NEW YORK -- Bedlam is breaking out once again at Bellevue Hospital's afternoon clinic, as the late-shows, the unscheduled and the emergency room's overflows come in search of cures. Crisp-coated interns and residents try to jump-start the examining room computers as patients begin to recite their ailments.
There's the swollen-legged Chinese man with liver cancer, the Mauritanian in need of French-language smoking cessation classes and the aching Bangladeshi woman who will say only that her past surgery is "a secret."
As each doctor stops by the desk of attending physician Danielle Ofri to check their diagnoses, she thrusts into their file-filled hands a photocopy of a poem. Written by a physician, the poem, "I'm Gonna Slap Those Doctors," is 30 furious lines about an alcoholic in withdrawal.
They come up with their noses crunched up like my room
is purgatory and they're the
godd--- angels doing a bit
of social work Listen, I might not
have much of a body left,
but I've got good arms.
"Here's the poem of the day," Ofri says. "Go to. Be strong."
It's pieces such as this Jack Coulehan poem that are appearing in the Bellevue Literary Review, a well-regarded magazine featuring fiction, nonfiction and poetry by Bellevue's doctors and well-established writers such as Julia Alvarez and Rafael Campo.
The nation's most venerable public hospital and physician training ground has turned to literature to help its doctors better understand their patients, and themselves. All third-year internal medicine students are required to write 1,000-word essays about patients. Medical students and residents and interns listen to poetry at the end of rounds. And sometimes the front entrance is turned into a space for literary readings.
"Physicians always want to get to the story of the patient, and that's not different from what the novelist wants to do," Ofri said. "I think we can take people who are basically empathetic and well-meaning and give them better skills to connect with their patients."
Literature is spreading its tendrils through hospitals nationwide. Harvard Medical School offers students a writers' lecture series and professor (and New Yorker contributor) Jerome Groopman talks of Chekhov and Tolstoy during his rounds. Columbia University's College of Physicians and Surgeons has started a journal.
But physicians and academics says it is especially fitting to house a literary medical journal in the 267-year-old Bellevue Hospital, a place synonymous with the public health movement in the United States. Its doctors have treated tuberculosis, leprosy and AIDS when private hospitals turned those patients away. It is the backup emergency center for presidential visits. When cops are shot, ambulances take them not to fancy private facilities but to Bellevue, because of its surgeons' fame in treating trauma wounds.
Through the decades, Bellevue doctors have helped police track down the unbalanced and the unhinged, not least them, Son of Sam (David Berkowitz). And they have welcomed a Barnum & Bailey's sword swallower and other circus folk who came to visit the leopard lady when she was treated for a skin illness. After the World Trade Center attacks, New Yorkers descended on Bellevue with photographs and handwritten posters of the missing, and the hospital's psychiatric counselors fanned out to console New Yorkers.
"I always think of it as the conscience of New York," said Sandra Opdycke, a historian and author of "No One Was Turned Away: the Role of Public Hospitals in New York City Since 1900," which traces the history of Bellevue and New York hospitals. "It's the oldest. It's the most generous."
Bellevue's medical staff long has had a way with words. Over the years, its ranks have produced two national book award winners: Walker Percy ("A Confederacy of Dunces"), who started writing after he contracted tuberculosis during his medical internship at Bellevue Hospital; and former Department of Medicine chairman Lewis Thomas who wrote "The Lives of a Cell: Notes of a Biology Watcher."
When Martin Blaser came to chair New York University's Department of Medicine in 2000, he set up his office in Bellevue, where he had begun his career as a medical student in 1969. NYU has an affiliation contract with Bellevue. He still remembers his patients from that first summer more by their stories than their medical conditions.
"People who are good doctors consciously understand the importance of good narrative," he said. "What I've been doing as the chairman is build on the narrative."
He required that all third-year medical students write a two- to three-page essay during a 12-week clerkship about a patient. The first round of papers were so "poignant and sad and unresolved," that Blaser established writing awards. He also thought there may be a demand for a national literary journal that focused on health and healing written by physicians and writers who had been exposed to illness. He started working with Ofri, who had been reading poetry to students and requiring them to write narratives. The Bellevue Literary Review was born a few months later.
The first issue appeared six days after the attacks on the World Trade Center, and in the ensuing issues, authors have reflected on organ donations, tuberculosis and mental illness. Some works were humorous; an essay by Anne K. Spollen tells the story of a man whose mother brought him to Bellevue to eat all of his meals, partly in case he became ill as he ate. Itzhak Kronzon's essay, "My Blue Cousin," published in the spring 2003 review, described a family worried about the defective heart of a relative, only to have her outlive most of them.
While some students treat their writing as another burden in a sleepless medical school experience, others thrive on the writing. Denitza Blagev, who wrote her third-year essay on rebuilding trust with a patient given too much morphine, says writing helped her cope with the stresses and tragedies of medical training. Blagev wrote an essay that appeared in the first issue of the Bellevue Literary Review about a fictional cardiologist who develops colorectal cancer. Now, she says, writing is helping her work through her feelings about a fellow physician who committed suicide.
"You didn't feel like you were swimming against the tide, that you were the only one who thought of patient care," said Blagev, who recently left Bellevue and moved to the Boston area to start her residency. "Through writing, it helped me assess why this is important."
It is a response that more than pleases Ofri. She is of Eastern European and Yemeni descent and grew up in Rockland County. When she finished school in 1996, she canceled her medical subscriptions and traveled through Latin America learning Spanish and working as a temporary doctor wherever she was needed. She came to writing almost as a necessity. Her essays describe the time she diagnosed her first AIDS patients, treated a Riker's Island inmate who swallowed a battery to get a "Bellevue vacation," and coped with the suicide of her mentor.
"I kept thinking all of those stories are flowing by, and I have to write them down," she said.
Ofri, 37, returned to Bellevue in 1998. This spring, she published her first book of essays, "Singular Intimacies: Becoming a Doctor at Bellevue," which chronicles her path at the hospital.
"We offer our patients so much more than medical knowledge," she said. "There are lots of things we can't solve . . . sometimes you have to hold the patient's hand and cry with them."
