Category Archives: poem

A Psychiatrist Waits for His Ten O’clock Patient and Imagines He Is Han Shan


–Richard M. Berlin

Daughter gone,

hair gone, my father

dead for half my life.

Patients I saved from suicide

lived until old age,

died from cancer instead!

Twenty years of hospital work.

Twenty years pruning apple trees

on the west flank of Cold Mountain.

Once they were sticks.

Now the branches bow with ripe fruit.

A faint wind stirs them.

I’ll share a bushel with the crows,

another with the worms!


 (Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Dr. Berlin, a psychiatirst and poet whose poems we've shared in other blog entries, reflects on life's rhythms and transience mimicking the Chinese poet Han Shan. Han Shan referred to himself as Cold Mountain. Dr. Berlin lives on Cold Moutain. Han Shan was a cynic and a hermit who liked to poke fun at the self-importance of the other monks. Enjoy this brief reflection on all we try to do and hope to do as healers/physicians and what it all amounts too.


Early Marriage: West Virginia

–Ann Floreen Niedringhaus

The other nurses called them brambles:
prickly creepers climbing up the rock face.
Stopping the car I gathered
blackberries to make an offering
for you—crystal jelly, all seeds
strained out through a dish towel.
Patients warned me later, “You better
watch for copperheads on those cliffs.”
You came home from hospital duty,
tired and distracted,
spread my ambrosia thickly and said,
I’d rather have Welch’s.

Driving to home visits, I took as a road
a dry creek bed overhung
with branches and vines.
It ended at a sagging porch,
the family processed a pig,
newly slaughtered, on the kitchen table.
Drawing me in near the carcass,
folks spoke their maladies: blind staggers,
drizzlin’ shits, a head gatherin’
that went away with white lightnin’.
And you walked home from your shift
in the emergency room
with your own stories: a man impaled
throw the chest with a telephone pole,
a woman with a neck goiter the size
of a cantaloupe; a child
whose smilin’ mighty Jesus
was spinal meningitis.
We talked in the dark before you fell asleep
feeling like Lewis and Clark.

Perched on the steepest hill in town,
our house was two stories high on the street,
four stories high in the back.
The gleaming Monongahela River
filled the winding valley bottom far below.
Years later my mother told us,
There was a hole in the bathroom wall.
I worried about rats.
We were surprised.
We couldn’t remember a hole.

(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Ann Floreen Niedringhaus, a registered nurse, holds a master’s degree in social work and was a public health nurse in a federal Maternal and Infant Care Program based in Morgantown, W.Va. She is retired, continues to write, and lives in Duluth with her husband.

Nurses, social workers and public health nurses are important members of the health care team in both urban and rural America. Given the focus on health care home, their roles are underlined. I think of home health as the eyes and ears of the clinicians who spend most of their days in the hospital or clinic.  Often a phone call to the public health nurse gives provides me with insights into how I can help a patient manage their health challenges. 

Read another poem by Ann.

Spring Planting

—Richard M. Berlin
                 For Julianna A. Luntz Van Raan, 1950–1998
A morning call wakes me:
something hard and fibrous in her leg
growing fast and uncontrolled
that can’t be weeded out.
Through my bedroom window
I study winter rye in April
swinging on strong stems.
I wish I could plant Julie’s leg
in a warm tangle of earth,
turn her face toward the sun,
and let her nurse on spring rain
like the dandelions waiting
to fill the meadow with stars.

Reprinted from The Country Doctor Revisited (KSU, 2010) with permission.

Dr. Berlin celebrates Spring and reflects on his wishes for his patient who is dying of cancer.  We grow attached to our patients. Their losses can become our losses. Although we need to maintain a certain professional distance so that we can contiue to care for them, we can still feel sad and should make the time and space to feel our own grief.

When you grieved the loss of a patient for whom you cared, did you talk with someone about it? Did you cry? Write a poem or story? Go for a run or a walk? We may be scientists, but we have hearts and we are human.

Spring and All, Revisited

—after William Carlos Williams

–Richard M. Berlin

By the road home from the general hospital
under the surge of the pink
towering clouds drifted from the
southwest—a warm wind. Beyond, the
edge of a mountain pond, redwings
on bulrush calling out their claims,
circle of black water
the veil of thin ice, receding
All along the road, the same reddish
purplish, forked, upstanding twiggy
stuff of bushes you saw years ago
Damp and buzzing, spirited
spring awakens—
Pickerel feed in the shallows,
skunk cabbage on the shore emerges
brownish-purple and mottled-green,
shell-like and hot
around the knob of tiny flowers,
above them, a great blue
heron, alert, waiting
And I think of you, Doc Williams
stopping by the road to the contagious
hospital that morning, standing in a
cold Jersey wind
before the rush of nurses in starched
uniforms and white-winged
caps, your patients with diseases
I’ll never see, like the ferocious
little girl with diphtheria in “The Use of Force”
Right now I’m a hundred and fifty
miles from the waste of your broad
muddy fields, the end
of a day with dementia and AIDS,
headed home to redefine
the objects in my world—
raw knuckles of red
rhubarb breaking the earth’s clay crust,
sawed-off apple limbs expecting fire,
sticky-swollen horse chestnut buds,
tips sharpened to stingers aimed at the sky,
all around, the grass a rumor of green.

Dr. Berlin, a psychiatrist in western Massachusetts, is a wonderful poet. He is a careful observer of nature and life, as was Dr. William Carlos Williams who Dr. Berlin paraphrases here.

Home Visit–sometimes your patient makes you laugh

The Brothers

–Ann Neuser Lederer

I go to visit two brothers,

one eighty-eight, the other past ninety.

