Angelica: September 2012

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Paris

February 17, 1903

Dear Sir,

     Your letter arrived just a few days ago. I want to thank you for the great confidence you have placed in me. That is all I can do. I cannot discuss your verses; for any attempt at criticism would be foreign to me. Nothing touches a work of art so little as words of criticism: they always result in more or less fortunate misunderstandings. Things aren't all so tangible and sayable as people would usually have us believe; most experiences are unsayable, they happen in a space that no word has ever entered, and more unsay able than all other things are works of art, those mysterious existences, whose life endures beside our own small, transitory life.

     With this note as a preface, may I just tell you that your verses have no style of their own, although they do have silent and hidden beginnings of something personal. I feel this most clearly in the last poem, "My Soul." There, some thing of your own is trying to become word and melody. And in the lovely poem "To Leopardi" a kind of kinship with that great, solitary figure does perhaps appear. Nevertheless, the poems are not yet anything in themselves, not yet any thing independent, even the last one and the one to Leopardi. Your kind letter, which accompanied them managed to make clear to me various faults that I felt in reading your verses, though I am not able to name them specifically.

     You ask whether your verses are any good. You ask me. You have asked others before this. You send them to magazines. You compare them with other poems, and you are upset when certain editors reject your work. Now (since you have said you want my advice) I beg you to stop doing that sort of thing. You are looking outside, and that is what you should most avoid right now. No one can advise or help you - no one. There is only one thing you should do. Go into yourself. Find out the reason that commands you to write; see whether it has spread its roots into the very depths of your heart; confess to yourself whether you would have to die if you were forbidden to write. This most of all: ask yourself in the most silent hour of your night: must I write? Dig into yourself for a deep answer. And if this answer rings out in assent, if you meet this solemn question with a strong, simple "I must", then build your life in accordance with this necessity; your whole life, even into its humblest and most indifferent hour, must become a sign and witness to this impulse. Then come close to Nature. Then, as if no one had ever tried before, try to say what you see and feel and love and lose. Don't write love poems; avoid those forms that are too facile and ordinary: they are the hardest to work with, and it takes a great, fully ripened power to create something individual where good, even glorious, traditions exist in abundance. So rescue yourself from these general themes and write about what your everyday life offers you; describe your sorrows and desires, the thoughts that pass through your mind and your belief in some kind of beauty Describe all these with heartfelt, silent, humble sincerity and, when you express yourself, use the Things around you, the images from your dreams, and the objects that you remember. If your everyday life seems poor, don't blame it; blame yourself; admit to yourself that you are not enough of a poet to call forth its riches; because for the creator there is no poverty and no poor, indifferent place. And even if you found yourself in some prison, whose walls let in none of the world's sound - wouldn't you still have your childhood, that jewel beyond all price, that treasure house of memories? Turn your attention to it. Try to raise up the sunken feelings of this enormous past; your personality will grow stronger, your solitude will expand and become a place where you can live in the twilight, where the noise of other people passes by, far in the distance. And if out of , this turning within, out of this immersion in your own world, poems come, then you will not think of asking anyone whether they are good or not. Nor will you try to interest magazines in these works: for you will see them as your dear natural possession, a piece of your life, a voice from it. A work of art is good if it has arisen out of necessity. That is the only way one can judge it. So, dear Sir, I can't give you any advice but this: to go into yourself and see how deep the place is from which your life flows; at its source you will find the answer to, the question of whether you must create. Accept that answer, just as it is given to you, without trying to interpret it. Perhaps you will discover that you are called to be an artist. Then take that destiny upon yourself, and bear it, its burden and its greatness, without ever asking what reward might come from outside. For the creator must be a world for himself and must find everything in himself and in Nature, to whom his whole life is devoted.

     But after this descent into yourself and into your solitude, perhaps you will have to renounce becoming a poet (if, as I have said, one feels one could live without writing, then one shouldn't write at all). Nevertheless, even then, this self searching that I ask of you will not have been for nothing. Your life will still find its own paths from there, and that they may be good, rich, and wide is what I wish for you, more than I can say.

