Forgotten, But Not Gone

Dying is symphony,
Fast-slow-fast,
Death is arrhythmic.

Grieving is staccato,
Din of tears,
Punctuated by silence.

Tears and screams,
Prayers and curses,
Are euphonious noise!

Rest is silence,
Silence isn't rest,
Silence is repeat.

In cancer care, the dying process can sometimes feel linear, inevitable, and almost rhythmic, like the familiar structure of a symphony; however, it can be punctuated at any time. Each discussion and patient can feel familiar, and yet totally unique, like how each performance and interpretation of the same musical work can be drastically different.

This poem was written to portray the strong, and sometimes confusing feelings I felt and observed as a fellow in oncology and hematology when managing end-of-life care for my patients. I framed it in the context of the symphony, with each stanza representing a movement and meant to mirror the larger structure. Each stanza was written in three lines, each with three words, to represent how many symphonic movements have three sections and to symbolize the staccato nature of cancer care and the dying process.

The tone is meant to represent the highs and lows of cancer therapy. Remissions and relapses remove and reinsert the specter of death, with a simultaneous crescendo of hope, denialism, and “fighter” mentality from patients and their families that ebbs and flows. It peaks and then often rapidly falls exemplified by isolation and silence from both families and the medical team towards the patient. My hope is that this will resonate with your readers as a familiar feeling and process. However, this poem isn’t meant to be pessimistic. I hope it can bring attention to this disconcerting sequence of events and spur discussion on how to address the dying process earlier and improve support after the decision is made to forgo further cancer therapies.