The Abdominal Exam

Unless we’re toiling away in an English PhD program, most of us don’t pause in our daily lives to read poetry — to read anything closely, really. We might scrutinize a job offer or rental contract, or devour a Facebook feed. Seldom, however, do we allow ourselves to pause over a verse, to wade into a line of poetry or prose and stop, feeling the chill, or the sting, or the pleasure of a series of words, before moving on.

Every month, “Versing Clio” will feature a poem from the American canon that integrates gender, history, and medicine.

This series is less about figuring the “meaning” of a poem — of cracking open a poem’s shell to find a juicy moral that might be hiding inside — than about locating and considering moments of interest or ambiguity that might come to bear on our understanding of gender, history, and medicine.

This month, in honor of World AIDS Day, we turn to a contemporary poem by Rafael Campo, a poet and physician at Beth Israel Deaconess Medical Center in Boston, and a professor at Harvard Medical School. Campo’s outstanding oeuvre takes us into the hospital rooms that occupy his daily rounds, and even deeper into the most vulnerable human conditions, both of doctor and of patient, exposed by that setting.

In this month’s poem, “The Abdominal Exam,” the speaker narrates a clinical visit that results in a difficult diagnosis and ultimately leads to a wholesale reconsideration of human mortality. Before you go any further, read the poem here, or below.

One of the first things to notice about “The Abdominal Exam” is its form: the poem presents itself in rhymed couplets, laid out regularly down the page — a very traditional form, and yet, an unusually traditional form for Campo, who often writes in less regular verse. I love coming across poems that vary from a poet’s traditional style, because it usually means that something interesting is going on: the poet is employing this form for a reason. “Pay attention!”, it seems to encourage us.

The poem begins:

[gblockquote]Before the glimmer of his sunken eyes,
What question could I answer with my lies?

Digesting everything, it’s all so plain
In him, his abdomen so thin the pain[/gblockquote]

In these first two couplets, we can tell that something isn’t quite right. Why are the eyes “sunken,” the abdomen “so thin”? Who is this person — this patient, presumably? We can feel the rhythm deteriorating from the first stanza to the second stanza: while the first couplet has the perfect rhyme and rhythm that we might expect, giving us a complete thought, the second couplet has an enjambed thought — that is, the thought “it’s all so plain in him” is split up across three lines: “Digesting everything, it’s all so plain/ In him, his abdomen so thin the pain/Is almost visible.” This enjambment translates the pain from the patient’s body onto the page, making the pain “almost visible” to the reader by stretching a single graphic thought across three lines, and staggering across two separate couplets. Rhymed couplets mirror the symmetrical and smooth function of our healthy bodies. From the outset of this poem, even before we have received the diagnosis for this patient, we see a poetic body and a physical body begin to unravel. Out of the nine couplets that make up this poem, only the first one gives us the perfect rhymed couplet of iambic pentameter that we would expect.

The poem continues:

[gblockquote]Is almost visible. I probe the lump
His boyfriend noticed first, my left hand limp

Beneath the pressure of the right. With AIDS
You have to think lymphoma–swollen nodes,

A tender spleen, the liver’s jutting edge–
It strikes me suddenly I will oblige

This hunger that announces death is near,
And as I touch him, cold and cavalier,

The language of beneath the diaphragm
Has told me where it’s coming from[/gblockquote]

As the doctor proceeds with the abdominal exam, the rhyme scheme continues to derail as the diagnosis presents itself to the doctor and to the reader. “Lump” struggles to rhyme with “limp,” the changed vowel sound creating a progression that feels deflated, powerless. “AIDS” pretends to map onto “nodes,” an imperfect rhyme that highlights the inherent awkwardness and unwieldiness of medical terminology when presented in a human context. When the rhyme begins to right itself in the next couplet (near/cavalier), we are woken up to the gravity of the situation: In the line “This hunger that announces death is near/ And as I touch him, cold and cavalier,” we still are not given complete clauses, but rather are confronted with the hard, freestanding, and unavoidable realities of “hunger,” “death” and “cold.” And who, in this scenario, is “cold and cavalier” — the speaker, or the patient? The ambiguity here prepares us for the final turn of the poem: perhaps, the poet suggests, the presence of death affects all of us, not simply the afflicted.

But first, this realization of death and its sources stops us in our tracks: “The language of beneath the diaphragm/ Has told me where it’s coming from.” This jarring realization literally grinds us to a halt — as soon as we’ve gotten used to the iambic pentameter rhymed couplets (albeit slightly off-kilter ones), we bump into a line of tetrameter: “Has told me where it’s coming from.” This line, containing four beats rather than five, seems to signal a finality of sorts, however unpleasant it may be.

On this note, the speaker envisions and articulates his own eventual end, as mirrored in the demise of the patient lying in front of him:

[gblockquote]And where I’m going, too: soft skin to rocks,
The body reveling until it wrecks

Against the same internal, hidden shoal,
The treasures we can’t hide, our swallowed gold.[/gblockquote]

In these final couplets, the speaker expands his diagnosis into a universal reflection on human mortality. AIDS, or not, we all eventually progress from “soft skin to rocks,/ The body reveling until it wrecks/ Against the same internal, hidden shoal.” These “rocks” that our bodies become echo the abdominal lump discovered earlier in the poem. Ultimately, this poem speaks to a shared human experience, in life and in death. AIDS does not distinguish us from each other in this poem, as much as it points to our shared physical frailty and the strange ways that our bodies can turn against us. The speaker concludes that the body eventually “wrecks/ Against the same internal hidden shoal,/ The treasures we can’t hide, our swallowed gold.” This somewhat perplexing last line suggests to me that our greatest treasures are internal. And yet, these internal organs that are so elemental to our physical selves, are most often the very things that fail — they allow us to live well, but they eventually give way, one way or another.

As I read and re-read this poem, I am most struck by the frank and intimate entry point that Campo affords us into the doctor/patient dynamic. Throughout the poem, Campo’s use of the present tense places readers in the room with the doctor, the patient, and the patient’s boyfriend. His mixture of anatomical detail and philosophical musing allows the reader to move past a documentary-style voyeurism by creating something new: a beautiful and tragic clinical poetry.