Levin GP Glenn Colquhoun talks with books editor Catherine Woulfe about his new collection of poetry, Letters to Young People.
Glenn Colquhoun is an acclaimed and accomplished poet. He has published four collections, including Playing God, in December 2002, which sold a massive 10,000 copies. He’s won a clutch of Montanas and the 2004 Prize in Modern Letters (which at $60,000 was the sweetest pot in New Zealand writing, until it stalled after just four rounds); he also writes children’s books and essays, often about medicine, occasionally for The Spinoff.
Colquhoun hasn’t been publishing as much lately. Nine years ago he helped to set up the Horowhenua Youth Health Service, a free one-stop-shop for people aged about 10 to 24. He is the only doctor working there, with a nurse and a receptionist. “We’re only open three days a week,” Colquhoun tells me. “We’ve grown now to the point where we have to close our books most of the time because there’s more kids than there are us. So we’ve worked really hard in the last two or three years to try and convince the DHB and anyone who’ll listen that we need more funding to open fulltime.” The service deals with any primary healthcare need, and he reckons that divides roughly into thirds: contraception and sexual health, mental health, and then everything else. But lately Colquhoun has noticed mental health is bleeding into just about every consultation.
He knows this because he knows the kids’ stories, because the way this clinic works is extraordinary.
“It’s a huge lie in primary healthcare that you can see someone in quarter of an hour, it’s the greatest, most perverse lie of primary health care. I’m furious that GPs across the country don’t stand up and say, ‘This is a lie, this cannot be done, it is not done, and we miss heaps’. We’re bent over by a financial model and we’re fattened up by it and we don’t call it what it is.
“At the clinic we’ve just said, ‘No, we’re not going to do it like that.’ The shortest appointments are for 30 minutes and we’ll regularly spend longer than that, and sometimes up to an hour and a half. And often when a young person enters the service we’ll spend a few hours with them every week until we untangle some pretty big stories, to be honest. And then, if and when a relationship has grown and you’ve seen what is really going on in a person’s life and what the real issues are, then you can have 10-minute consultations because that kid knows that if they need longer they’ll get longer. And you’ve got a plan and you’re just working on this little bit today.”
The team bakes cakes for kids’ birthdays, sends them birthday cards with $1 scratchies inside. Huge hit. There’s lots of flexibility, lots of texting. “It’s easier sometimes for the young people to talk in that way … And when you go to lockdown for example, it’s so easy. Half the kids have got our phone numbers so we just gave it to the other half.”
He says it’s like having 600 nieces and nephews. It’s proven to him “that the old medicine, of setting up somewhere and staying there, is a great medicine. And there’s huge efficiencies in it.”
And another remarkable thing: sometimes, having fired all his “medicine bullets” at a patient, Colquhoun will sit down and write them a poem. Letters to Young People showcases a few dozen of those poems – ‘To you a young person finding the journey difficult’, ‘To a young man haunting himself’, ‘To a young woman raped by a friend’ – as well as a poem to a niece beginning her nursing career, and one for his daughter, Olive.
Colquhoun tried to contact all the young people he had gifted these poems to. Many asked for their name to be attached to their poem. Some, Colquhoun was unable to contact. “I like to think those poems wait here for them to return one day nonetheless,” he writes in the introduction.
We spoke ages ago, one evening in late October.
The Spinoff: What does it feel like for you, putting all these gifts, all this energy, into one volume and sending it out into the world?
Glenn Colquhoun: It’s been a very tender experience, is the word that comes to mind. Most times I finish a book of poetry I kind of don’t want to look at it for a couple of years because you have to reread it so many times, you sort of obsess about whether you use “and” or “but” or a comma or no comma and you’re just so tired of looking at the writing. But I still like picking this book up. It’s like looking at a photo album and reminding me of the kids that have come through the clinic and the connections to them. We’ve had spectacular failures but they have been, by and large, very tender intimate interactions, you know? Listening to young people’s stories and their vulnerabilities and trying to find ways to connect with them really, and ultimately to let them know that you think they’re worth heaps. And that they’re unique and that you can see the uniqueness in them. And the kids have a way of forcing an honesty from you.
