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JCO's Cancer Stories: The Art of Oncology podcast series consists of author interviews and professional readings of the section’s content. This platform provides authors with the opportunity to comment on their work, offers better accessibility for readers, and stimulates more conversations. Art of Oncology publishes personal essays, reflections, and opinions in the Journal of Clinical Oncology, giving our readers a chance to reflect on important aspects of practice and help shape our professional discourse. We hope you enjoy listening to these thought-provoking stories.

The series also includes interviews with pioneers of the field of oncology. These conversations bring fascinating insights into the scientific basis for the evolution of cancer care as well as the courage, vision, and ability to overcome logistical barriers to make the advances that we now take for granted. By understanding how we got to the present, we can work toward a better future.

Cancer Stories is hosted by Dr. Lidia Schapira and Dr. Daniel Hayes.

Disclaimer:

The purpose of each podcast is to educate and to inform. The podcast is provided on the understanding that it does not constitute medical or other professional advice or services. It is no substitute for professional care by a doctor or other qualified medical professional and is not intended for use in the diagnosis or treatment of individual conditions. Guests who speak in a podcast express their own opinions, experience, and conclusions. Neither American Society of Clinical Oncology nor any of its affiliates endorses, supports, or opposes any particular treatment option or other matter discussed in a podcast. The mention of any product, service, organization, activity, or therapy on a podcast should not be construed as an ASCO endorsement.

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MUSIC: "Chase Your Dreams" by Nicolai Heidlas

Jun 25, 2020

In the poem, Housekeeping, by David Harris, a patient struggles with what it means to be saved. Read by Seema Yasmin.

 

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

 

Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org.

 

Housekeeping by David Harris. I've been clearing out my closets so that my husband won't have to afterward. She wiped her eyes on her hospital gown. I imagined her at home, pulling out hangers and holding up clothes to her wasted body, choosing what to save and what to throw away.

 

And by save, I mean leave behind for her husband afterward. Me imagining her imagining him, pulling out hangers, loosely dangling clothes, a Christmas sweater, the jeans he liked, a scarf, a blouse. Him wondering what he is supposed to do with a pink blouse.

 

Should he throw it away or bury it in some unsorted pile, half forgotten, or save it, leaving it hanging in the closet of their bedroom? I am talking to her about CPR now. About what we can save and what we can't. And by save, I mean prolong.

 

And she turns to me and asks what she is supposed to do with the word terminal. Afterward, after latex gloves are peeled off hands, after the bag is found and zipped around her quiet body, after all the things I said or didn't say, this is what we save. Her hospital gown, unbuttoned, washed clean, folded onto itself, with thousands of other gowns.

 

With me today is Dr. David Harris, a palliative care physician at Cleveland Clinic. Dave, welcome to our podcast.

 

Thank you, Lidia. I'm grateful to be here.

 

It's great to have you. You're the author of a poem that we recently published called Housekeeping. Before we start to talk about your poem, tell me a little bit about what you enjoy reading and perhaps what's on your nightstand right now.

 

Sure. I've been reading some nonfiction work on behavioral economics by Predictably Irrational or Thinking Fast and Slow by Daniel Kahneman. But I should also probably talk about poetry that I like reading, since the poem in JCO was published.

 

Two of my favorite poets, and if you read my poem and you want to find more like it, would be Mary Oliver and Marie Howe. And if you're looking for a place to start with those poets, you could look for What The Living Do by Marie Howe or The Fourth Sign of the Zodiac by Mary Oliver.

 

So training does one need to have to read and appreciate poetry?

 

Oh, that's a great question. I think when I was in high school, I kind of got scared away from poetry because it felt like something that I really didn't understand and that you had to have a lot of training to read and appreciate. But I don't think it necessarily has to be that way.

 

I find poetry really nice because it's short, and if you find authors that keep their poetry accessible, you can just read it and spend a moment appreciating it, and go on with your day. So I'd say you don't really need a lot of training other than just being a human being and bringing to the poem the experiences that you've had in your life.

 

I love that. And with that, let's talk a little bit about the poem that you wrote and that I've had an opportunity to read and love it, and that is Housekeeping. There's a line here that drew me right in, and that is the line, a very simple line, me imagining her imagining him.

 

It seemed to me that that's almost the perfect definition of empathy. Is that what you had in mind? The ability to connect and just imagine what it's like to be somebody else, to see the world through the mindset of another person?

 

Yeah. Thank you, Lidia. That's exactly what I was going for. I mean, I think that this poem is mostly in the speaker's imagination. The inspiration for the poetry was the quote at the beginning of the poem, which was told to me by a patient. I'd been cleaning out my closets so that my husband won't have to afterward.

 

And I think we've all had patients tell us something, and after we leave the room, we just pause and say, like, wow, I can't believe that that conversation just happened. And, you know, what a strange, and meaningful, and powerful thing that patient said to me. So that was the inspiration for the poem. And then for the rest of the poem, I was just sort of imagining different scenes or different thoughts that were inspired by that line.

