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Medical Humanities

Jaundiced Smile

Sinthiya Punnialingam

April 3, 2015



With eyes coloured in bile
She greets you
With an anorexic smile
Soft cheeks long forgotten
Ebony bruises rooted in skin.
Lips cracked and dry.
Breasts unidentified.
Skeleton of hope lies within.
Muscle stretched and beaten.
Spindles of pubic hair
Soaked in pads of cotton.
Uncompromising, her pregnant

Rivers of clotted water
Flow from her degrading gut.
Drips, wires, masks
Hang on her somewhat.

With eyes coloured in bile.
How do you greet that
Anorexic Smile?


View Editor's Comments

Haemato-oncology is a sub-speciality that can offer the most precious hope in malignant management: cure. With that gift, haematologists are crusaders of evolving research and the use of varying chemo-toxic agents. However, there are some patients who have to endure disturbing side effects. This includes the prolonged cycle of overcoming infections, managing the heavy destruction of graft-versus-host disease, the numbing of all senses and the tragedy of confinement. Slowly, like the changing seasons, you observe either the demise or the triumphant works of chemotherapy.

This poem is based on a female patient who I had the pleasure of looking after. Despite her pain, she always greeted the physicians with a warm, encouraging smile. While her organs slowly tuned out of life’s orchestra, her smile continued to linger. Even at death’s door when the nurses were making sure she was as comfortable as possible, that smile never disappeared.

I remember her so fondly and I know physicians shouldn’t have favorites but she was mine. I remember the night when she passed away, while I held onto her warm thin hand, watching her face. Despite not having her wishes come true, I was grateful that she didn’t have to endure any further suffering in this world.

I wrote this poem in her memory, for doctors to understand that sometimes you can do so much for your patients and yet for some reason, whether it be fate, God or just chance, some patients do not pull through.

I don’t remember her as a woman who had seen many sights and joys, as a mother or a wife. Sadly, I remember her as the woman who had a body that was slowly failing her, and a soul that was kind and gentle. I wish I had known her for who she was and perhaps we should all remember as we manage our patients, to ask them, what do they still want?

Despite the patient's fragility, pain and isolation from the world, she had the greatest desire to live. Hence, the poem is composed of diction that balances vulgarity and persistence. I hope that physicians will continue to assess their patients' emotional stability, rather than lose themselves in protocols, trials and numbers.

This woman had spent so long in hospital, and her final desire despite her morbidity was to surround herself with the doctors and nurses she was used to. She was too frightened to die alone at home.

Sometimes, the end of life is about with whom and how it ended rather than why it ended.

Dr Sinthiya Punnialingam


Department of Medicine

St Mary's Hospital Campus

Imperial College London