I have been reading the "Sonnets of Desolation," as one does when rotating in the ICU. “Desolation” might seem indelicate: cases of recovery and resolution do happen relatively often in our unit. But what stayed with me were the closely monitored tragedies, tuned to the beeps and alarms of bedside devices in glass-doored rooms. No silence here, no place for quiet in the deep hours of the night as I place orders, check vitals, answer calls, and confront the limits of medicine under unforgiving fluorescence. After my first 24-hour shift, I slept for nearly a full day. Then I picked up Hopkins.
In the late 19th century, Gerard Manley Hopkins wrote the half-dozen sonnets that scholars often group together for their fervid wrestle with life, faith, and the temptation to despair. One feels, in these intricately constructed poems, a mind alive and trembling, awake to every shade of anguish and desperate for relief, yet unable to look away from its wounds. During my time in the ICU, Hopkins’ turns of phrase have provided me with a particular kind of succor, holding my hand in the hours when I return home weary with the physical and emotional turmoil of the days and, worse, the nights.
"What hours, O what black hours we have spent
This night! what sights you, heart, saw; ways you went!
And more must, in yet longer light’s delay.
With witness I speak this."
The ICU is a crucible of the extremes of existence, a borderland of life and death where every moment feels freighted with the potential for the pendulum to swing in the opposite direction. That heaviness is reflected in the meter that Hopkins deploys: he developed “sprung rhythm” to rely more on stresses than syllables to distinguish metrical feet. Each line of “Carrion Comfort” has approximately seven stresses, producing two more feet than the pentameter of a conventional sonnet. The added weight of these two stresses creates the impression of being stretched past one’s limits, amplified by alliteration and the enjambment that makes each verse spill into the next:
"But ah, but O thou terrible, why wouldst thou rude on me
Thy wring-world right foot rock? lay a lionlimb against me? scan
With darksome devouring eyes my bruisèd bones? and fan,
O in turns of tempest, me heaped there; me frantic to avoid thee and flee?"
The poem is a frenzied disavowal of despair, rife with questions, outbursts, and entreaties that forbid an easy resolution. And yet its contorted defiance speaks to my sensibility of effortful resistance to the overwhelming feeling I experience whenever I return to the floor, and — in particular — to the doors darkened by poor prognoses past which families separately suffer. I understand my professional responsibility to stay level-headed and bring to each encounter a capacity for hope, at least for comfort. But Hopkins’ poem remains a necessary reminder that the darkness is never truly done — grief spills over from one line to the next — and perhaps the best we can do is make space for it.
"O the mind, mind has mountains; cliffs of fall
Frightful, sheer, no-man-fathomed. Hold them cheap
May who ne’er hung there. Nor does long our small
Durance deal with that steep or deep."
In Hopkins’ conceit of the topography of mind, vertiginous peaks at “no-man-fathomed” altitudes are the domain of those who have felt unimaginable distress; people who have not “hung” from such heights cannot know these “cliffs of fall.” Similarly, no matter how invested we feel in their care, we cannot fully glimpse the panorama of what our patients and their families endure; still, we can strive not to “hold cheap” or dismiss the importance of recognizing the spectrum of their struggle and allowing them, at every stage, a voice. And, whether debriefing with my team or on these pages, I too must allow myself a voice to express the things I carry; denied such outlets, “This to hoard unheard, / Heard unheeded, leaves me a lonely began.”
"My own heart let me more have pity on; let
Me live to my sad self hereafter kind,
Charitable; not live this tormented mind
With this tormented mind tormenting yet."
For many in medicine, the most difficult skill to develop is being kind to ourselves. I feel squeamish, even expressing my ongoing wrestle with self-doubt, especially when I am in environments like the ICU that unsettles me. Our perfectionist tendencies can swiftly castigate our weakness, while the extreme rigors of training force us to countenance the reality that we may not have the reserve to do and be our very best in every moment. This disjunction has exasperated me for much of my residency, but "Sonnets of Desolation" renews my resolve to extend to myself the compassion that tends to come more easily for my patients — though, in truth, I expect my “tormented mind” is not quite done with its “tormenting yet.” Therefore, the struggle continues, and reading Hopkins may spur us to remain incongruously and insistently alive to it.
What pieces of art and/or literature had an impact on your practice of medicine? Share your favorites below!
Anoushka Sinha is a resident physician in pediatrics at Columbia, where she completed medical school and the masters program in narrative medicine. She is passionate about integrating the arts and humanities into medical education and practice. @anoushkaasinha
Image by Jorm S / Shutterstock