Hi, everybody, this is Donna Prosser with the Patient Safety MIMMA Foundation. Today, we're here to talk about the impact of handoff communications on patient safety. And we're really excited to be joined by Dr. Annegrette Hanawa. She's a professor of communication science at the University of Lugano, Switzerland. Welcome, Annegrette. Nice to be here. Thank you, Donna.  And you direct the only patient safety center in a communication science department at a university. You founded a global research center that combines communication science with patient safety research. And you've also delivered some groundbreaking research yourself over the last decade. So tell us, what does communication play in patient safety? What role does that play? Well, it's omnipresent, right? So it's the vehicle for which health care takes place. We need communication for everything that we do. So in that sense, it really starts with history taking. It goes over diagnosis, treatment planning, treatment execution, post-treatment care, all the way up to discharge. And then, of course, as a preventive function in those contexts. And then also, when we look at the disclosure of adverse events, for example, we look at communication as an urgent or a safety critical competency there as well. So it's everywhere. And so the goal has become lately to optimize communication, as I said, both as a preventive function as well as for safe disclosure. So you mentioned preventive communication. What interventions have been done so far? So quite a few. And as we're talking about hand-ups today, of course, that's been a critical context in patient safety that we've been looking at. And so we've had multiple tools of frameworks that people have introduced. And of course, one of the most advertised one is TeamSTEPPS. And within that, of course, there's four skills embedded in that framework. And one of them being communication. And among those communication skills, there's four different sets of techniques that have been introduced. And if you will have a slide that you can look at right now. So if we go up from the bottom, there's call-outs, which is for communicating important or critical information to other team members, such as airway status clear, breath sounds decreased on right, blood pressure, 96 over 62, and so forth. Then we have check back, which goes into closed-loop communication. In my sense, it's one of the most important things to look at. Of course, it's about validating message receipt. So we're closing that circle of communication. And then one further up is a team communication tool, SBAR, which has been implemented all over the world. SBAR stands for Situation Background Assessment and Recommendation, which is, again, for communicating critical information. Within the team, though, it's not a hand-off tool per se. And then we have, of course, the iPass mnemonic, which is a linear way of standardizing and structuring communication in terms of structuring the content for hand-offs. And that looks as the eye stands for illness, severity, and then patient summary, actionless of what's to do, situation awareness with event statements. And then for me, again, the most critical part is the synthesis part, where the receiver repeats what was said, can ask questions, can confirm the action that needs to be taken place. So all that is kind of a linear assumption again, and that we kind of go through those processes, through those content categories to cover the basics. And it really, all these mnemonics serve kind of a recall or reminder for the staff to make sure that all the important information gets covered. So whatever those mnemonics serve quite well, there's lots of them. So this is just one of the examples. But as I said, now, IPaS has probably been tested most among the ones that have been available, although only few experimental studies have been done today to test the effects of IPaS on objective outcomes, particularly at adverse events. Sort of the golden key study that we've seen there, of course, in the New England Journal of Medicine, reported a 30 degrees in the rate of preventable adverse events, but only a two thirds of the investigative sites. And what I'm missing is the effect sizes haven't been reported in that study, but it's a start. But I still think that there is more research needed to be done to really look at patient safety outcomes as well. So why have preventive communication interventions not been successful up until now in solving our communication problems? Well, they have been successful to some extent, but I think there's a long way to go to look at larger effects of interventions. And I think one of the reasons why we haven't achieved as much as we could have is the fact that these mnemonic devices or these tools and frameworks that have been introduced, they've always been context specific and kind of problem focused. For example, the problem of handoffs or the problem of disclosure or the problem of bad news delivery, right? So they've always been tied to particular contexts. And so there's also no one handoff mnemonic that is ideal for all handoff situations, right? So we've seen variability there as well and there's no evidence that any one mnemonic is better than the other and really affecting patient safety measures. For me particularly, one of the biggest issues is that as we're teaching mnemonics instead of kind of the, we'll talk about that later, that their shared sense-making skills is that we're cluttering medical students as a nursing student's minds, right? Because they have to remember so many different mnemonics for different types of context that it could be really challenging for them to really grasp them and practice them as skills rather than something that's purely brain driven. So for me, I think that there's a path for development open there where we can look at something that applies to all care stages and all contexts and really strengthening that interpersonal sense-making process as a resilience enhancing skill set and rather than just looking at fixing little context specific issues like we're putting a prosthesis in a knee or something like that. So I think that's where we still have opportunity for growth. So what's the path forward there? How do we get to that place? Well, I think we first need to recognize the problem of the problem, right? And I think that there's a couple of pieces to that. First of all, we need to recognize that communication is not a synonym for information. I think still in the literature, oftentimes we see that being a metaphor. Like communication is just like a car that breaks down or a telephone that fails to operate. So I think that the first start is to recognize that communication is much more interactive than just sending a message and making sure it arrives as it was intended, but it's a very dynamic interactive mechanism then also of course now with digitization, right? That's increasing the problem because also with digitization, it rides on that assumption that communication is linear. So I think we need to be careful that we're using digitization tools for enhancing that interpersonal sense-making process rather than just running on that same problematic path that we've been arguing on. And then also recognizing that communication is not a problem, it's a human condition, right? So we communicate everywhere and not very well. That's in communication science, we research lots of different contexts of communication problems. You see workplace bullying, you see intimate violence, domestic violence. You see so many issues that we're researching and healthcare is just one other context where it gets dangerous just like in the airline industry because failures there threaten lives. So I think that if we realize that the healthcare setting is very unique and that there's many people on different backgrounds coming with variable linguistic and cognitive skills into one place and they have to interact quickly, many times a day under