Raymond Carver's poem "What The Doctor Said," published in 1989 in a collection of his poems entitled A New Path to the Waterfall, is interesting, in part, for its lack of literary devices (with a couple of exceptions discussed below). The subject of the poem, the poet's diagnosis of advanced lung cancer, may help explain Carver's decision to avoid literary devices such as metaphorical language and poetic diction. One can argue, however, that Carver employs a kind of stream-of-consciousness, which is a literary device, and uses irony and humor to create the dominant tone of the poem.
As several poets have done in the last half-century (for example, e. e. cummings), Carver abandons almost all conventional punctuation in this poem, and this gives the poem its stream-of-consciousness feeling--but, in this case, rather than reflect the mind's free-flow of random thought, which is characteristic of the stream-of-consciousness technique, Carver recalls in precise detail the conversation he and his doctor have:
He said it doesn't look good/he said it looks bad in fact real bad/he said I counted thirty-two of them on one lung before/I quit counting them. . . .
By leaving out all sentence punctuation, Carver creates the breathless, urgent flow of the conversation while, most important, leaving the reader to create the tone, the facial expressions, the feelings, that must have accompanied such a conversation. In other words, there is a lot of emotional content in this conversation, but the reader is left to imagine how each speaker conveys and receives the emotional content. The matter-of-fact and hurried diction, with nothing to soften the devastating content of the conversation, leaves the reader as stunned as the person who is getting this news from his doctor.
The only softening of this harsh reality is through the literary devices of humor and irony, which helps to detach the reader, as well as the man receiving this news, from the harsh reality of the conversation's content. When the doctor has described counting 32 tumors on one lung and then stopping the count, the patient responds:
I said I'm glad I wouldn't want to know/about any more being there than that. . . .
The tone shifts slightly from being completely grim to almost humorous as the patient accepts the overwhelmingly devastating news of his condition with resignation tinged with humor. Humor and irony both come into play when the doctor asks the patient if he responds to beautiful nature scenes, and the patient's reply is, "I said not yet but I intend to start today." Clearly, the irony of the patient's situation, which he recognizes fully, is that nothing he can do will change the outcome, but he accepts that reality with grim humor.
Carver employs direct irony very effectively in the last few lines when he describes the end of the conversation, and the patient
In a great ironic twist--irony being the recognition of a reality that is completely different from what appears to be the case--the patient, recognizing that the doctor has pronounced a death sentence, detaches himself completely from the reality of his situation and leaves the doctor with thanks for having given him the gift of a death sentence. In this instance, humor and irony are the literary devices that also, in the real world, allow someone to accept a harsh reality.