A while back I read ‘Histories’ by Sam Gugliani – It’s a very good read relating the stories of various individuals, clinical and non clinical, who work in a hospital, and gives their differing perspectives of what takes place there. To give you a flavour, here are a couple of quotes that stood out for me and got me thinking.

“Hospital words spun like stones across the still waters of people’s lives.”

“We’re all victims, aren’t we, of medicine’s success.”, and

“Their voices change key when they speak to him, lengthening to a sing-song, as if his dying might be rendered in nursery rhymes.”

And then there was, “We had the experience but missed the meaning”. Those more literate than I will know without resorting to an internet search that it is a line from the third of T.S. Eliot’s ‘Four Quartets’ entitled ‘The Dry Salvages”. It has been on my mind since discovering this remarkable, if perhaps bleak, poem.

Drawing on a 2010 blog by Ben Myers which helped me understand the poem, Eliot seems to be saying that ‘as one becomes older’ our pasts reveal, if we will see it, a pattern in which moments of ‘sudden illumination’, those times when we are happy, are the temporary exception to the norm. They are like a ‘ragged rock in the restless waters’ which serve only to reveal that the true nature of our existence is one in which permanency is characterised by abiding ‘moments of agony’ – such is ‘the primitive terror’.

‘And the ragged rock in the restless waters,

Waves wash over it, fogs conceal it;

On a halcyon day it is merely a monument,

In navigable weather it is always a seamark

To lay a course by: but in the somber season

Or the sudden fury, is what it always was’

Eliot describes Time as both our ‘destroyer’ and our ‘preserver’. The only thing that keeps us alive is the very thing that brings about our demise. Eliot is urging us to see this deeper truth that our moments of happiness display. We have these experiences, he says, but are want to miss their meaning.

So what do I take from this as a doctor? Like moments of happiness, health is but temporary. In due course normality will be restored and we will all succumb to the ravages of time. It will ultimately destroy us. I don’t mean that we should resign ourselves to a life of melancholic anticipation of death, but we should, I think, appreciate health for what it is – a state of being that we should value whilst we have it. Furthermore, as doctors, we should be realistic in terms of what we can expect to achieve for our patients. We are, after all, only doctors. We should make every effort to tend the sick and whenever possible endeavour to effect a cure, but just as important perhaps is how we encourage our patients to value their health as the fragile state it truly is and we would do well to consider also how we might prepare them for the inevitability of death. Colluding with patients that with the right combination of pills and sufficient attention to lifestyle death will be avoided is dishonest and, perhaps, detrimental to all our chances of enjoying the life we have.

To end on a more positive note, it should be remembered that ‘The Dry Salvages’ is but the third of Eliot’s ‘The Four Quartets’. The fourth, ‘Little Gidding‘ offers us some hope of redemption. Ironically perhaps, the reader is asked to reflect on their experience of what they have read earlier and understand that they may indeed have missed the meaning. There is redemption but it is a redemption not from, but through death.

“What we call the beginning is often the end

And to make an end is to make a beginning.

The end is where we start from…

We shall not cease from exploration

And the end of all our exploring

Will be to arrive where we started

And know the place for the first time.”

Similarly then, might we, and our patients, know happiness, not by the avoidance of all sadness, all difficulty, but rather through experiencing hardship and sorrow in all its dreadful intensity? Too often I make the mistake of thinking that I can only be happy when I’m not sad, and so, when unhappiness steals its inevitable way into my life, I am left feeling that I can no longer know what it is to be happy. Foolishly, before allowing myself to smile again, I insist on striving to put an end to everything that reduces me to tears, on endeavouring to put everything right. But I simply cannot do it. Whilst I hope for that time when all will be well, waiting until then before being happy only succeeds in leaving me a long time sad. But, seemingly contradictory, happiness and sadness are not mutually exclusive. In some sense we cannot know what happiness really is without knowing the pain of sorrow – and sorrow requires the memory of the temporary nature of happiness.

To be truly happy then we cannot deny sadness – on the contrary we must embrace it. And we must learn that it is possible to know what it is to be ‘sorrowful yet always rejoicing’. It is not that we can not be happy because we know sadness, nor that we can not be sad because there are things to be happy about. Paradoxically, we can be happy and sad at the same time.

As Leonard Cohen sang, shortly before his death, ‘There is a lullaby for suffering and a paradox to blame’.

We may have to be patient but even on the darkest nights there is the hope that there will be other better, brighter days. Days made all the more enjoyable for having known the sadness that preceded them.

Understand this and we, and our patients, may experience life – without missing its meaning.

To read an extended, more theologically minded, version of this blog, one which considers whether Eliot’s view of life is consistent with the Christian faith he professed, click here

Other related blogs:

To read ‘The Life I Lead’, click here

To read ‘General Practice – a sweet sorrow’, click here

To read ‘Eleanor Rigby is not at all fine’, click here

To read ‘The Medical Condition or Hannah Arendt is Completely Fine’, click here.

To read ‘I’ll miss this when I’m gone’, click here

To read ‘Dark Reflections’, click here

And finally, to read some thoughts on a couple of other other poems, click either on ‘The Windhover’ by Gerald Manley Hopkins, or ‘Be Drunk’ by Charles Baudelaire.

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