This thought-provoking poem is best read with a representation of the painting to which it refers in view (the painting, Landscape with the Fall of Icarus by Pieter Bruegel, is reproduced in On Doctoring). Auden considers the nature of human suffering: "how it takes place / While someone else is eating or opening a window or just walking / dully along . . . . " For each individual life affected by personal catastrophe (in the painting, Icarus falling from the sky into the ocean), there is the rest of humankind which must go about its daily business, either oblivious or unable to assist (in the painting, Icarus might almost be overlooked, flailing in the lower corner of the picture while the ploughman in the foreground has his back turned). Life, and death go on although the sufferer, and sometimes those who are paying attention, find this inconceivable. And what about the ship "that must have seen / Something amazing" but "had somewhere to get to"? What is the context in which suffering is noticed, what obligations exist, what can and cannot be remedied?
Although the title suggests a letter, this prose poem is written more as a dramatic monologue. The speaker speaks to his wound ("my dear") as though it were a jealous lover. Written some 18 months after a diagnosis (which is left unclear), the poem allows the speaker to think back over the time, reflecting on "what a great change has come over us recently", meaning a new kind of maturity, of empathy, brought about by the speaker’s suffering. The "letter" ends with the speaker’s remark to his wound: "The surgeon was dead right. Nothing will ever part us. Good-night and God bless you, my dear. / Better burn this."
Beginning with the words, "They are and suffer, that is all they do," this poem describes the experience of those who are recovering from surgery and their treatment at the hands of impersonal doctors ("The treatment that the instruments are giving"). Suffering and pain narrow the patient's world and isolate patients who "lie apart like epochs from each other" and for whom "truth" is "how much they can bear."
The speaker also describes how difficult it is to imagine pain when one does not have it ("we stand elsewhere / For who when healthy can become a foot?"). Finally, the speaker refers to "the common world of the uninjured" where we "cannot / Imagine isolation," but share happiness, anger and "the idea of love."
Auden wrote this poem in memory of his own physician, Dr. David Protetch. He begins, "Most people believe / dying is something they do, / not their physician . . . " Auden, whose father was a physician, knows better. His father had warned him about doctors who are too aggressive or too concerned with money. Fortunately, he found a consultant who thought as his father did, perhaps because he (Dr. Protetch) had himself "been a victim / of medical engineers / and their arrogance, / when they atom-bombed / your sick pituitary / and over-killed it."
While prescribing for Auden’s minor complaints, Protetch himself was "mortally sick." Because of this, Auden felt that he could trust his doctor to tell him the truth about his medical condition: "if I were dying, / to say so, not insult me / with soothing fictions." Thus, Auden praises Protetch for having been, "what all / doctors should be, but few are . . . " [78 lines]
Miss Gee wants to be a good girl and keep "her clothes buttoned up to her neck." Time goes by. Finally, she gets on her bicycle and goes to the doctor about "a pain inside me." The doctor diagnoses cancer. Later, over dinner, he comments to his wife that "cancer's a funny thing" that attacks "childless women" and "men when they retire."