the pressure of distracting noises, limited privacy and oftentimes life and death situations. And that's just not a fertile ground for safe communication to just take place naturally. So I think that once we've recognized that problem of the problem, then we need to approach it with more of a fundament of that as I said that I like to call it an interpersonal sense-making process as a resilience enhancing safety feature, right? So that we're teaching or learning core competencies. And so if we standardize anything, it should be standardizing the skills to get us to a shared understanding and not so much the mnemonics. And I think the mnemonics are very helpful and that they do in situations that are under high pressure make sure all the content gets covered but beyond that we need to make sure that as a fundament underneath those mnemonics interpersonal sense-making processes are resilient to failure. So you talked about core competencies and safe communication, what does that look like? So we've analyzed hundreds of patient safety cases to find an answer to that question, which is not that easy, but we came up with a pretty simple explanation. So what we found is that all patient safety events that we've looked at always reduce down to at least one of five communication things that go wrong. So those five we've turned into competencies to prevent them from going wrong. So that's how we approached it. And what we came up with is what we call safe communication as a context that we'll show up later on a slide, Sasha. But to understand first of all, what's the fundament for that, for those skills to happen is the understanding of how communication takes place. And that's pretty simple and many scientists probably at a university intro level of communication, but so what happens is we first get a thought in our mind that that's very complex, right? And our language is very abstract. So we have to take a very complex thought and put it into non-verbal and verbal codes and cues and to convey that thought to someone else so that then it can reassemble like a puzzle in their heads. And we kind of conduct that process as long as it takes for us to really come out with that same puzzle that we share when we look at it. So that's a communication process. So we call this in coding. So when I take that thought and I put it into non-verbal and verbal cues and send it to you, so to say, and you would decode that, that's decoding where you reassemble what I've disassembled to hopefully the same puzzle. And then we engage in the third process that's transactional sense-making where we make sure that we've done that process successfully so that we're actually recreating that exact same puzzle that we had in our mind. So that's the three processes through which communication takes place and that's an old knowledge that doesn't come from me, of course. So, but that as a fundament, we've found five different competencies. We've identified five different competencies that go both into quantity as well as quality of communication. And those three processes, as just explained are embedded in each of them. So the first one, and we'll put that slide up now and so you can follow through the Sasha framework which summarizes as an acronym of those five competencies. So the S stands for sufficiency which is about the quantity of the informational content that's included, right? So many of the mnemonics that we've looked at actually move in that realm of making sure enough content is covered. So, but again, with those three processes it's about conveying content, enough content, extracting enough content and also exchanging a sufficient amount of information with each other to arrive at a shared understanding, right? So safe communication is about arriving at a shared understanding. So that's what sufficiency as the quantity factor looks at. And then the other four are accuracy, clarity, contextualization and interpersonal adaptation that you see up on that slide and accuracy stands for not just conveying correct information or interpreting information correctly but also to utilizing that transactional sense making process for ensuring accurate information, right? So it's sort of a validation process that we can utilize between us and to validate the accuracy of the communicated content. And then we have clarity which is the next one where it's about, of course, again, expressing and also interpreting both verbal and non-verbal messages clearly so to avoid ambiguity in the way that we talk but also to utilize our communication with each other to reduce uncertainty, right? So it's an uncertainty reduction process. And then we have contextualization which in healthcare we found is the most frequent communication error that's happening is there's, as I mentioned before about the context of the healthcare setting being very complex. There's lots of contextual barriers that can hinder finding a shared understanding, right? So they're hierarchies. There's time pressure. They're possibly discrepant goals, right? A patient who's getting treated may not have the same treatment goal as the physician or the nurse dealing with that patient. So to what extent can we utilize our communication to neutralize these barriers so that we can actually achieve a shared understanding? And then the last one is the IA of Sasha is in a personal adaptation. So we've seen a lot in a sense of non-verbally expressed needs to which we need to adapt as listeners or as co-participants in the communication for us to really attain a shared understanding. If we don't, we're not going to arrive at a shared understanding, right? So there's different, it can be emotional needs. We've talked about handing an issue to the patient. For example, that's a simplified version of the problem, but there's also linguistics needs, for example. So if, or a cognitive processing speed differences or differences in education or experience and the healthcare setting that need to be adapted to so that we can actually attain a shared understanding with the other person. So these are the core competencies that we've kind of identified as fundamental resiliency enhancing processes, right? For improving the quality and safety of care. So that's, I think, one of the ways in which we could move forward and help those mnemonics to achieve higher effect sizes because then the mnemonics remain what they are in a sense of helping a recall function, a reminder function, a focusing function in contexts that are under time pressure that are critical. But at the same time, when those processes are trained well, then they can achieve much higher effects at the front line of care. Annegrette, last year you also had the experience of being a patient yourself. Can you tell us a little bit about that experience and how your Sasha framework could have improved the safety of handoffs? Well, it was, there's an article that's gonna come out in August now that you can free to post it on your network as well. In which I explained the frustration I had to experience being a communication scientist, having published for years on this topic and then witnessing how discouraging it is to be in the skin of a patient. So what I saw is two things. First of all, there were multiple handoffs I experienced even within the first few hours. I entered the emergency and then urgent care and then was delivered into my bedroom where I had a numb sensation of about 5% numb sensation in my arm. The first neurologist took it down as a tickling sensation, passed that off to the next physician. I corrected that physician said it was not a tickling sensation, it was a numbness, I felt. And then the next morning there was another handoff where that tickling sensation was then handed off as pain. And again, I again had to correct them and make sure that in their records they would correct that as simple thing that I had corrected before and it still wasn't corrected in the records when I was discharged from the hospital later on. So