By Jody Cole and Linda Castine

When she began her career as a Seattle-based diabetes educator in 1993, Linda Castine, RN, BSN, CDE relied on traditional approaches such as handouts and videos to instruct patients on how to eat right, exercise, take medication, and manage stress.

But about 10 years ago, she sought treatment with therapeutic massage for a serious whiplash injury. She felt as if the massage, which put her in a dream state, relaxed not only her body but her mind. This allowed her creativity to flow and led her to explore alternative therapies for diabetes education.

In 2007, the same year in which she was named Educator of the Year by the Washington Association of Diabetes Educators, Linda's professional work with diabetes took on new meaning and direction stemming from the painful loss of her brother Alan the previous year. His sudden death, related to diabetes complications, served to strengthen the course of her mission.

Poems as roadmaps for care

She moved forward with the idea of self-publishing a collection of poems about diabetes, Poems for a Purpose. She would go on to share the poems with her diabetes patients and peers, dedicating the book to Alan's memory.

"Poems use strings of words to portray desired images. Like art therapy, poems can help people express thoughts and feelings about chronic conditions that ordinarily can't be explained in traditional counseling encounters."

Linda says that when she speaks about her brother, people often ask about his family left behind. Although Alan lived alone, Linda says he had a "most intimate roommate, diabetes."

"He used humor to cope with the disease. In our last conversation, he giggled about serious matters such as a new endocrinologist adding Byetta to his insulin regimen, and that he was extremely nauseated during his recent birthday dinner with friends."

"Personal Motivation" was written following a visit with her brother in 2004 as he minimized the seriousness of his blood sugar highs and lows. The poem begins:

Personal motivation must come from within
On the journey for diabetes control,
Policing our loved one may trigger emotions
That are bound to take a toll.

A bridge to communication and healing

As a certified diabetes educator employed in community health, Linda has also been immensely inspired by the voices and stories of the culturally diverse population she serves. Many of her poems began as seedlings of an idea written on a napkin in a parking lot.

"Poems use strings of words to portray desired images. Like art therapy, poems can help people express thoughts and feelings about chronic conditions that ordinarily can't be explained in traditional counseling encounters. The goal is emotional freedom for healing and purposeful advancement through stages of change toward better health."

Each poem is like a roadmap providing hope for reaching a destination of health, wellness, and prevention. Patients find Poems for a Purpose appealing because each poem provides diabetes self-care messages that are simple to understand, and relate to people across different cultures and age groups."

One more tool in the toolbox

The evolving theme of her collected poems—that of taking care of all aspects of a person's health—meshes well with the American Association of Diabetes Educators' concept of the Seven Self-Care Behaviors: healthy eating, being active, monitoring, taking medication, problem solving, reducing risks, and healthy coping. Individual poems reflect similar themes such as "Healthy Table," "Monitoring Blues," and "Gratitude."

Kathleen Givan, RN, CDE has used Poems for a Purpose as a tool for her own patients. She says, "Rhyme has been a very useful tool across the ages for providing information in a simplistic and pleasant, sometimes amusing vein. Setting one's own thoughts and feelings to rhyme is a helpful coping mechanism for challenges one has difficulty meeting."

"I've used the poems in my groups to invite participation. They not only invite humor and break tension; they often inspire patients to write poems about their own challenges. This is a tool at its best when a group of patients tries to outdo one another interpreting a poem from the book or creating poems of their own stories. This book of poems is one that fits nicely in my toolbox. Poems for a Purpose is a lucky break for diabetes educators."

"Her little poetry book was an encouraging means to creating more balance in my life. I let it guide me to a better place."
Patient Laura Girrard

Linda notes that many people living with chronic conditions like diabetes are susceptible to burnout from the complexity of a treatment regimen, family and financial stressors, and limited access to care, support, and resources. "It's very rewarding to witness the emotional transformations from tears and fears to perceptions of hope and opportunity for living well despite this unwanted condition."

One patient, Laura Girrard, living with type 1 for over 30 years, relates, "Over time, I slipped in and out of control and more into denial. I was playing that classic game of 'Russian roulette' with my life at stake. Linda gave much time and energy getting me on better footing."

"Her little poetry book was an encouraging means to creating more balance in my life. I let it guide me to a better place. I began to get a firmer grip on the reality of my life with new respect for myself. Life should be a happy experience regardless of the challenges we all face!"

One of Linda's favorite poems is "Nourishment." It serves as a reminder of the holistic meaning behind the word. The last stanza summarizes the poem:

So take control of stocking your pantry,
Nourish yourself take heart,
Remember when making your shopping lists,
Your food plays only a part.

Paying it forward

Not only has Linda Castine worked with people to reduce their "diabetes distress" and improve their self-care with her poetry, she has donated her own money to improve their care. Proceeds from the 2007 sales of Poems for a Purpose were donated to Neighborcare Health a provider of primary medical and dental care in Seattle for low income and uninsured families and individuals.

"The money was used to subsidize monitoring supplies for our underserved patients. Some patients can't even afford the $13 for test strips." Her goal is to "subsidize strips, generic medications, and therapeutic shoes for those really in need, so many."

Although Linda does not have outcome data about her poetry, she hopes to participate in impact studies about this is the future. She is completing a Master's In Nursing at the University of Washington in the Clinical Nurse Leader role. She plans on continuing her role as a "change agent," and plans to conduct a literature review about the phenomenon of diabetes distress for her scholarly project

Are we in the boat?

There is no doubt Linda will continue her role. She uses her own story "in the boat" as a metaphor to convey essential elements of patient-centered care.

She recently returned to raft the White Salmon River, a river fed from glacier water from Mt. Adams. On a rafting trip 2 years earlier, Linda got out of the boat before it went down Husum Falls (rated a level 5 waterfall for those with advanced whitewater experience). She returned determined to meet the challenge. Her raft tipped upon resurfacing and all the passengers were successfully rescued.

Also a 3-year breast cancer survivor, Linda is conquering her own fears and continues to help others conquer theirs. That is where her poetry comes from; deep within. Poems for a Purpose are forged from life experiences that make her a survivor and enable her to teach her patients to be survivors too.

"If one person each day gets it, then it's worth it."