Scoured and shaved and smiling for the nurse.

Shoes shined, pants pressed and belted,

plaid shirts buttoned to the neck.

Past ninety takes his teeth out

when I ask to look in his mouth,

then he goes to bite me.

Both brothers chuckle.

This morning, says the young one,

he told his brother

while changing the diaper:

You’re just like an old cow now.

I have to clean out your stall.

The brothers laughed and laughed.

The older brother adds:

My brother’s a funny guy.

He don’t say much,

but then

he comes out with something.

 (Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

It is important to like what you do. Some days are drudgery, that’s life, but most days your work should make you happy.  If not, reconsider what you are doing.  It’s important to take the time to find the delights–the experiences in your day that make you smile.  Nurse Ann Lederer shares a home visit poem with us about two brothers.  Watch Ann Lederer read her poem.

White Coat at Midnight

–Richard M. Berlin

This morning my best friend

will come with his chain saw

and ax, and we’ll cut down

the ash where a barred owl

perched last night and hooted

his four note song. We’ll split it

and stack it into cords, and I’ll be

thinking about midnight

in January when the air is twenty

below zero and the northern

lights shimmer purple and blue.

My Defiant woodstove will be

burning today’s work at 700,

and I’ll be warm enough to open

a window wide and listen

again for owls and the calls

of coyotes yipping at the moon,

my monogrammed white coat

draped on a peg, washed

whiter by the moonlight,

hanging around for the next

moment of healing, like winter

waiting for the earth’s heart to thaw.

 (Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Dr. Berlin, a western Massachusetts psychiatrist, is a gifted poet and observer of nature. Many of us who practice rural share the same love of the land as our patients. Watching the changes of nature both restores us and reminds us of the constancy of change in our lives. This careful attention to detail, much like mindfulness practice where you appreciate each moment and don’t get too far ahead or behind yourself, is in itself healing.

Learn more about Dr. Berlin’s writing

DINE: Navajo, People

–Maureen Connolly

Tsaile is cool at five thousand feet,
little snow, lots of space.

Weekdays I rise in the dark, watch the sun
bleed across the Lukachukai Mountains
out my kitchen window.
I see patients in the Indian Health Center:
pregnant women, diabetics, old women
in long skirts and velvet blouses, infants
brought in on cradleboards, injured men.

I learn how to speak some Navajo
how to listen to what is not said.
At the end of the day I walk outdoors
to where I sleep in the compound
near the dwellings of the other doctor
and the nurses. On the other side
of my little house, the sun bleeds
purple and orange over a pearled sky.

Once a week, I drive a winding road
into the dust and mud of Chinle
to a tiny emergency room bulging
with people. This winter babies
on the reservation are having trouble
breathing. There aren’t enough beds.

Friday nights at the trading post,
I look at axes in a barrel, consider
popcorn versus pretzels, pick up
a free copy of the Navajo Times.
Weekends I hike the canyons.

In Window Rock I go to a rodeo
for the first time, sit on rough
planks in the stands, a white
woman alone among the Navajo.
Mothers put fry bread in toddler
mouths. Prepubescent girls eye
cowboys walking to the chutes
spurs glinting on their boots.
Boys enter on bucking calves
then grown men clinging to huge steers.

Clowns open gates, tempt belligerent
animals away from fallen riders,
know that elusive thing, when
to step out of the line of danger.
I leave early, fearful of livestock
or a drunken driver wandering
into my headlights on the dark
journey through the mountains.

I attend mass in a hogan-shaped
church, its curved inside walls shared
by St. Francis and the corn goddess.
Statues of a medicine woman and man
stand alongside the Nativity crèche.
I discover the Irish and Navajo have
nearly the same word for “people.”

The night before I am to go home
it snows for hours into the quiet.
By morning the mountain passes
near Tsaile are closed. I head my
rented sedan the opposite direction
from the airport in Albuquerque
in hopes of circling back.

In Navajo country a milk-blue sky
blurs into rich cream land,
rust-red canyons claimed
by the snow. A brindled horse,
breath foggy in the air, stands still,
ears erect, against the horizon.
The landscape, impossibly, expands.

Two jeeps appear, one before
me, one behind, angel me
a hundred miles, no other
vehicles in sight, past scattered
Navajo villages, above the timberline,
over a mountain. I slide
onto the interstate, the jeeps are gone.

Near Gallup I stop at a convenience
store, dizzied by its repleteness.
Albuquerque can only be entered
from the west, they say, the snow.
I am coming from the west. I aim
for Albuquerque, home, my lover.

Then the airport and a plane that will fly.
More people, things, speed, sound.
A prayer forms itself.
I continue to move in and out of danger.

Dr. Connolly describes her time working on the Navajo reservation. She is aware of her foreignness, her otherness, in that setting, a different culture, with strange traditions; she describes her awareness of being different. At times she senses danger due to her unfamiliarity with the setting, but she has some resolution.

Today in many rural settings the provider may be from an ethnic group or race different from his/her patients. In some settings, international medical graduates, who were raised and educated outside the US, provide care to patients quite different from themselves. In other communities immigrants from outside the US have settled, drawn by connections with a church or seeking employment opportunities. Some communities and medical settings do a good job of integrating cultures different from the people who settled there over a century ago. Local businesses welcome the immigrants; schools have special programming for immigrant students; clinics and hospitals hire translators and immigrants as support staff, place signage in other languages. In other communities there may be tensions between the different races and cultures.

If you are in a setting where a variety of cultures are learning to live and work together, notice how they have or have not negotiated their differences. Has the majority culture welcomed the minority? What more could be done?