I was just really discouraged to see how such a simple thing as a sensation in your arm which is nothing compared to a much more complex scenario. I had a stroke so that was much more complex to understand already there the communication failed several times and me as a patient could not correct it. So that's the weakness I see in most of these handoff protocols is that the communication is reduced to the caregivers and the patient who's really supplying also non-verbally and verbally of course, as much as you can lots of valuable information to the safety of the care procedure is just bracketed out, right? And then there was another issue where they were following some sort of a weird as far procedure as a handoff, which was odd. And so they were so occupied. I don't know if it's because they realized I'm a communication scientist in the field or if they were just trying to do it really well I could tell I felt humbled by that, right? But they were so into their mononics that they didn't communicate anymore. And they were just, nobody was making eye contact everyone was just looking at the pen pad and taking down the notes and they went like a linear process through the end and then even the synthesis which should be the part where communication takes place was just another check on that list that they had to complete. And while they were going through this, there was a couple of things I wanted to correct among other things that tickling sensation and I tried to say something and they shut me up. They raised their hand at me like, you know stop sign and said, keep your thoughts to the end. We need to get through this otherwise things get confusing. And then in the end, you're welcome to add what you have to add. So at the end, the problem was we're out of time they had to leave.  So I wouldn't even have been able to recall much of what I wanted to say. So that's just as I said before that not understanding communication enough as an interpersonal dynamic sense making process but rather as that conduit metaphor of that the phone line or like sending information through to the end and just leaving it up to best luck to get there is problematic. And so as I said before, I think that there's a lot we can improve there and talking about patient engagement or family activation I think it's critically important that it's more than just allowing the patient to listen but it's recognizing that the patient is part of the communication process. And if there is a shared understanding to be established you can't bracket out one of the communicators. That's right. Absolutely. Well, and that brings us to the topic of patient-centered care which we're all supposed to be focusing on anyway. And if we don't have the patient at the center of care then clearly they will not have as good outcomes. So, well, thank you so much, Anna Gret. This has been such great information and we really appreciate you sharing your Sasha framework with us. We will definitely be looking for your paper in August and be posting that on our website as well. Perfect. Thank you, Donna. Thanks for having me. Thank you, Anna Gret. Have a great day.


So I'm going to read some very straightforward poems, I think. The first one is called 1918. It takes place in Hope Cemetery or around Hope Cemetery. 1918, a sculptor was tapping eyes out with his chisel, slipping sinews in the forearm, his patron twitching in anticipation of the weight of granite sitting on his corpse. I like to walk around the cemetery because the inhabitants encourage people to bring them flowers so they do nothing. And their families argue about the proper way to acknowledge the row of children lost the flu epidemic, an angel, a tree of life, a bench to rest on. The next three poems are from a book that I have coming out in July with 30 less publishing. The Fifth Winter of My Grandmother. Her father tied her to a sled and walked quietly through snow to leave her with a distant relative. The song of the runners, the creek of the crossbar as he pulled, an owl above his now clear, now distant figure, as snow shifted around him. Her father didn't die not then, but disappeared in the same woods. It was her mother she searched for. Her mother would pluck the oldest and youngest to leave and reset the table for four, a blue water pitcher, this potato, this salt pork. No matter how many times my grandmother cooks the same meal, they never take her back. 43 Howlin Street. When my father waved goodbye, sobs bent him bowed over his cane while the car of his children disappeared. Terrible fear is love with its constant seizure of assurances. Long ago, walking in the early morning in Belgium, his pack chafing his shoulders, his rifle jostling, he couldn't see the next stretch, quiet, except for the feet of this platoon pattering and the sleepiest river gliding over its worn bed. He thought he had lost the weight of himself. Eulogy. My mother spent a long time at 15 years in a nursing home and I visited her once or twice a week and it was difficult as you might imagine. Eulogy. I take the corpse of my mother out. The ground is dry enough for her to shuffle safely across the parking lot. She squints and admires the gulls if they are gulls. I'll cry when she finishes slurping out her rare words and some other herb can be summoned as partial, as extinguished. My mother lived so long McDonald's died. The five and dime migrated to the dollar store and the drugstore lunch counter forever closed. It's gray for my good stall. Singles night. She bundles herself around the last beer and watches the man at the next table tap his finger with a pencil as though larding his skin with thought and another one stroking her knit vest and the weave of her hair.  High Holborn Street. Sounding like a river in spring the man with aphasia calls the dog and the dog brings a stick, a bum, whatever's left over from other dogs. His neighbor, the hospice nurse is coming home from her late night shift and rehearsing the soft thunk the freezer door will make when she reaches for vodka and glass. The man with aphasia goes on calling the dog conjuring specks of his former life. The nurse nods at him, wordless. Early mornings exhausted, houses empty, the street hushes and the moon is fading. I spent many years working in human services and a lot of it was just being a witness to tragedy and suffering. So this poem is mostly about those experiences and also teaching at community college in Vermont. Chase.  An EMT with a shiny forehead arrives first. The car slid into a ditch filling with icy snow melt and the driver, an older woman, is trapped. The driver's door held closed by the bank and the car is filling with icy water and the woman is saying, help me and touches the blood on her face. He doesn't know how to break the window.  The woman is cold and her leg is caught. She's baffled by the blood. Help me, she says, help me.  The water is cold, his hands ache terribly as the water rises, but she's just sleeping now. People say, stay with me because our stories are lonely. EMT and I go on telling the stories until someone promises to stay through the night though we know they can't. When I was on the playground with a new child coaxing a staff member ran across the brown lawn shouting, New York is bombed, the towers are falling. I thought, drama queen but the radios were blurting through the barns in general store and the upper grades couldn't imagine a building taller than the three-story Coca-Cola plant. The total dead in New York would mean this village in the next two handlets would empty. The story of mismatched socks, strewn lunch bags, and the unraveling sleeve of the worst girl vanished. Scale matters in a tragedy. The size of absence and smaller tragedies invisible. A war veteran in my class had been driving in a convoy when the guy in the back tapped him on the shoulder and said, look out. He was turning his head as the shell glided through his shoulder but it took the center of the guy in back. I loved his scarred head and the stories of his childhood and the careful voice in which he gave up and disappeared. That's what it means to be lost. Your story muffled by the transit of bodies shuffled from battlefields. On a husk of stained carpet in a rented room and a warrant of rented rooms I was watching a baby stretch. I traced this baby several times. The father in jail, the mother on the run but I kept calling and now I could see he looked like his grandfather. 