Love Poems

That is what poetry can do. It speaks to us of what does not exist, which is not only better than what exists, but even more like the truth. — Zinaida, from Ivan Turgenev’s First Love 

While studying for Step 1, medicine was a huge, fantastical world, full of puzzling presentations, key symptoms, surprising lab tests, and brilliant diagnoses. Only the brightest brain could get the diagnosis, and save the life.

Now that I’m halfway through my 3rd year rotations, I’ve found that “real medicine” is a far cry from medicine as it’s depicted in Step 1. And it’s much less glamorous. In sharp contrast with the paroxysmal nocturnal hemoglobinurias, hereditary spherocytoses, and hereditary hemorrhagic telangiectasias of Step 1, my daily practice now confronts the stark reality of common disease, chronic disease, and the uncertainty that comes with treating real illness.

A Portrait of Mental Illness in a Young Man

“I . . . committed sins of impurity, father,” confesses Stephen Dedalus, the character whose tumultuous coming of age is chronicled in James Joyce’s beautiful A Portrait of the Artist as a Young Man, during a moment of particular anguish.

Stephen confronts intense dread when he, after having visited brothels, learns from his religious leaders the torments awaiting sinners like him in hell. Stephen’s first thoughts are of overwhelming regret: “Could it be that he, Stephen Dedalus, had done those things? … Yes, he had done them, secretly, filthily, time after time, and, hardened in sinful impenitence, he had dared to wear the mask of holiness before the tabernacle itself while his soul within was a living mass of corruption.” [1, p. 137] Stephen’s agonies take on aspects of vivid delusion: “And the glimmering souls passed away, sustained and failing, merged in a moving breath. One soul was lost; a tiny soul: his. It flickered once and went out, forgotten, lost. The end: black cold void waste.” [1, p. 141] Stephen even experiences hallucinations, which soon give way to physical symptoms: “He sprang from the bed, the reeking odour pouring down his throat, clogging and revolting his entrails… He stumbled towards the window, groaning and almost fainting with sickness. At the washstand a convulsion seized him within; and, clasping his cold forehead wildly, he vomited profusely in agony.” [1, p. 138]

Stephen’s eventual confession ushers in a period of religious bliss, which, nonetheless, soon begins to develop characteristics of a neurotic obsession. “Gradually… he saw the whole world forming one vast symmetrical expression of God’s power and love. Life became a divine gift for every moment and sensation…” [1, p. 149] the narrator declares. Stephen begins dividing his day into periods of prayer, constantly saying rosaries and devoting each day of the weak to repentance for one of the respective seven deadly sins. Stephen also undertakes the repression of his senses, “striving also by constant mortification to undo the sinful past rather than to achieve a saintliness fraught with peril. Each of his senses was brought under a rigorous discipline.” [1, p. 150] Stephens penance soon acquires an obsessive character, as “[h]is confession became a channel for the escape of scrupulous and unrepented imperfections.” [1, p. 152] Stephen finally becomes miserable and isolated. “To merge his life in the common tide of other lives was harder for him than any fasting or prayer… His soul traversed a period of desolation in which the sacraments themselves seemed to have turned into dried up sources.” [1, p. 152]

Stephen later, happily, develops into a mature and profound man. These difficult periods constitute pivotal milestones in his growth. That’s why it could strike us as unsettling to entertain the prospect of attributing these thoughts to Stephen’s suffering of mental illnesses.