     What else can I tell you? It seems to me that everything has its proper emphasis; and finally I want to add just one more bit of advice: to keep growing, silently and earnestly, through your whole development; you couldn't disturb it any more violently than by looking outside and waiting for outside answers to questions that only your innermost feeling, in your quietest hour, can perhaps answer.

     It was a pleasure for me to find in your letter the name of Professor Horacek; I have great reverence for that kind, learned man, and a gratitude that has lasted through the years. Will you please tell him how I feel; it is very good of him to still think of me, and I appreciate it.

     The poem that you entrusted me with, I am sending back to you. And I thank you once more for your questions and sincere trust, of which, by answering as honestly as I can, I have tried to make myself a little worthier than I, as a stranger, really am.

Yours very truly,

Rainer Maria Rilke

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IDENTIFYING DATA

HC is a 30 years old, female, married, Filipino, Roman Catholic, born on August 19, 1982, who resides in San Pablo City.

CHIEF COMPLAINT

Vaginal bleeding of 2 months duration

Source & Reliability

Information was obtained from the patient and has fair reliability (75%).

HISTORY OF PRESENT ILLNESS

The patient consulted with a complaint of vaginal bleeding of two months duration. The patient’s symptom began two months prior to admission, when she experienced a sudden onset of vaginal bleeding during coitus. It was characterized as bright red and spotting-like. No pain during coitus was noted. No medications or consult done, and the symptom persisted.

Few hours prior to admission, she sought consult at the UERMMMCI Outpatient Department. In her internal examination, an 8x5cm mass was palpated on the right aspect of the vaginal canal. She was subsequently admitted for further observation and treatment.

PAST HEALTH HISTORY

In 2008, H.C. was admitted in the Community General Hospital in San Pablo due to hematochezia, constipation, and diarrhea of 6 months duration. She was said to have external hemorrhoids and a rectal mass was found. A proctosigmoidoscopy and rectal mass biopsy was done. She was then diagnosed with rectal adenocarcinoma, stage II (T2N0M0). She was referred to UERMMMC where she underwent an abdominal perineal resection with posterior vaginectomy.

In 2009, she underwent chemotherapy and radiotherapy in UERMMMC. Later that year, she had a colonoscopy and CT scan, which revealed no recurrence of the cancer.

In 2010, she again had a colonoscopy and CT scan. The tests were negative for recurrence but showed that she had a fatty liver. She was also then diagnosed with uncontrolled diabetes mellitus type 2 and was prescribed metformin, 500mg, twice a day.

In 2011, she was admitted in UERMMMC due to bacterial vaginosis and cellulitis.

Family History

H.C. has a family history of hypertension and diabetes mellitus on both her maternal and paternal parents.

SOCIAL AND ENVIRONMENTAL HISTORY

H.C. is a college graduate and has been working as a midwife for 4 years now. Most of their income comes from the family business. She lives with her husband, 5 year old daughter, and 2 others in a house in San Pablo. She eats 3 meals a day, and does not do any form of exercise. She usually sleeps at 10pm and wakes up at 4am, averaging 6 hours of sleep per day. She has no history of cigarette smoking, alcohol intake, and illicit drug use

REVIEW OF SYSTEMS

General

She reported weight loss from 180lbs in December 2011, to her present weight of 163lbs.

Genitoreporductive

She had her menarche at the age of 13 (1995). Her last menstrual period was in 2009, and she has been taking medroxyprogesterone (Provera) since then. She reported post-coital bleeding two months prior to admission.

PHYSICAL EXAMINATION (Upon admission)

General Survey

She is awake, coherent and ambulatory. She is not in cardiorespiratory distress or pain.

Eyes

Her conjunctivae are pinkish and sclera are anicteric. Her pupils are equally brisk and reactive to light. Extraocular muscles are full and intact.

Thorax and Lungs

Her breathing is effortless and her chest expansion is symmetrical. No tenderness or chest retractions. She has clear breath sounds. No adventitious sounds.

Breast

Her breasts are symmetrical. No discharge, masses, or tenderness.

Cardiovascular

She has an adynamic precordium, with distinct heart sounds. No murmurs.

Abdomen

Her abdomen is soft and flabby with normoactive bowel sounds. She has a colostomy bag on LLQ. No tenderness.

Genitoreproductive

She has a prominent firm pelvic wall with a vaginal mass on the right side.