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Volume 1, Issue 3
Autumn 2005:

Ester's Poem

Geoffrey Ankeney

Cell 2 Soul. 2005 Autumn; 1(3):a2

Ester and I were put on Ward 17 of the psychiatric hospital on the same day. I was beginning my 3rd year psychiatric clerkship; she was beginning an indefinite stay as a patient, although I didn't realize this at first.

"Are you a social worker here?" I asked.

How was I supposed to know she was a patient? She was dressed extremely well; nice hat, expensive dress, well-accessorized, perfect make-up.

Ester replied airily, "Oh no. I don't work here and won't be here for long. I was brought here by my husband; I have no idea why, actually."

I blushed as my classmates chuckled, but Ester seemed appreciative of my assumption. Over the ensuing days, we spoke frequently. She often found me on the ward to see how I was doing and to notify me that she would be leaving quite soon. I found that she was an orthodox Jewish woman with children and a husband. She showed me great affection, and couldn't help but enjoy the attention. In the rarefied air of medical school where compliments are scarce and precious, her affection was hard to resist. I suppose this is why, when she started writing me poems, I accepted them.

Poem 1, Ester's 3rd day

The poem was written on a small, crumpled sheet of paper, with Hebrew scribbled in corners and on the opposite side. Ester found me on the ward while I was on break during a lecture to give me the paper. I was taken aback and a bit uncomfortable. Was this appropriate? What should I say to her? My fellow students were watching over my shoulder and I could tell they were laughing (again).

She whispered, conspiratorially, seductively (and way too loud), "Because I think about you all the time, I want us to know each other."

"Why don't you write poems to your husband instead?" I asked, using my best "clinical voice".

In response, Ester quickly flipped the sheet over and pointed into a garbled mass of Hebrew characters, stating firmly, "That's my address."

She then walked away, leaving the poem hanging loosely in my hand. I had no idea what she meant.

The poem read, in part:

To Jef, special for you
Love (really),
Esther

I don't want to be alone
I want to take another
I want to speak with you
& not with any other

Because I want a special man
He will be my King
I will be his queen (Ester)
O, bring to me, BRING!

I took the poem home that night and thought about what had been written. I would be hard-pressed to call what she'd written "good" poetry, although I'm no expert. The composition did possess some verbal symmetry and cadence. It was legitimately expressive. She was certainly mentally competent — she had created a rhyming poem in her 3rd language. And from the garbled additional Hebrew lettering I suspected that her mind was racing and filled with passing ideas.

Ester was also showing, both in the poem and on the ward with me, classic signs of hypersexuality often seen during mania. Like her affections in general, I uncomfortably found that her sexual overtures were not entirely unwanted on my part. I was not physically attracted to her, and am also happily married. So although I was generally embarrassed by her advances and primarily interested in learning about psychological pathology, a small part of me enjoyed the feeling of being attractive, being desirable — even though it felt inappropriate.

Poem 2, Day 8

I received poem 2 before I had resolved within myself whether or not I should be accepting Ester's overtures, including her poetry. But irrespective of my own conflicted thoughts on the matter, poem 2 was different. I realized Ester herself had also been different with me in the previous few days. She was more polite, more respectful of personal space between us. She was more guarded in general. In the poem, it was clear to me that her focus was shifting:

To be like a bird
That doesn't fill anything
A bird that brings in her neck just food
Or little pennies

To be like the sun
That shines
Without the darkness…
Yes!

Me or You
Or Another?
Answer me, my brother!

In my conversations with her, Ester had often mentioned the overwhelming task of caring for her children. She explained that she had 3 sets of twins, plus other single births, thus she was the mother of 12 children all under the age of 14. The life of orthodox Jewish women generally revolves around caring for a large family, but her situation was unique even for her culture. 12 kids!