20 years ago his grandfather worked for me before he raped a client and went home to his wife reading the newspaper and shot her. His two daughters endured the state's care until one of them dies at 16. I can't tell you her story. I don't know if anyone was listening but the daughter that runs and keeps on running I want to tell her as though he was reaching out from prison to strangle her, don't let him win but a cliche won't release her from the terror of blanketing her. I keep waiting for her but she's not here today. Just the new daddy, just the young daddy newly on parole. Is this how you hold him he asks her child born strung out and laundering himself. Help me I say, the EMT and I am pacing by the side of the road. The EMT is watching a woman speeding around a blind curve and the woman on a side road here somewhere being shot by her Doug dealer and so on always just behind me.  The EMT and I bring our tools and push through the detritus of lives that never really began then return to our good dinners and walks afterward across the park. The enjoyment possible from a shared meal and a walk the way love and hope are sustained by ritual and utterly beyond transmission. What I would really say to the mother of this baby waving at a shadow is I don't want my hands frozen in a cradle for the dead. I'm not sure where we are but help me look for another exit. Maybe I would match her footfall for footfall kicking at the substrate. Public tragedies offer some mutual island. When the challenger blew up and blew up on the wide TV of the group home I was working in no resident had an IQ above 20. The lot of us voyagers covered in miles of space and scraps of burning cloth orbiting the planet. Adornment is the ear of culture an echolocation of place so we don't forget where we belong. I hurry to keep in front of the ambulance or the convoy not knowing what station I'm headed for. I imagine the sound of the sirens is always around me. Up the road for me an apartment burned containing a young acquaintance and her boyfriend. I mean the ambulance went past my door and the snow smoke drifted down. I'd seen her a few days before admired her second baby and imagine the future contained her but not me. The neighbors could hear the yelling for help pounding on the walls when will I stop hearing the ambulance go by my door? You're probably wondering about the trajectory of the orphans of the burning parents and the grandparents the anarchy of loss and then keying forward over the years not everyone reunites with the living. When my mother died she wasn't more lost to me than she had been before. Schizophrenic she was unpeasable and never said stay with me though she has. I'll read one more poem. This poem is a complete shift in tone it's called a tragedy in three acts and it isn't. One. I was driving past Walmart when the transmission fell out of my car. Two. It reminded me of bumping my suitcase up the steps of the greyhound when the cover sprang open festooning the passengers with my underwear. Three. At school we played polio victim. The smallest I was daily loved by grieving classmates from tarmac to apple tree where a miracle occurred because I didn't want to be the main corpse. Thank you. Now I'll now introduce Ralph. Ralph and I went to school together really really a long time ago. And I think you babysat just when I babysat one of his sons. My old skin. We go back a long way. Ralph Culver first arrived in Vermont in 1970 to do his undergraduate studies at Goddard College in Plainfield right down U.S. Route 2 where we focused on creative writing, literature and studio art. He has pretty much remained in Vermont ever since. He currently lives in South Burlington. His latest book of poems is The Passable Man published by Mad Hap Press in 2021. Thank you Sam. We were just talking about Jason turns 50 on me first. Um I'm totally disorganized but you know I've I'm at the age where I don't care anymore. You know I just don't care. Um first things first Poem sitting my pillow here is just the greatest celebration of National Poetry Month in the country I think and it is such a delight to be here to be back at the Kellogg Hybrid being a part of this. Um I didn't want to mention though we've had a couple of really big bosses in our poetic lineage in Vermont just within the last few weeks. Norman Dooby was born in Barry he went to Goddard did his undergraduate work at Goddard and I think he got out at 65 which was five more years before I got there. Um but he worked with a lot of the same people. Um he passed away on February 20th in Arizona and it's just a fabulous poet and totally genuine in every in every respect and then a very good friend a mentor of mine and in fact he was the he was the faculty clinician for my senior study at Goddard Barry Goldenson um who died just a week or two ago in New York and I just wanted to mention both of those men because like I'd like to celebrate them. Um so the first problem I thought I would read is from my book which is here if anybody's interested you can see me after the reading. Um which is the poem of Solace this is called Memento for my friend a carpenter whose father has died it's dedicated to Erhard Mocha when you were in your car driving the darkening road and the sadness strikes you when the lost face rises from the shatterings of rain that uncoiled pale wine across your path when you were eating your cold lunch by the half finished houses and something leaves you and you take up the handle of the hammer and close your grip on it slowly slowly when in a moment there is the sea change a draining of blood salt that heros your eyes to fire and water under cupped hands awake something that never comes remember never forget that the road you take is taking you under the quavering stars that the rain is a thing you wear in your hair like dew crowned with trees in summer that the houses are patient the nail is straight the hands are in no need of waiting that your eyes are the father they are of the world and are not meaning bears you across the world in the water to witness what all is not this is a recent poem but it's dedicated to the memory of Norman Dooby so I thought I would read it and talk about a changing tone this poem dedicated to the memory of Norman Dooby Norman Dooby by the way was a very he had a very dedicated Buddhism practice and there's a word here Zazen which many of you may know I will tell you what it means Zazen is sitting meditation this poem dedicated to the memory of Norman Dooby this poem dedicated to the memory of Norman Dooby begins like every poem with silence not the silence of the instant before the meditation bell is struck but the silence the gong of the meditation bell rides upon into our years as we sit Zazen wondering when is dinner for fuck's sake I'm starving thinking I'll do anything for a cigarette right now the body flies off our bones which become meal for the earth Dooby said Mark Strand was asked if he wanted to still be read after he died he replied I'd rather be alive after I die this poem is called Dancing Down Broadway Brandy it's dedicated to my friend Danny Sidenberg I'd like to read it for Jack and Marge I in particular who are here for this today Dancing Down Broadway with my bottle of brandy for Danny Sidenberg one sober you continue to be repulsive another sheen green senses the need you sense and pivots pursuing an immediate elsewhere turns one eye to the top most of two pulses wet at her wrist confirms she's history from either approach what it is it's you think