Picture of Ally FlemingAlly Fleming is a writer and publicist at Anstruther Press


Illness doesn’t end when you leave the doctor’s office. Affliction is carried, and pain is, as Shane Neilson writes, “a concerto in your back pocket.” As a writer with bipolar disorder and chronic pain, I’ve often felt utterly lost, blinded by what Rita Charon calls the “glare of sickness” . For many, the fundamental question of medicine is not how to be fixed (for it’s often not possible), but how to live one’s life, broken. Physician and pain researcher Shane Neilson’s trilogy of poetry collections from Porcupine’s Quill leads by example.

“Practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument,” (p. 215) writes Charon in Narrative Medicine: Honoring the Stories of Illness. Neilson, with one foot perpetually planted in medical practice and the other in love, unflinchingly offers himself to his readers. This trilogy blazes a new trail—it creates a space for voices like mine, for illness narratives beyond the hospital.

I: Complete Physical (The Porcupine’s Quill, 2010)


At twenty-five, degree on my wall,

I looked to yellowed yards of textbooks

for wisdom, and found data only.

There is no preparation: people die,

and I solder silver linings to grief.

Complete Physical is an introspection on the practice of medicine. In the first book of his poetry / pain trilogy, Neilson explores power and powerlessness, the futility of even great ability in the face of illness, death, and love. In addition to evidence-based medicine, Neilson argues for dialogue and empathy: “what I tell you / is like connecting dots: there are points of light, / and if you cannot see them, I will heal your blindness.”

Of note in this book are the poem-pairs “My Illness” / “My Illness Revised”; “Love Poem for the Doctor’s Wife” / “Love Poem for the Doctor’s Wife Revisited”; “Before (Doctor Monologue)” and “After (Patient Monologue)”. In these couplings, Neilson explores a temporal element, a change in stance or perspective through reflection. One of the pairings, “My Illness” and “My Illness, Revisited”, presages a theme that unfolds over the next two volumes: the poet’s personal experience with mental illness:

My illness is antarctic, is brittle absolute zero,

is the highness of high places, is a frosted four-leaf clover

wished upon: is it over, is it over?


II: On Shaving Off His Face (The Porcupine’s Quill, 2015)

In my face is proof of life and death, no masks but these.

look close to see eternities of axe and dove. Grace emitted

in grimaces given to those who know I’m off, wrong,

embattled by stars.

On Shaving Off His Face begins with a study of countenance, and what facial expression betrays of illness and pain. This is exemplified in a trio of poems that use pathology (“St. Anthony’s Fire”; “St. Vitus’s Dance”; “Facies Leonina”) to explore bodily transformation. At times, these metamorphoses are almost beyond human, and in each case they are traceable to invasion by some microscopic, insidious pathogen.

The second section of the book is conceived around an imagined academic conference on the topic of Darwin’s theory of Fervourism, at which historical medical figures (Benjamin Rush, Emil Kraeplin, Phillipe Pinel, Jacques Lacan) are invited to present abstracts alongside serial killers (Adam Lanza, Jared Loughner, Seung-Hui Cho) and artists (Lead Belly, Robin Pecknold of the Fleet Foxes, Edvard Munch, Robert Lowell). The juxtaposition of presenters calls for the reader to reexamine the concept of expertise: who are the most learned in humanness, in fervour? What does it look like when those at the margins are given equal voice?

On Shaving Off His Face concludes with Neilson reflecting on family life, and, in particular, his son’s struggle with seizure disorder. “Fast” is a standout poem, narrated with his young son’s phrasing: “At night I not tired. Is this the end, the hop-sital?” Here we see a practitioner who cannot heal – not himself, not his son. The grief is palpable:

I want to stop the car,

walk off into the forest, and come out starving, pure,

with a cure. But the thought doesn’t last.


III: Dysphoria (The Porcupine’s Quill, 2017)


What’s a safe space in an unsafe age,

all the implements in our hands drawing our blood

from the well?


In the tire-fire sanctuary of dysphoria, don’t suffer,


Wracked, paranoid and calling on Percy Sledge, Rita Charon, Mad Max, and the Reverend Jim Jones, Dysphoria’s long title poem is a lament set in a hospital isolation room. Howling for love and freedom, a man is straightjacketed by the relentless policing of self, other, and mental illness. Neilson pointedly references Sammy Yatim’s 2013 shooting by Toronto police (and, later in the book, the taser death of Robert Dziekanski):


Off with their head

said the first responder. His gun said, blam blam blam

(pause)                    blam blam blam blam blam blam.


Here, and throughout Neilson’s poetry, we see involution, a turning of narrative tables. Nothing is clear-cut: who and what to trust, or how to move through the unknown.

Inhabiting Dr Benjamin Rush’s Medical Inquiries and Observations Upon Diseases of the Mind, in the persona of Dr. Rush himself, the core of Dysphoria is rooted in the agony of madness and passion. Here, Rush’s textbook becomes a reconstructed vernacular of bloodletting, leeching and gyrator machine. In Neilson’s version, there is no hope for cure, only respite, a drop in pressure:

Natural as to frequency is viscous sleep

madmen never had, but treatment

seizes them to its bosom until comatose.


Orchestration of blows, a great tide against a cracked barrier—where

these men are and what they see, they will only sing. Give them pens.

A key component of Neilson’s work, as it is in all narrative medicine, is voice. Neilson’s poetry has influenced me immensely — his words are a methodology, not of cure but of recovery. Though, in illness, those who suffer may lose themselves, shake their fists in bewilderment at circumstance, Neilson’s books are fundamentally an appeal for wonder, complexity and love.

As patient, as poet, and as practioner, Neilson urges those in distress to sing their passions, their furies, their illnesses – precisely what he has done in the trilogy reviewed here – and, just as importantly, encourages the rest of us to stand alongside, in the glare, and bear witness.