When I’ve failed [as a doctor] over the years I’ve gone away and thought “I wasn’t in that consultation in the way I needed to be, I was using something from another consultation, or I was carrying an energy from somewhere else into that, or taking it for granted, or taking it lightly and not giving each person the space that they deserve” … so you know, you go back and you try and do that.
That’s exactly the same as writing a poem. It’s like, how do I keep my spirit open enough to be moved and touched by this thing I’m looking at? How do I not bullshit when I have a facility with words and I can get away with bullshit. How do I not bullshit, when I’m a doctor and I’ve got slick at a whole lot of things, how do I not bullshit?
Above all else don’t bullshit.
So how did the poems come into your medical practice? Do you remember the first time you wrote for a patient?
I do, I do. It’s a poem called ‘An attempt to prevent the suicide of a young woman’, it’s the second poem in the book.
I do not want
you to die
I have my
but they will only
make us argue …
She was a young woman who was really intelligent and insightful and had been, out of the blue really, struck down with a depression. She had a strong desire to stop existing. Most of the young people I’ve talked with don’t really want to die, they want to stop feeling bad feelings. And they want the shittiness to go away. But this young woman was really challenging about why, if her life was so unhappy, she should be prevented from not existing. And you know, she got all the traditional treatments, but I just became deeply, deeply fond of her and also challenged to answer her, as a human being. Like: why is life worth living? And the part of me that was a poet was challenged to write a poem about that: what would I say?
I shared it with her and she said, you know – I still love it – she said, “Thanks so much for that, I really appreciate that you thought about things from that perspective and took the time to write something for me, but I don’t know what it means. And it doesn’t make me feel any different.” (Laughs.)
It was great, she put me in my place. But I think it’s all relationship building as much as anything. She got through that period of time and she moved away and we’ve had contact through the years.
I wrote another couple and then I thought, what if I just kept writing? I’d started to see the usefulness from a medical point of view but it was also a nice poetry problem: how do I write a poem to a kid with focal segmental glomerulonephritis, you know? How do I write something pretty but also understandable for a young person? They became long thin letters, most of them. I don’t know when the poetry project took over from the medicine project, they kept weaving around each other, but I knew I wanted to take each poem back and give it to the young person. That it wasn’t finished until that was done.
Were you actually printing them out or texting them through, or what?
I would print them out when I thought it was finished and I would text the young person or call them and say, “Hey can you come in and see me?”
And of course every time a doctor calls a patient, everybody in my experience thinks they’ve got cancer, so I’d say “No it’s alright, you don’t have to stress, I’ve just written you a poem and I want to give it to you”, and they would just be gobsmacked. If I could have caught the looks on faces eh. They were just completely “What the fuck?”
Then I’d insist on reading it to them and then I’d give it to them, and yeah. Tell them that they are awesome and that if nothing else, if this is a pain in the arse then if nothing else I thought about them and what they were going through, and that they moved me and touched me as human beings, and they’re worth heaps to me. And send them on their way.
Most of them I think just took it as a gift. Sometimes it opened up new channels for us to talk. Some were really moved and it really did add another layer of shine to the connection and others were like, “Oh man, thanks”, or “Oh, sweet”, and they’d sort of shuffle off a bit shy and not really knowing what to make of it. Or they’d change the topic and talk about something else pretty quick to get away from the awkwardness.
Did it get properly awkward? You must have been having to think carefully about boundaries.
Yeah, that’s true in any area of medicine and particularly in youth health. But I think sometimes we in medicine, you know, we use that old chestnut “Be careful of your boundaries” to stop the power of relationships. Same in education. “I don’t want to break boundaries” can become a way of just saying “I don’t want to put the work in”. I think boundaries are there for very very good reason and I don’t take them lightly ever, but also, you know, it’s hard to walk away from a kid who’s opened up to tell you something. It’s like there’s an unspoken thing sometimes for a young person: I tell you to see if you stay. They’re looking to see what happens next. I think you can stay, in lots of ways, and maintain boundaries.
[Sharing the poems] brought intimacy. Was it awkward? Yeah man, but some of the biggest moments in medicine are awkward. It’s awkward when people die, when they vomit, when they wet themselves. Being sick is awkward, and it’s like holding the energy of that awkwardness and saying you know what, we can get through a bit of awkward, eh.