too obvious things tend to support this conclusion in spite of your demand for little if not nothing from any then her butt-trust foot discerned at the logical end of the last glance falls without thought just beyond the potential lee of a fresh dog pile that squats dead center in the street lights wisdom you think of a barbell and several eastern religions you think life is basically stupid you go home with this weight fat with retreat and break out the last bar you skiffle on the rain-spat paving swing the amber dancing club about your head a warning and a benediction you've finished now you wind your way through these convenient double doors approach the bench two close clown counselors take a brief stock of their virtues compromise is obviously ordered his and hers their dewy stines announce McNally's eyes appraise your burden his fat finger points at your specific self he smiles just close as far as you're concerned the chatter den is if nothing else you've learned when you're not wanting your teeth by the girl's feet you envisage a matched set of pearls broken and scattered in some jug room fray your company in hand you turn away that's that back in the street quietly an old pain sparks two men waiting for a bus a drunk snores in his swollen clothes the obvious again speaking that rough unquiet diamond end of the other of love there is never, never enough this is a prose poem called lesson she poured herself a glass of water the act of retrieving the glass from the cabinet and filling it from the kitchen tap letting the water run across two fingers until she was content with its coldness and then holding the mouth of the glass at an angle to the silvered stream is it steadily filled had satisfied her thirst more than if she had actually drunk from it she set the glass down gently on the kitchen table then just as deliberately seated herself with a reach of it besides a glass tall and narrow tinted a jean blue her distorted expressionless face she considered the glass she considered containment mass and volume how they are in some ways the same and yet utterly different mass the amount the glass carries volume being the space the water occupies and she thought suddenly and unbidden that her entire life to that moment had been spent holding grief within herself although grieving what or for her home she knew she could never fully comprehend and that it didn't matter in any case a gout of grieving and yet oceanic and entirely captive within her she dipped a finger in the water and brought to her lips then she rose and tipping the glass slowly emptied it into the sink Li Bai is a great Chinese poet who liked his wine and the moon in the west he's often known as Li Pao or Li Bo this is this is okay this is called Lamentation of another Evening Waystick after Li Bai the wine jug both right there's a little dude out there with a stick I see just trying to get our attention Lamentation of another Evening wasted after Li Bai the wine jug has been filled and emptied filled and emptied my lips alone have kissed its wide white mouth leaves of torn and crumpled papers scattered about the chamber covering my feet an entire night of raising a cup to beg the moon's blessings hands blackened with ink stained of auto moonlight on my writing desk stained of forsaken verses on my fingers a night of drunken lines mourning my drunken days one page worth seeing if I thought I could make it back to my room I would drag my body down to the banks of the Yangtze in the Awakening Dawn and let this single sheet set sail on its waters under the branches of the Red Naples this is called Coen of the Sort folks know where the Coen is in Buddhism it's sort of a Zen monk would tell you it's like a knock on the forehead to wake you up Coen of the Sort the sounds of water as she rises from her bath while I slice bread in the kitchen how can I still feel sorry for myself yet somehow we managed to Sam's former babysitting charge my son Jason will be 50 on May 1st I don't know how that happened this is a poem called Boy at the Plate not the dinner plate but the baseball plate since the season has just started maybe it's appropriate Boy at the Plate for my children and for my parents spread the boy's legs are unsteady as tent poles in a swallow it is useless to tell him I know what this is waiting on someone who seems as near as the end of his reach chance at shame that he hardly believes it is himself I heard that voice in my head so many times it became a weapon the only weapon I had it is useless to tell him the same voice splits from the throat of the field mouse rearing up to teeth as long as its own four legs useless and wrong for now the boring must believe he stands in the mouth of the first fear birthed in the world later in time perhaps while watching his own and shaken by the glory of it that it is he will see for himself the common fear the common love he fell out of now into and watch and love a couple more I do want to read this this poem is for Hill it is dedicated to her it is called her heart morning her heart morning the roses have used up their time on earth well for now in five months spring will have to say but today the snow has changed everything from despair and promise equally the light increasing from the east frames her of the window as she looks down on the featureless yard beneath its white obscured mantle what to feel she wonders that space in her chest non-committal even though she senses how much the man in the bed behind her loves her what to feel when what we have is good and still not what we wanted she understands she desires a sign a cardinal alighting on the branch just beneath the sill maybe the dog will bark or a rabble will cross the yard by the trunk of the maple in the meantime waiting she sees just clearly enough that she didn't choose to spare or promise one over the other just now his breathing is even a constancy her own breath fogs the window pan under a couple of newer problems I've often wondered I've often wondered if over time I've kissed every square inch of your body it troubles me to think that there might be even the smallest portion of you my lips have not honored I imagine you giving off a steady tell-tale glow a saffirine iridescence and you place my mouth his common contact with you making it easier to isolate and identify those minute segments that have suffered for my unintended neglect there an unlit spot the size of an 11-point lowercase o between the third and fourth toes of your left foot hungrily gratefully I lift through lustrous angle you opened me you opened me with your lips, your hands, your intuition in service of the heart as much as pleasure those two facing books from the same, I'm sorry those two facing pages from the same book the evening skies opening for the moon it had been a long time since I had felt such awakenings the density of light and concomitant shadow more than the thin broken being made whole again a replenishment the way houseplants that have been neglected except the offering of water not a new thing but the essential thing done in a new way all the incertitude in me set free by your rapturous eyes and I'll finish with this as it's called every morning every morning that he awakens it is into a sense of wonder I'd like to dedicate this to my friend Keith up in Grand Island every morning every morning that he awakens it is into a sense of wonder or perhaps more accurately incredulity he has been given another moment of waking which is this moment he assesses his gradual re-understanding of and recommitment to being he tests his perceptions the light limning the edges of the window blinds dogs sleeping at the foot of the bed cat sleeping at the head of the bed woman sleeping beside him a gladness in him for these things joyful all made more acute by the understanding that a final waking awaits the distance between this and that moment narrowing thank you it is my pleasure and privilege to introduce Stephen Lee he is emeritus poet laureate