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Q J Med 2002; 95: 555-556
© 2002 Association of Physicians

Coda

Rhythms of life

John Launer

Without a doubt, the school teacher who had the most profound effect on me was my sixth form English teacher. He had the ability to excite enthusiasm for the kind of knowledge that at first seems innately boring. So I came away from his lessons with, among other things, a lifelong fascination with poetic metre and rhythm.

Metre and rhythm, he taught, are not the same. Metre is the implacable drum beat that underlies any piece of verse (excepting some modern poetry). Rhythm is the actual pattern of conversational stress that you hear when the verse is spoken aloud. Sometimes the two coincide, but when they do not, the effect can be striking. To give an obvious example, the metre that lies behind most Shakespearean verse is as follows:

Ti TUM ti TUM ti TUM ti TUM ti TUM
If metre and rhythm were always the same, Shakespeare's most famous line would therefore go:
To BE or NOT to BE, that IS the QUEST.
Instead, what Hamlet says is this:
To BE or NOT to BE, THAT is the QUEStion.
Consciously or unconsciously, our attention is arrested by the premature fourth stress, and by the weak extra syllable at the end. There is an almost shocking disjunction between what our minds anticipate and what our ears hear. It is this tension between the expected and the observed, the confluence of altered arithmetic with altered meaning, that creates the drama of poetry and distinguishes inspiration from platitude. Of course, exactly the same thing is true in medicine.

There is another analogy worth pointing out between poetry and medicine. The favoured metre of English poetry—iambic pentameter—exactly reproduces normal human heart sounds, counted on the five fingers of one hand:

Lup DUP lup DUP lup DUP lup DUP lup DUP.
(Next time you listen to a healthy heart, try reciting ‘Shall I compare thee to a summer's day?’ while counting your fingers at the same time, and you will see what I mean – although it may take some explaining to the patient.) The effect in the line from Hamlet can therefore be likened quite accurately to the sense of subliminal unease that attends a ventricular extrasystole. Other, more elaborate effects mimic more sinister dysrhythmias. Thus King Lear's dying, disjointed words decelerate progressively into asystole:
Do you see this? Look on her, look, her lips,
Look there, look there!
It would be nice to think that this likeness between poetry and cardiology could be applied universally. Sadly it cannot. While some other languages such as French and Russian often trot along in iambic metres like English, others do not. Classical Greek verse gallops along on trisyllabic hooves, sounding to our ears alarmingly like an imitation of heart failure. Sanskrit and Hebrew metres flutter and fibrillate, with varying numbers of syllables between each stress. It is tempting to pathologize other cultures while seeing one's own as the epitome of health. However, it is probably more scientific to recognise that it is just a nice coincidence that English metre usually resembles a healthy heart, so that our poetic rhythms can be understood through cardiac metaphors.

It is also worth remembering that the distinction between poetry and prose is, in any case, a somewhat artificial one. Poetic rhythms can diverge so far from any recognizable metre that they turn into ‘free verse’. Conversely, prose can become raised to the density and regularity of poetry. Remarkably, researchers in Glasgow have noticed that the latter phenomenon occurs in the speech of terminally ill patients, and they have demonstrated this by writing out some of their patient's stories in verse (Murray S, et al. ‘I knew ...’ Br J Gen Pract 2001; 51:776–7). The following stanza comes from a recording they made of a lung cancer sufferer, as he describes the moment his consultant told him the diagnosis:

He said
‘Well,’
He said,
‘I'm not going
To beat about the bush’
He said
‘You've got
A tumour in there
And a blockage,
And it's cancerous’
He didn't mess
He just told me
There and then.
These lines are not so much Shakespearean as biblical. With their short, irregular rhythms and their bleak, unremitting refrain of ‘he said’, they echo the poetry of the prophets, as transmitted firstly into the Latin Vulgate by St Jerome, and thence into English by William Tyndale and the great Jacobean translators.

Literary critics tell us that no text is ever entirely original; knowingly or not, each one refers back to prior texts and a prior tradition—a process known as intertextuality. So from the mouth of this dying Glaswegian we hear the unflinching directness of a Jeremiah or an Ezekiel. Perhaps if we listen to our patients carefully when they speak to us in clinics and on the wards, we may also hear echoes of Milton, Homer, the Mahabharata or the Epic of Gilgamesh.


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Home page
 Qualitative InquiryHome page
M. Kendall and S. A. Murray
Tales of the Unexpected: Patients' Poetic Accounts of the Journey to a Diagnosis of Lung Cancer: A Prospective Serial Qualitative Interview Study
Qualitative Inquiry, October 1, 2005; 11(5): 733 - 751.
[Abstract] [PDF]

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