Jim Gallagher rose from his chair, wincing in pain, and I watched as he shuffled across the waiting room toward me. As we shook hands at the door to my office, I was struck by the difference between us. I was a young Black doctor in my twenties, working as a medical resident at the Manhattan V.A. Hospital, on Twenty-third Street and First Avenue. Jim was a portly white man in his seventies. Years of stress were evident in the small vertical wrinkles marking the sides of his face, and in the bags under his eyes.
When we reached my office, Jim told me his story. In a halting cadence, he said that he had been diagnosed with prostate cancer nine years earlier, in 2008. He had completed forty-eight sessions of radiation, sending the cancer into remission—but then, five years later, it had returned. He began to suffer back pain, and a CT scan showed that the cancer had migrated to his spine; it soon invaded his bones, making walking difficult. He had researched his prognosis and knew how much time he had left—he thought he had maybe two years.
As an earnest young physician, I wanted to provide him with a different kind of experience. So I turned away from the computer screen, with its long list of routine questions, and asked, “What gives you purpose as you face your own mortality?”
It had never occurred to me to pose such a question to a patient before—I asked on a whim. In response, Jim reached into his sports-jacket pocket and pulled out a rectangular black leather calendar book. 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 out and carefully stapled or taped onto each calendar page. Writing poetry, he said, was one of the main sources of joy in his life. “I’ve always appreciated the verse,” he said, with Shakespearean flair. But it was only in the past few years that he had found himself writing all the time.
As I thumbed through the pages, I saw poems of different lengths and forms. I took a minute to read one, while Jim sat in front of me. It was called “in a fragile time”:
It was a fragile time
And we lived it carefully,
Making sure there was
Not too much distance
Between the soft words
And the gentle giving
Knowing time was limited
But not dividing
Or counting it
In days and weeks
Or looking for a sign
Of its end . . . .
The poem reflected my initial sense of Jim—who gave me permission to tell his story and quote from his poems—as a man faced with his own mortality, trying to capture or rewrite his own concept of time. I handed the book back and told him that I would be happy to read more. He left. That evening, while wrapping up my day, I reviewed his chart. I saw that he had been coming to my hospital since 2014, bouncing from oncologist to oncologist until finding his way to our primary-care clinic. He was on an antihormonal therapy called abiraterone, meant to starve the cancer cells in his prostate of the hormones that they needed to grow, and he struggled with the side effects—debilitating fatigue and joint pain. As I typed my own notes into his chart, I thought about Jim’s poem—another kind of report on the state of his life, rendered in a very different language.
A couple of months later, Jim arrived for his next appointment. We greeted each other like friends. His voice was stronger, and he told me a few stories about his life and travels while I checked his neck for swollen lymph nodes and palpated his back for tenderness. He had served in Vietnam, in Army intelligence, then spent decades working around the world for a global industrial-manufacturing company. Now retired, he spent most of his time at home, in New Jersey, with his wife. He had met her in 1986, in Hong Kong, where they’d both been members of a local hikers’ club. As I moved gingerly through the physical exam, Jim occasionally lurched forward in discomfort. I noticed that telling these stories seemed therapeutic for him. He took a deep breath as he moved off the table, and mentioned that his back pain was causing a slight limp. I thought that a lidocaine patch and a back brace might help.
Before ending the visit, I asked him how his poetry was going. He said that he had just written a new piece, and that he’d 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 been writing most of my life. I explained that I’d loved poetry when I was young, writing poems during car rides with my family or on lazy summer days in our suburban New Jersey home. In high school, I’d entered poetry contests, and I’d studied literature in college, reading Wole Soyinka and Langston Hughes. What I didn’t mention was that I hadn’t written a poem in years. At the beginning of medical school, I’d thought that I would write every day, inspired by new patients and clinical experiences. But studying and practicing medicine turned out to be all-consuming. At home, I left a blank sheet of paper on my desk, in case inspiration came, but I was always rushing out the door or off to sleep. I was also coming to terms with being gay. I started slipping into the same depressive symptoms that I was learning about in my medical textbooks. The page remained blank.
I didn’t want to admit to Jim that I hadn’t written a word of poetry in three years. When he asked to read one of my poems, I told him that I would send him one soon.