Perhaps the little bird she described represented her sense of futility in caring for so many children. At one point during our conversations around the time of this poem, Ester confided in me that in fact she didn't want to go home (I'd never heard anyone say that on the locked psych wards). She felt she couldn't handle the enormous effort required to care for her children any longer. In tears, she described the work of preparing a simple lunch for the kids. She made hand-motions of pouring juice into cups…she poured and poured and poured, 12 times. She showed me how she made sandwiches, 12 of them and then cut them into 24 halves. She said her husband never helped — he was busy studying Torah, as was expected of him. The couldn't afford to pay for help with the kids, so she was all alone every day.

Ester often mentioned freedom. Her sexually-charged advances toward me, and the attraction she described for me, was often included in her descriptions of simply wanting to be free again. In this second poem, I believe she is referencing herself when she says she wants to be like the sun that shines without the darkness. I think she wants to be able to shine without the burden of the darkness of her mind, perhaps like it once was when she first met her husband, when she was in love and had the time to love.

I took some measure of comfort in the fact that she called "me" brother in the end of the poem, although I can't be sure that I am the one she is referencing. In the first poem, I was the object of her sexual affections, but her perspective of me in poem 2 had shifted toward "brotherly love", and her actions toward me on the ward were in kind with the nature of the poem. At that point, some of my confusion about my relationship with Esther began to fade away into irrelevance, and I found I could focus more easily on her disease and life.

Poem 3, Day 17

The poem was given to another student in our class. Ester told the student that it was originally written for me, but since I was not there that day, it would be fine if the student wanted it. He gave it to me later.

To be like a little flower
That still hasn't blossomed
She really wants the autumn to come,

To be like a bird, a little sparrow,
Who hasn't opened his wings.
He still waits for the day to fly.

To be like the straight barley,
Still not ripe, but waiting,
To be like an airplane,
To be like lightning, strong.

To be like God,
It is impossible to be.

To Geoff,
Best wishes and best memories
Ester — The Flower

Ester's focus had moved, in her poetry at least, from me to herself. By the end of my clerkship, when she wrote this poem, it wasn't even necessary to her that I be the recipient of it, although it was signed to me. The poem speaks of potential, and longing. But I'm fairly certain this is not the sexual potential or physical longing she initially expressed to me. The subject is waiting to become all that he or she was created to be — but cannot seem to achieve it. I believe Ester's last poem is a sad one, as though the little flower waiting for autumn was similar to trying to be like God — something impossible.

I haven't seen Ester since the clerkship. I don't know how she is doing or if she was released from the ward. I suspect that she is doing better. Just by observing how the themes and subjects of each of the 3 poems changed gave me the sense that she was improving. I had made it a point to not "admit" Esther formally for my clerkship, and I avoided her medical chart until my last day on the ward. My goal was to form my own impressions about her, using her language of poetry rather than my own of medical terminology. And in an emotional way, I suppose I had identified her diagnosis from her words even before I finally did read it in her chart. It was written in the cold, blank language of medicine — a poetry of it's own, really:

44 yo married orthodox Jewish female, 12 children, admitted from ER for acute manic episode, initial tx with lithium and diazepam.

During my last talk with Ester, she said, "You are my savior during this dark time, Geoff, because you understand how it feels to be me."

Do I? I wondered to myself. Do I know more about her than I would have by just looking in her chart? Could I have been a better doctor for her if I'd "treated" her with this highly personalized approach? Would I even have done it if I'd not enjoyed her affections toward me?

I've never been able to really answer any of those questions. All I can say is that I believe I knew Esther in her own words, and the experience made me feel like I was doing the work that real doctors do. Although in practice I'll probably never have the kind of time and emotional energy I had for Esther, there is a part of this encounter that I'll hold forever.

I didn't write this essay to address the issue of doctors getting too emotionally involved with their patients. I wanted to describe another method for how care-givers can make meaningful contact with patients. But my exploration into forming stronger connections with patients was unexpectedly accompanied by moral conflicts I had not anticipated. I believe I learned more about my patient because I engaged her in her world through her words. This was appropriate, it was unique, and it had the potential to bring her to a state of mental health. But I also responded to her emotionally in ways that I still question. Maybe my response was normal and acceptable, I don't know for certain. What I do know is that I still have her poems — and the feelings of consternation that has always accompanied them.

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