrong with them. When we do not see people in their contexts, we do not see the medicine they possess that can help them get better.
Copyright © 2016 Glenn Colquhoun. This is an extract from Glenn Colquhoun’s book Late Love: Sometimes Doctors Need Saving as Much as Their Patients, published by Bridget Williams Books.
About the Author
“I have fought a running battle with medicine for much of my career. I have wanted to leave it for poetry. This is the story of how that has come to change for me. And how both those worlds have at last arrived at some sort of reconciliation.”
As a youth worker, doctor and award-winning poet and children’s writer, Glenn Colquhoun has led a ‘life lived in two parts’. Writing and reading has always transported him to a world ‘flickered’ by colour, warmth and connection. Meanwhile his work as a GP in the Horowhenua has confronted him daily with scenes of doubt, dislocation and disadvantage. Late Love is a meeting of these worlds, a moving attempt to show what it is, as a doctor and writer, to be alongside people.