At our next appointment, Jim was walking better. The lidocaine patches were helping, but he still had some back spasms. I said that I would prescribe some muscle relaxants, and refer him to a physical therapist and a nutritionist. He didn’t bring up poetry during our session, so I didn’t either. But, as he was leaving, he handed me a new poem. I read it later, seated and sandwiched on my subway ride home:
On the empty shore
A solitary someone stands,
Confident of promise,
Teasing the water’s edge,
Waiting for a sea sign
To come closer
And a welcoming wind
That all is ready
For another voyage
And return
To begin
His words helped me forget for a moment the sea of human bodies surrounding me on the train.
I started a few poems to give to Jim, but never finished them. So I decided to look back at my older pieces. Instead of waiting for our next appointment, I e-mailed him one of the last poems I’d written during my first year of medical school, before the words stopped flowing easily in my mind:
I take an oath rooted in her spirit,
Bathed in Hippocrates’ poetry,
To devote myself to her music
To learn the arc of her story
To widen the pools of my mind
I stare into a midnight river
Carrying strips of moonlight through the city,
Reflecting the hopes of a young healer
First to heal himself,
To turn the world towards brighter dawns
To find truth in the opening of my heart.
Jim wrote me back. The poem, he said, was “now in my book that I carry each day. Next to some works by Auden. It’s in good company.”
I’d later learn that Jim, too, had once lost touch with poetry. Born in 1943 in a working-class neighborhood near the Brooklyn Navy Yard, he majored in literature, at St. John’s University, and submitted poetry to college quarterlies. With a German-born arts-and-language professor named Eric Albrecht, who’d worked in the U.S. intelligence services during the Second World War, he’d sometimes take lunchtime walks; once, they stopped in a bookstore, where the owner, speaking in German, showed Albrecht the numbers tattooed on his inner arm. On Jim’s birthday, the professor gave him ten dollars to buy three books from the bookstore; Jim chose an 1862 edition of Shakespeare, Walt Whitman’s “Leaves of Grass,” and the “Rubáiyát of Omar Khayyám.” He still has them on his bookshelf.
Jim stopped writing poetry after college. He enlisted when he was twenty-one, and arrived in Vietnam on the second day of the Tet Offensive, working on a team providing intelligence support for the 3rd Brigade, 1st Infantry Division. Nine years later, he took a job with International Telephone & Telegraph, which allowed him to travel the world on company business, working in the Philippines, Taiwan, and India, and living in Japan. In the mid-nineties, he settled back in New Jersey with his wife. He didn’t pick up poetry again until around 2013, five years into his illness. The farther the cancer spread, the more he felt compelled to write. Memories flooded his mind.
“Sometimes, I don’t want to put down that pen because I don’t know how I’ll feel the next day,” he told me. “I don’t know how I’ll wake up. Sometimes, the pain in the bones is so bad. Each time I’m writing is so precious.” Corresponding with Jim about my old poem got me writing poetry again.
As the years passed, I monitored Jim’s blood pressure, checked for diabetes, and made sure that he was up to date on his vaccinations. I did all the things a primary-care doctor should do. But our visits kept coming back to poetry. More than any medicine, the poems seemed to blunt Jim’s pain—they were his most effective treatment.
Our final visit was in June, 2018. I was leaving the V.A. for Columbia University Medical Center, where I was to begin training in infectious diseases. We went through Jim’s list of medications, his upcoming appointments with specialists, and his most recent test results. We reviewed our plan for his pain, which was under pretty good control. Then we took some time to talk about how far we had come. Jim admitted that, when we first met, he didn’t think he would still be alive two years later.
As a parting gift, he handed me a black binder with a transparent cover. The title page read, “in summary: a collection of poems by James M. Gallagher.” I flipped through—some of them I had read before, others were new to me. They were accompanied by illustrations or photos, mostly shots of nature. When I asked Jim whether he still hoped to publish his collection someday, he said that his mind had changed. He had been discouraged after hearing how daunting the process was.