 

So in the poem, you talked about having the difficult conversation with a patient, and you state this in the present tense. I am talking to her about CPR now. And then you bring us also to the world of the very practical task of having this conversation and imagining a time when the patient is no longer present, her death.

 

And then you have this parallel process where you describe all the tasks, the very practical housekeeping tasks, of what happens after death. The sorting of possessions and the dispatching of the body. Tell us a little bit more about how you thought about putting these two things together, and so compactly and beautifully.

 

Oh, thank you, Lidia. Yeah. I think as I was writing the poem, I began to think more and more about those material pieces of our lives, that they're of special significance when we're thinking about end of life. And that came from the patient who was going through her closets and holding out clothes and thinking, you know, am I going to wear this before I die or can I throw this away, and thinking about how much clothing means to people.

 

And then I thought about the hospital gowns and how much of a contrast that is, how impersonal that is compared to what people wear in their day to day lives. That sort of focus on these material possessions and these tasks that can be kind of mundane at times came out as I was writing the poem.

 

And there is this parallel, also, about what we do as physicians when we are looking after patients who are so ill. There are some very practical things, but then there are conversations that have to do with the ultimate abstraction, which is imagining not being here.

 

I think the title grounds us in the same way that some of these tasks, perhaps, ground us in our day to day world. I also thought that it was very interesting that you used the word afterwards twice, including leading with it in the last stanza. And I imagine that, perhaps, as you were thinking of a title, another title could have been Afterward.

 

Yeah.

 

So does that capture some of your process?

 

Yeah. Afterwards was a rough draft title. You guessed it. Because I think that so much of the poem is about thinking of the future or we're thinking about what's going to happen next.

 

I think I chose Housekeeping instead because one of the things that I really am interested in in art and in talking with patients is the importance of daily lives, or the importance of these kind of mundane tasks that we all go through.

 

And how, for people who have cancer and are struggling to maintain quality of life, sometimes doing the laundry or cooking suddenly becomes really meaningful and important to them, or maybe even housekeeping becomes meaningful and important to them. So that title felt like there were more layers to it, which is why I chose it.

 

You know, as I was reading this, and I read that you were imagining your patient imagining her husband's grief and her husband's reaction to her passing, I was imagining what you, as the clinician in this situation, were imagining and feeling. It was very impactful to me.

 

And there's something about how simple the lines are and the language is that really drew me in. Tell me a little bit more about your feeling and what this kind of an encounter with a patient does to you as palliative care physician.

 

Thank you for asking me that, Lidia. You know, this meant a lot to me. And after I left the room after having this conversation with the patient, I was struck by how profound that moment was and how meaningful having those conversations with patients is for me.

 

And part of the purpose of writing this poem and publishing it is to share that experience. I think most of us in oncology and palliative care go into the field because we look for moments like this and we appreciate moments like this. But also, day to day life can kind of make us blind to these things with all the paperwork we have to do and all of the red tape.

 

And when I talk to physicians who are feeling burned out, I notice that they don't really bring up moments like this anymore, and I feel like they're not noticing them the way they used to. So noticing moments like this and appreciating them helps me from being burned out, and I'm hoping that people will read this poem and sort of be able to be resensitized to those moments in their practice.

 

That's a lovely thought. I also would add that one of the themes that we find in the submissions we receive to Art of Oncology is this very sincere desire to honor a patient. And I read that also in your line.

 

Yeah. I mean, this patient has passed away, but they've made such an impact on me, and it feels like I need to do something to remember them. That's part of what made me write this piece as well.

 

Well, thank you for sharing all of that with us. And I hope our readers go back and read your beautiful poem, Housekeeping, over and over. Let me finish by just asking you a little about the process of writing. You-- are you a repetitive writer? Do you have time set aside to write, or do you write when you're inspired or when it calls you?

 

That's a great question. And I feel like people who have previously been on your podcast have said something similar. But for me, I have these moments, and it feels like there's something in me that has to come out. It feels like I already know there's a poem there, and I just have to start writing it.

 

So usually, that's how things begin. If I'm not feeling burned out and I'm in a place where I can notice those feelings, and then I start writing. And then once I've begun writing, I notice different ideas that I want to develop in the piece.

 

These are things that you picked up on, sort of this interest in the mundane, daily tasks of life, or another thing that I wanted to develop in this piece was the idea of saving, and what does it mean to save something. And then, you know, I just kind of keep writing and trying to figure that stuff out until it feels like the poem is done.

 

Well, thank you so much, Dave. I loved Housekeeping, and I hope you keep writing. So this ends our podcast. Please join me again for more of about cancer stories.

 

Until next time, thank you for listening to this JCO's Cancer Stories, The Art of Oncology Podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology Podcast is just one of ASCO's many podcasts. You can find all of the shows at podcast.asco.org.