Jim Gallagher got up from his chair, wincing in pain, and I watched him cross the waiting room, shuffling his feet towards me. As we shook hands at my office door, I was struck by the difference between us. I was a young black doctor in my twenties, working as a resident doctor at Manhattan VA Hospital on Twenty-Third Street and First Avenue. Jim was a stout white man in his sixties. Years of stress were evident in the small vertical lines marking the sides of her face and in the bags under her eyes.
When we got to my office, Jim told me his story. In a hesitant cadence, he said he had been diagnosed with prostate cancer nine years earlier, in 2008. He had had forty-eight sessions of radiation therapy, sending the cancer into remission, but five years later, he had returned. He started to suffer from back pain and a CT scan showed the cancer had migrated to his spine; it soon invades his bones, making it difficult to walk. He had researched his prognosis and knew how much time he had left — he thought he was maybe two years old.
As a serious young doctor, I wanted to give him a different experience. So I turned away from the computer screen, with its long list of routine questions, and asked, “What gives you purpose in the face of your own mortality?” “
It had never occurred to me to ask a patient such a question before – I asked on a whim. In response, Jim reached into the pocket of his sports jacket and pulled out a rectangular black leather calendar. He was, he said, a poet. He handed me the book. Inside were some of his own poems and copies of verses written by some of his favorite poets – Carl Sandburg, Walter de la Mare – typed and neatly stapled or taped to every page of the calendar. Writing poetry, he said, was one of the main sources of joy in his life. “I have always enjoyed verses,” he says with a Shakespearean touch. But it wasn’t until the last few years that he found himself writing all the time.
As I flipped through the pages, I saw poems of different lengths and shapes. I took a minute to read one, while Jim sat across from me. It was called “in a fragile time”:
The poem reflected my initial feeling of Jim – who gave me permission to tell his story and quote his poems – as a man facing his own mortality, trying to capture or rewrite his own concept of time. I returned the book and told him I would be happy to read more. He left. That evening, as I finished my day, I reviewed his file. I saw that he had been coming to my hospital since 2014, going from oncologist to oncologist until he found his way to our primary care clinic. He was on an anti-hormone treatment called abiraterone, designed to deprive cancer cells in his prostate of the hormones they needed to thrive, and he was battling the side effects – debilitating fatigue and joint pain. As I was typing my own notes in his chalkboard, I thought of Jim’s poem – another kind of report on the state of his life, rendered in a very different language.
A few months later, Jim arrived for his next date. We greeted each other as friends. His voice was louder and he told me a few stories about his life and travels as I checked his neck for swollen lymph nodes and palpated his back for tenderness. He had served in Vietnam, in Army intelligence, and then spent decades working around the world for a global industrial manufacturing company. Now retired, he spends most of his time at home in New Jersey with his wife. He had met her in 1986, in Hong Kong, where they had both been members of a local hiking club. As I cautiously walked through the physical exam, Jim stepped forward uncomfortably at times. I noticed that telling these stories seemed therapeutic to him. He took a deep breath as he walked away from the table and mentioned that his back pain was making him limp slightly. I thought a lidocaine patch and a back brace might help.
Before ending the visit, I asked him how his poetry was going. He said he had just written a new play and had started compiling his poetry into a book, which he hoped to publish before he died.
Jim asked me if I wrote poetry. I told him that I had written most of my life. I explained that I loved poetry when I was young, writing poems on car trips with my family or on lazy summer days in our suburban New Jersey home. In high school, I took part in poetry competitions and studied literature in college, reading Wole Soyinka and Langston Hughes. What I didn’t mention is that I haven’t written a poem in years. When I started medical school, I thought I would write everyday, inspired by new patients and clinical experiences. But studying and practicing medicine has proven to be consuming. At home, I left a blank sheet of paper on my desk, in case inspiration came, but I always rushed for the door or fell asleep. I was also starting to come to terms with being gay. I started slipping into the same depressive symptoms that I was learning in my medical textbooks. The page was left blank.
I didn’t want to admit to Jim that I hadn’t written a word of poetry for three years. When he asked me to read one of my poems, I told him that I would send him one soon.
By our next date, Jim was doing better. The lidocaine patches were helping him, but he still had spasms in his back. I said I would prescribe muscle relaxants for her and refer her to a physiotherapist and nutritionist. He didn’t talk about poetry during our session, so neither did I. But as he left he handed me a new poem. I read it later, sitting and having a sandwich on my subway ride to my house:
His words helped me forget for a moment the sea of human bodies surrounding me on the train.
I started some poems to give to Jim, but I never finished them. So I decided to go back to my old pieces. Instead of waiting for our next date, I emailed her one of the last poems I had written in my first year of medical school, before the words easily ceased to flow through my mind:
Jim answered me. The poem, he said, was “now in my book which I carry every day.” Next to some works by Auden. It’s in good company.
I would learn later that Jim, too, had lost touch with poetry. Born in 1943 in a working-class neighborhood near the Brooklyn Navy Yard, he majored in literature at the University of St. John’s and submitted poetry to academic journals. With a German-born arts and language teacher, Eric Albrecht, who had worked in the US intelligence service during World War II, he sometimes took a walk around at lunchtime; They once stopped at a bookstore, where the owner, speaking in German, showed Albrecht the numbers tattooed on the inside of his arm. On Jim’s birthday, the teacher gave him ten dollars to buy three books at the bookstore; Jim chose an 1862 edition of Shakespeare, “by Walt WhitmanBlades of grass,” and the “Rubaiyat of Omar Khayyam. “He still has them in his library.
Jim quit writing poetry after college. He enlisted at the age of twenty-one and arrived in Vietnam on the second day of the Tet Offensive, working in a team providing intelligence support to the 3rd Brigade, 1st Infantry Division . Nine years later, he accepted a job with International Telephone & Telegraph, which allowed him to travel the world for corporate business, work in the Philippines, Taiwan and India, and live in Japan. In the mid-90s, he moved again to New Jersey with his wife. He did not resume poetry until around 2013, five years after the onset of his illness. The more the cancer spread, the more he felt compelled to write. Memories flooded his mind.
“Sometimes I don’t want to put that pen down because I don’t know how I’ll feel the next day,” he told me. “I don’t know how I’m going to wake up. Sometimes the pain in the bones is so bad. Every time I write is so precious. Corresponding with Jim about my old poem allowed me to write poetry again.
Over the years, I have monitored Jim’s blood pressure, checked his diabetes, and made sure he was up to date on his vaccines. I did everything a primary care physician should do. But our visits always came back to poetry. More than any medicine, the poems seemed to ease Jim’s pain – they were his most effective treatment.
Our last visit was in June 2018. I was leaving the VA for Columbia University Medical Center, where I was to begin infectious disease training. We’ve gone through Jim’s medication list, his upcoming appointments with specialists, and his most recent test results. We revised our plan for her pain, which was under fairly good control. Then we took the time to talk about how far we have come. Jim admitted that when we first met he didn’t think he would still be alive two years later.
As a farewell gift, he handed me a black filing cabinet with a transparent cover. The title page read: “In summary: a collection of poems by James M. Gallagher”. I flipped through some of them that I had read before, others were new to me. They were accompanied by illustrations or photos, mostly nature shots. When I asked Jim if he still hoped to publish his collection someday, he replied that he had changed his mind. He had been disheartened after hearing how intimidating the process was.