of the state of Vermont 2011-2015 he is also the recipient in 2021 of the governor's award for excellence in arts which is the highest award that the state can give a person in that category and he has his book is it here that you brought which book did you bring today here so he brought his book here collection of poems which is on the back table for sale and his two books coming out a collection of poems called what shines and book of essays such dancing as we can Stephen Lee I didn't realize that I met these two young poets oh let's talk about age see ya on page say I'm the first time I'm the first time today Ralph in Sam's case we're putting together my successors poet laureate I'll never forget the phone call Alex Aldridge was at the Vermont arts council and they called up and told me if I would accept being a poet laureate not my person in the room was my then 16 year old daughter we have 16 year old daughters he's poet laureate of Vermont he said I think it's pronounced low rate low humility never hurt anybody and Ralph I encountered when I was the judge of a chapel contest and I followed him working with him I've been to him ever since the passable man but available back there at Wilworth I'll read a few poems from I'm sure came out with exclusive timing as does the nation walk down church building at all events I'll read a few from there and a couple from the forthcoming book and then a couple even more recent than that the first one is called The Owl my father I've meditated on this quite a bit in my over the years the country makes less progress than one wishes it would he was the company commander of a company of so called colored troops in World War II a lot of people don't realize that it was on the left of the war rather than Truman integrated the armed forces and he was stationed of all unfortunate places before going overseas for Wales and then the Normandy and Gatston, Alabama and he made a great mistake of showing something that this column will report on once the Jim Crack cross got burned on a lawn my mother took off back north to have him my father was stationed in Gatston, Alabama before the Second Great War commander of so called colored troops and he invited a few of his men inside the house it seems a radical thing indeed just then in the heart Jim Crow Dixie so my mother escaped giving birth down there although I don't have any idea why I think of this which near to her death many years after why now I'm watching a bothered owl glide to a hemlock going dark at sundown everything else is well going dark around here where I stand once at midnight she thought she'd heard a hoop of human anguish and wondered whether some soldier was being lynched outside my father went for a look that found nothing my lifelong relations with my mother were vexed I now suspect in part because between us too stood a lot in common Jews were being crammed into cattle cars to send to her dad of those troops the evil in Europe they several months ahead still real or imagined that cry of mortal misery stuck with my mother though no signs of nearby violence turned up next morning the company came on mass to mess shit on the shingle as the GIs said red beef on toast so life went on at least for a while more or less it ought to bring comfort that I'm where I am aging but save my kid constantly squilling the sons and daughters produce their sons and daughters and winter so harsh this year giving way at last a spring with snow drops clinging freshest making their reminiscent cascades through the woods I recall how I'm up in love this season why isn't this lonely sensation it feels that I'm in some pitch black tunnel and won't get out again that this is as the saying goes it that all has at the end of course there can't be anything to it it's a sorrowful eight note anthem of that single owl the sound that just now having reached my vexed old head though it'd be foolish to think that song was addressed to any human in 2016 I was in my old age my my young age and I was about 16 I realized I could not I couldn't run using them somewhat loosely to stay in shape anymore and so I took up in a fit of what that same daughter called Giza Madness the competition that flat water kayak competition which I continue to do and I was we have a camp up in Washington County Maine and I was training for this and feeling very good I was 73 years old I think we were good sheets up here not during any of the workouts it was a 12 mile race and I was practicing at 9 and came back and it wouldn't go away it wasn't very painful at any heart but any shortness of breath or disease or anything like that on the other hand what's my father, grandfather and great grandfather old guys in their 50s and current or in troubles like me living in a cardboard box down here in front of the fire house I suggested that I might want to have a look at in the middle of Wisconsin Howard because clinic so we could easily, we were going to do it so I drove now there Cal's name and the new run of the quarter and out of blood test we were having a heart attack I can't be having a heart attack it was not like any heart attack it was my life and I had a stent put in and a fence felt better than I did when I didn't know there was anything wrong with me so I'm still on the right side of the graph but this is a I noticed when I put this book together and I don't buy into the notion that poetry is prophetic, at least of all mine but I noticed when I was putting this collection together there was a lot of poetry that I had to do with physical press here, it's called here being here which becomes a I'd rather to be alive after I said that I'm not dead yet it's a fine thing and I found myself sort of celebrating my capacity to enjoy the hereness of here and I had this event and this is the final poem in that book it's called here itself because most of the poems were written before this for this incident and the description is from the eastern main medical center patient's report 821 2016 the losing stent placed in occluded right coronary artery, otherwise hit a pleasant 73-year-old male guess which of those adjectives my wife's had some pause over at any rate that's the inscription I had a heart attack it's something I kept on thinking when here's from others in search of dazzling revelation I wandered blind into the world and begun to see as much having approached Paul's barbershop for instance down the same asphalt alley in the same old hard scrabble hamlet and through the same old waiting room with these copies unchanging of guns and ammo popular mechanics, whatever I contemplated the ancient jug with Lucky Tiger Paul's horseshoe-pitching trophies the snapshot curling around his tax of the 350 pound bear in his birdfinger and Paul's and myself right there in the mirror as ever it's 40 years and more he's been cutting my hair and it's dwindled 3-4 full decades of identical questions when he's nearing the finish whether dry shall I do the eyebrows a little more off the top trim the ears of course he knows the answers but right that's all I'm in a very comfort wonder lies in a miniscule thing I'm here there's a tough late solitary dahliad in our flower garden Oded Maganzer Drake is grading like a rusted hinge from our time I notice these things it seems to me now I haven't before I felt no fear just wistfulness of my childhood friends I had a breath rehearsal for death but no terror strapped to a gurney I went off to visit the wonderful Isness of Was the issue of Isness of the River an Indian summer paddle trip on my beloved kinetic river reflected below crows crossed the water and it disappeared behind a scrim of yellow lead cottonwood silver maple I can't quite describe it but here I am to see it I push through the windrows of Wester's Fall foliage on the surface there above the village's steeple a cloud resembling nothing only itself not chastity not purity not cotton, not whipped green itself who want another to see it itself entire some new ones what is