Has anyone come back to you down the track and said that their poem did leave a mark?
Yeah, there’s heaps of ongoing tenderness. So that poem ‘Via Dolorosa – to a young woman and her remembering’, for Bree, the big long poem in 14 parts, I can barely read that without crying.
It’s about a young woman that I’ve had a conversation with most days of my life for the last five years. It’s like a five-year-long consultation that’s still unwinding. She also has a huge story, such as no young person should have to go through, and she spent her whole adolescence from the time she was a little girl, you know, of six, untangling that tangling, and trying to find meaning in her life. I fired all the medicine bullets and it didn’t really do any good and so we just held on. We go for long walks around the streets of Levin and chat.
That’s a poem really about the boundaries of medicine: what is the end of medicine, where do we stop, you know, where does the connection stop?
My friend, here we are.
What is wrong, we know,
it sits like a mountain
risen up from the plain.
Its height, we know
and the number of days
it will take to walk around it …
It’s about walking off the path and starting to go up the mountain with a kid and not leaving them, but also not screwing them up. One of the things I’ve seen a bit is that in situations like this, sometimes people do graft onto people and it’s OK to bond to them for a while. Just like a plaster cast allows the leg to sit within it until the leg is strong again, and if we deny that part of ourselves as human beings or doctors to form, then we ignore a powerful medicine.
It was a very soothing book to read. I mean obviously some of the backstories of these young people are grim, but there was something about the rhythm of the poems and the care that you took – as I read I found that my thinking had taken on the same rhythm as your writing, which was a really peaceful way to finish a day, so thank you for that.
The image I use a lot for what happens there is you just try really hard to be still. I think always of that image – it’s a bit prosaic – of a handrail going down a set of stairs. The stairs can wobble and the kids wobble, and you just keep running beside them, keeping the same distance, not too close so that you’re doing everything for them, not too far away so that they can always put their hand out. And you’re never far away.
Sometimes they cling on for three or four steps then let go for a while, then 10 steps later they just quick touch again. Sometimes they walk down the whole stairs with their hand on the rail, there have been relationships like that where they’ve become almost part of the family. Other times just once or twice and you’re away. They’re bowling down the steps by themselves. It’s keeping still, because their heads are aswirl. Whatever’s happening, there is a stillness.
And it took me a while to find that letter-writing rhythm, stylistically. It took me a few poems to think they need to be long, thin letters, not too many words in a line, not too dense for them, just little, and gentle, like you’re writing to somebody encouraging them, telling them that they’re worth something or that you’re there or that you thought of them.
The book feels a little bit like a wrapping-up, is this a you’re moving on from medicine moment, or … ?
No, no, no, no, no … I know that it’s right to hold the stories for longer, you know?
There’s beautiful doctors out there, colleagues and mentors for me, but I reckon as a profession we’ve bolted from the story, we’ve bolted from patients in pain, we go back to leafy suburbs and we don’t stay in the hard streets, and our kids don’t go to the same schools. We leverage our social power to get the fuck out of there. And we don’t sit and hold the story, not just with individuals, but with communities. You know, and yet that’s such brilliant medicine.
I interviewed a surgeon once who is campaigning for a more compassionate approach to medicine and he sent me research showing that if you are in medicine and you take that compassionate approach consciously and consistently, you come out in a better place as well. That it reflects back at you.
Oh Jesus Christ yes. The kids have saved me, you know. I had a very compromised relationship with medicine.
In the book you call it “a wide ocean of miserable medicine”!
Yeah that pretty much sums it up, you know. (Laughs).
There’s a poem at the end about love, it’s like when you fly over the sea on the way to another land and you come down, skim the waves, and you think “I can’t stop I’ll drown, I’ve got to keep going” – and one day you stop, and you start to drown, until you realise that you can breathe this, you can breathe underwater, and that what you get back from patients gives you oxygen.
So my life has much more energy in it now. That’s the irony. It’s like, I can breathe this. There’s days you feel like holy shit, but I don’t feel drained, I feel filled up. It’s an amazing bittersweet human feeling, like this is what it must be like to be a teacher in a community for a long time. And this is what it must be like to be a doctor in a community. The community feeds us.