Poet-Doctor Uses Fiction to Give Students Instincts : Medicine: He says literature can help reveal answers--on how to interpret a patient’s often oblique language, how to respond to ethical quandaries, how to move technology toward humaneness.

When it’s right, the heartbeat ought to be iambic, the classic da-DUM, da-DUM, da-DUM rhythm of a sonnet, says Dr. John Stone, who listens through his stethoscope with the ear of a poet as well as a cardiologist.

“Each of us,” he has written, “is born with two hearts.”

The crossover of healing science and literary art, says Stone, who is at home in both, makes better medicine.

Stone leads cardiology fellows on clinical rounds and he leads a seminar called “Literature and Medicine” for seniors at Emory University School of Medicine, where he is dean of admissions.

As he pours 25 years of practice into couplets or free verse, symptoms become symbols. And sometimes cosmic becomes comic:

Mouth hands thighs bed

Cane crutches wheelchair

Dead.

Stone can be found cajoling a smile from a shy 6-year-old cardiac patient at a state-run clinic, or writing, “early and late,” at the word processor next to his piled desk, a drift of open books, magazines with pages marked, phone messages and sheaves of photocopies. They are the materials of a new, ambitious bridge from writing to healing.

Stone and a colleague, Dr. Richard Reynolds, are editing an anthology--poems, essays and stories with “doctoring” as the theme and authors ranging from Dylan Thomas to Raymond Carver. It’s set to be published by Simon & Schuster this spring, and a philanthropic foundation will distribute copies to all 17,000 to 18,000 freshman medical students in the United States this fall.

But, doctor--rhymers and storytellers? Wouldn’t the time of physicians-in-training be better spent in the lab or the research library?

If truth is a number

Not only is it never

In the back of the book

But it never comes out even

Ends in a fraction

Cannot be rounded off.

Those lines from one of Stone’s poems could be his answer.

“One of the major lessons that students need to learn has to do with ambiguity,” he said in an interview.

“I’m sure there are doctors who hope that we’ll come to a time in medicine in which we’ll understand everything, or at least everything can be objective: You can stand in front of a computer, tell it the symptoms, type in the blood reports, the lab results, the X-ray results, and zip, back comes the answer.

“The problem with that is that disease is always going to be ambiguous when it first presents; it’s rarely classic. Besides which . . . disease is lodged within a human being, and they have their own ambiguities and passions that they bring to this encounter.”

Fiction can help reveal answers--on how to interpret a patient’s often oblique language, how to respond to ethical quandaries, how to move technology toward humaneness, Stone said.

“Medicine, some people think the profession is troubled right now,” said Reynolds, who conceived the idea of the anthology and asked Stone, who has published three volumes of poems, an essay collection and many medical articles, to be co-editor.

These days, patients demand more accountability from physicians, there are complaints that technology is overused and too expensive, and some frustrated doctors are leaving the profession, Reynolds said.

“The relationship of trust has eroded,” he said.

Reynolds, a former practicing physician and medical educator, is executive vice president of the Robert Wood Johnson Foundation, which will spend nearly $300,000 to make the book available to students.

He and Stone use the same word to describe what they hope their collection will help instill in students: “caring.”

“It’s the first anthology of its kind, so far as I know,” said Fred Hills, senior editor at Simon & Schuster in New York.

“It’s a book about people in extremity, and that’s often where character is revealed. And that’s why the subject (medicine) has appealed to everyone from Ernest Hemingway to John Keats,” said Hills, who had a personal interest in the anthology. When his siblings were born, he said, they were delivered by William Carlos Williams, the late physician-poet, whose work is included.

Although not all of Stone’s verses deal with medicine, many begin in medical cases, with such titles as “To a 14-Year-Old Girl in Labor and Delivery,” “Autopsy in the Form of an Elegy,” “Heart,” “Brain,” “Stroke,” “Death.”

Death

I have seen come on

Slowly as rust

Sand

Or suddenly as when

Someone leaving

A room

Finds the doorknob

Come loose in his hand.

Sometimes writing can help in dealing with pain and death; sometimes weeping can, Stone said.

“To be vulnerable to that kind of thing is part of the healing process; it helps the doctor himself or herself cope with the really terrible, awful--in the real, etymological sense of that word--with the awful responsibilities that devolve upon physicians.”

In one poem, Stone describes making a house call to an aging woman seven years after her cardiac valve surgery. She shows him around her house and garden. The poem ends:

At the hospital, a thousand times

I have heard your heart valve open, close.

I know how clumsy it is.

But health is whatever works

And for as long. I keep thinking

Of seven years without a faint

On my way to the car

Loaded with vegetables

I keep thinking of seven years ago

When you bled in my hands like a saint.

In a soft accent of his native Mississippi, Stone reads from his work around the country, but he has given up trying to read certain pieces. He can’t.

One he mentioned is “about a patient I lost, a young patient. . . . There’s something about the impact of forming the words in your throat.” It’s a hard essay for anyone to read, but ultimately it’s about the poetry in a heartbeat.

The patient, whom Stone had seen through years of difficult treatment, was in intensive care and declining. Only 22 years old, he asked not to be resuscitated if his breathing stopped. Finally, it did.

Tragically, his exhausted mother, who had been constantly at his bedside, had gone home for a brief sleep. Now her son was gone, and yet his heart monitor continued to register impulses. Stone watched it and waited for several minutes. At last, the summoned mother returned, rushed in, cradled her son.

Only then did the impulses stop.