it called Hangman's Moons I dream of horses on a nighttime road dead silence rather than stride the moon would hide to it when that pallid company travels together along this lane you might think the whole world is asleep the horsemen kick free of their stirrups dismount, mills for a moment and a mutter it seems there's an excrement someone climbs holding me into its saddle someone who thought himself a flower whose petals were distant to last someone who all through his gaudy life believed himself bright as blood he too turns pale as the ghostly moonlight and gallops off with the rest somebody got my wife on me, I tell you oh so nice I better take this somebody's trying to sell me my car one jeez almost a new book what shines astonishing it's never ending effort to have had a happy childhood why does it matter now why wound yourself into all that forgetting she may have been a good mother at least she tried did she once again you're the one who's trying you contend you do remember moments of the glow you picture her standing one day in the snow her teeth and a chatter no doubt and yet she looks quite cheerful where she seemed to be crying as you are the teeth at least were one good feature radiant to the end you were poised at the top of the hill on a flexible flier red sled that shone your Christmas present at nine it may have brought you joy you're trying to alter the down slope slope rush to make inch shiny too to forget the icicles of snot the raw fingers chill blade pain a father was there a good man you always believed is now no more than a specter whose presence is no more advantageous than on that day or was it of some avail you can't remember you honestly can't remember perhaps you just don't want to well at least you're trying with this you're often bid to window the damage and see if there's anything more than just the sorrow well there were certain answers you say I remember stones you say I saw a beach by moonlight and did those pebbles glint like stars if you insist are you quite sure clouds never came into eclipson you keep on crying there's that pervasive gleam along the shore and you take a step forward and suddenly there's nothing short moments yeah I just want you to know that I am lots of fun in real life so let's train this is called suspension season of the strawberry moon the aganth is called it the berries ripen in June we see them along what's left of nature toad roads some say rose me moon some say hot we won't be but if we were forced to forage those shy red bubbles wouldn't start to sifle our hunger if salad tuna can be shared we share it here deep in the woods and that's where it is there are gullible perch in the lake under damp dust in the forest bright worms for bait we own a stable canoe rain dripped all day from the eaves then blue broke through exactly on time for moon to delete it our correctly portable radio says fair tomorrow hot but pleasant more than fortune what did we do to deserve this in a jagged row at our clearing did wild roses glow like gemstones displayed on the fell mere minutes before the darkness heals the moon like two and they go one again to fell the fly kept drying its wings all afternoon on a wall beneath the eaves it listed just this dusk to hover briefly over its tiny world the way we do over ours and finally another patling poem this is a more single when I'm not pretending I'm 24 out there with my typical kayak I often go down the river and back with my wife and I hope I can do and let's remember the moment of that kind to my wife's back I'll make it but for a scrap to trap my gaze as we paddle the deer or familiar nubs with spine bone punctuating that sun warmed sloth the slender muscles that troubled the same sweet surface we've watched and smiled as green herons flushed and hopped at every bend and we've looked up at a red tail tracing open script on the sky so clear and deep you might believe it's autumn no matter it's August still another fall will be on us before we know it of course we adore that to make motion of color but it seems to come again as soon as it's gone away they all do now I look for you over 40 years extends in all directions but just now as you're back we've seen a mix but please we've seen an osprey start to die but seeing us think better to see these wagons and hash land it works though as long can't see your legs but they're longer I know Phoebe Osprey Marvel's under black mountain but I'm fixed on your back indifferent to other wonders right when I was flared in the shallow the gleam of that torque makes a coat even the fleas and its fur the various burrs the luster creatures just to survive I watch your back never have I wished more not to die thank you we were we left some room in case anybody wanted to ask anything provided it's quite because we're old poets it's implicitly sensitive and weak don't want to do it on camera I'm in that case I don't want to ask you anything just as well what do you think would be different I'm not sure different for regular what if you read each other's points I just wonder if it would bring a different dimension to the point I'm just curious what you think about that thank you much I think it would I think it would go ahead Rob I was going to say one of the things I like to do when I read which I didn't do today it's the first time in a really long time is read a poem by someone else like start by reading a poem by someone else and I actually I brought one of bears which I thought I would read but I thought we were wrong the reason I didn't do it is because time frame I think that's a terrific idea and I don't think there's any question at least in my mind that each individual person would bring some sort of nuance or energy to the poem that probably the poet himself would not it's really interesting I was just thinking yeah do you want to respond to him or well I was thinking about how different it is I'm a big fan of John Berryman and at some point I realized he was on YouTube and I listened to some of his poems and I thought no that's not right I know that road by heart our stresses are all wrong so really it's interesting Kira and you know it's kind of a revelation sort of like for me I'm a big fan of Mary and Louise Kelly's on NPR and I wonder what she looks like I had this picture of her it's completely different I said I wish I'd ever done that now paying the same kind of attention I said I should but I think one of the things that we underplay or I can speak for myself at least as a recovering English teacher is that the you know it's just poetry we're made of something else in language whatever we put on there in a way we just peel out a way to see what the deeper meaning is whereas it's really a physical art in many ways I mean lyric comes from playing the lyre and singing it so it's a column of air coming up putting something into the room I make myself recite my own poetry to myself when I think it's finished and if I get to a phase where I'm kind of mumbling my way through it's wow it's not finished so it's a wonderful question I don't think I've ever I did have a weird question once are those real poems or did you make them up which was a very hard one to understand but a lone answer I love what you said Sando you mentioned bearing specifically because I've had that same experience too I've heard and not just poetry but prose and fiction as well when I hear I've heard the author read something that I really loved and I just wanted to go nah that's just not right it's not the way that I heard it and it's almost like when I was when I was driving down from Burlington I was listening to the radios I'm always doing and I heard a couple of I was listening to what was it anyway there's some serious explanation the point is that they did the DJ did a little stint of songs where the original artist did it and it was followed by a cover version of the song and the thing that is so cool about that and sort of goes back to your original question is how great the cover