I told Jim that I would read every page, and that, even if it never got published, the collection would always have a prominent place on my shelf. We hugged each other goodbye, and promised to remain in contact. That evening, he e-mailed. “Thank you for all you did for me today and in past visits,” he wrote. “I will miss you but if you don’t leave, you’ll never fly. It has been a rewarding and meaningful experience to have been associated with you.”
A few weeks later, he e-mailed again. He’d visited a new primary-care doctor at the V.A., and it had gone well. Still, he wrote, “since you left, when I walk in the hospital it’s not the same.” He attached a poem titled “a scene not painted”:
Even a perfect artist
On the journey from trained eye
To perfect hand and brush
Could not hope to translate
And move from this compelling place
Onto waiting blank canvas
What eyes have tasted and drunk
I learned a lot from Jim about medicine, especially when it comes to treating hospitalized, critically ill patients. I often meet people after a severe infection has ravaged their bodies. Most of them have so much less time left than Jim did. Now I always take a moment to ask them, “What do you hope for?”
And Jim gave poetry back to me. The first new poem that I sent him was called “Curiosity and Connection.” It was inspired by my grappling with how to connect to patients I would never be able to speak with, because they were intubated or had irreversible neurological injuries:
Eyes opened slowly
Drawn to the room’s sterility
Waves of flowers at the bedside
A smile creeping onto her face.
Death asked who is she?
Donned in colorful headwraps and gold earrings
A mother, a muse
My patient, there with me.
I smiled when I saw Jim’s e-mailed response: “Compassion and the will to see the individual apart from the disease are skills not easily acquired and kept,” he wrote. “They are specialties also.”
Jim’s cancer is incurable. The treatments only keep the inevitable growth at bay. Sometimes, I think that the only reason he holds on is to get more poems written. I hear from him every month or so, especially on holidays, whether it’s Chinese New Year, Memorial Day, or the Fourth of July. His e-mails usually have a finished poem attached, or an update on a specific work in progress. Then he updates me on his cancer, his latest medication and its side effects, why he is changing oncologists, and other medical matters. He always asks for my opinion.
Jim’s life is simpler these days. He mostly relaxes at home with his wife and his five-year-old cat, Bao Bao. There is no more travel for him—just travel stories. So, when I am able to get away from the hospital, I like to share with him what I’m seeing. The fall before covid-19, I e-mailed him from France. I was sitting in an uncrowded train to Saint-Rémy-de-Provence, drinking warm coffee, eating fresh bread, and I wrote him a poem:
Peace, the whir of the train
Floating by rows of trees
And tilled soil
The sun lands lightly on the hills
Dripping between leaves
A lush summer in Lyon
Children on small bicycles
Waving to parents through windowpane
Winding through thin alleyways
Laughter rising to the sky
The squares of St Rémy
Caught in tranquility
A few days later, on Veterans Day, I sent him a picture from Paris of a fiery sunset above the Seine. “So great you captured this moment,” he replied. “So wonderful about timing and vision.” He had spent that morning, he went on, “putting my new piece together.” We often promise each other that “a new piece” is coming.
Recently, I called Jim. His voice was raspier, but he had the same husky laugh and self-deprecating humor. I told him that I had been thinking about our friendship. He said, “The patient-doctor relationship has to have a common denominator that produces trust. Ours is putting something down that lasts longer than we are going to last.” He said, “We’ve stayed friends because of the bond of ‘the verse.’ ” At the end of the call, Jim told me that his cancer was spreading again. He is running out of options and time. He is hesitant to start chemotherapy, with its potential toxic effects, given the limited extension of life that it may provide. He doesn’t want to be a burden on his wife: “You’re breathing, but you’re not living.”
I listened to him work through this impossible quandary, and told him that there was no wrong decision. Whatever he chose, I would be there for him every step of the way. The truth is that I have been celebrating and mourning Jim from the first day we met. My favorite poem of his is called “the last day”:
Time is promise,
But uninvited circumstance
And wounded souls
Eventually barter it away.
The owner of my borrowed time
Will arrive at random to insist
All what remains of me vanish . . . .
A shadow of a shadow
Passing into mist.
So, I and my last day
Will take a journey together
When we both are spent,
That leaves the familiar
Once infused in all the days,
To stand at the edge of night,
And wonder in the dying light
Exactly where we went.