versions can be and still be so different from the original version and how the cover versions can be so different from each other as well as from the original version yeah that's a really good idea I wanted to talk about if you and I don't remember where Sam went she died okay having a with some or thoughts or a human part about the drive to continue writing poetry as the age what do you think about that all my kids are all saying money and women you can't beat the money I can't do that I don't know I can't stop doing it that's all I don't need to drive the discipline is to go pick up the grand kid the writing is nothing that's what I do it's the only way I know to make sense of things I do it if other people like it that'd be good but I do it because I understand things better if I'm writing about it I think about the things Sid said like you're reading this thing out loud that you've written oh no that's a dead zone that's not what I really felt so it really is a see I understand more about being alive and of course which does change it's really tremendous yeah that's what I was going to say it isn't so much the drive to write itself that changes but the subject matter has really changed the material has really changed and I think that has a lot to do with what they have changed I remember somebody saying to me many years ago when I was a kid something like you should just be in love and pissed off all the time because that's where the best your best poems are all about being in love and being pissed off and now I'm in love and hardly ever pissed off and so I'm just kind of stuck with that old chestnut and and the other thing is it's the biggest chestnut of the mall is the whole mortality thing as I've gotten older with Norman Doody and Barry just within the last two months and we all have that sort of familiar sense of I mean if we live long enough we're going to lose people that we really love and care about and that has a very interesting way of reflecting back on how we feel about you know what we have left like how much time we have and so that's certainly become an occupation without a preoccupation in the last you know that that changed me in a way you know I mean I think I was more death obsessed when I was in my 40s than I am now you know my mother nature is undefeated I don't have a teacher about that but I don't sit around thinking well gee I'm 80 slowly life expectancy fruit but I just don't do it and I was interested in what Sam said because I think it's a kin to what I've often told people that I write to find out what I didn't know was on my mind and I also write to find out what I didn't know I knew and is that hard to that's hard to explain but geez I'm aware of that and I've been aware of it for a long time but I haven't been aware of the fact that I'm aware of it you know and it's the discovery I find that's why I think you know people have programmatic views toward poetry I do like political poetry even when even when the politics are politics I agree with well this person knew where she was gone before she wrote the poem so there's no surprises here why don't you write a letter to the editor and then write a poem which contains that animus of that emotion against a certain recently happily sequestered or not yet I still got it why don't you incorporate that into the poem without being odd home in him or odd feminine you know just to take off in what so already been said I often find that in the process of writing I discovered that what I believed I thought about something it turns out it's not what I think at all I actually think something completely different so it's interesting to see you have to let yourself be honest because we all have an inborn sense you don't have to show it to anybody but that's really the way I that really might take on the situation but that's shameful but that's it's genuine to put it back in the drawer and then burn it if you know when it gets discovered don't become a memoirist you gotta let it go honesty is so rare that finding that in any piece of work that's a great one-liner it's just a great thing that you can do in writing or in painting but to create something honest that does say what you feel the complexity of it sure it's a lot of work and I I can fudge it but I used to have a whole slew of people to whom I feared my poems completely buried and but I don't read anymore she's not a literary person though very highly literate but she knows me really well and she's right you know, snag new age, sensitive new age guy I know you're better than that you gotta get changed that come on and it's humiliating it's chasing me in a proper way I just had thought the first thing about having somebody else read your poetry etc I think I'm a classic poet but the as a reader of poetry which I have always done what I like about that experience is that the poem when I read it is no longer your poem that reading a poem just transfers into the experience all of that I've never really been interested in a poet a poet but you know what happens when that goes into my brain and becomes part of my narrative that's really good it comes public property in that sense you don't have that all wrong you don't have it right by your life and I think I want to throw it in an essay and I still stand by it I think there in almost every case I write a poem there's a hidden allegory in it and it's hidden even from me I really do I wrote a long poem after my younger brother the torture of life he died a cocaine addict very young and I could write for like six months after he died we've had a very twisted relationship and he's gone what was that all about and then all of a sudden I sat down I wrote the longest poem I've written 15 pages and I never stopped I kept going I kept going it escalates and finally the narrator who thinks he's just you know, God's gift to the earth is house burns down and he loses a child in the fire it's not a happy poem and I when I got done writing it I was kind of like shaking it just came and I said well being a good puritan I said well this can't be anything really this game is too easy I thought I didn't change more than 10 words I'm an obsessive repiser and I came to think later on that the allegory of that poem was you warded yourself over your brother you were the good guy you know he did everything wrong you did everything right and that wasn't that wasn't I think that's why I came in such a rush I had no idea of when I was doing it and I made me wrong even in that construal but it sort of makes sense that might have been and more to bring back to what you said about I mean I'm just paraphrasing but sort of a sense of ownership like when I when I read the work of poets I really love I feel like I've taken that in almost the way that you would like eat a meal or something like that and then you just kind of assimilate that and it becomes a part of you and there's there's no and even sometimes we'll hear even these kinds of sessions people being asked well could you sort of explain what you meant by something and you know it's and then the person goes on talking about what they meant or thought they meant and I feel like attacking them on the shoulder and say no you got it wrong it might be your problem but it's my poem now I know damn well actually Jack did you want to say something way back yeah I write stories I try to write stories and it seems to me that I've been trying to write the same stories and get them right for the decades to come and I can't it's difficult very difficult and today listen to Sam, Ralph, Sydney send to you guys your word ahead of us what might be an insight a practical consideration that is an maybe a sure sense of what I can get rid of in the work with some necessary and my experience reading poetry friends who are poets that poets means with narrative is very powerful sometimes what's after 130 I think they were saying now we've been here for 65 minutes okay you all for coming thank you so much thank you thank you