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DURHAM, N.C. -- Most weeks, writer Virginia Holman helps patients at Duke University Medical Center, especially young children, deal with their pain. She hands out blank writing journals to patients, helps children write poetry and leads a well-respected literary roundtable for hospital patients and staff.

Holman coordinates the literary arts program at the Duke Medical Center, for years a model for hospitals across the United States, but her biggest coup yet may be a prestigious Pushcart Prize that she recently won for her essay about her own childhood pain. In her essay "Homesickness," Holman describes a visit to her childhood home, now abandoned, and its surrounding Virginia countryside, where she once lived under the care of her untreated schizophrenic mother.

"I'm tickled," Holman said about receiving a Pushcart.

Not much of a talker, Holman admits she's sort of a therapy failure, which could spell big trouble for a Southern writer, given how these writers have a reputation for being great conversationalists. But Northern publishers, fortunately, don't pay much mind. Already, Holman has had her essays and articles appear in such national magazines as Self, Redbook and DoubleTake, proof enough of her success as a writer. Now this spring, she scored big with her essay in DoubleTake.

"Homesickness" received a nomination not only from DoubleTake, which originally published it, but from other editors as well, said Pushcart Prize publisher Bill Henderson, who calls Holman's piece a wonderful evocation of home. "If it's real intense and written well, it's gotta be a winner," he said.

DoubleTake deputy editor Albert LaFarge added that Holman's piece contains many elements - including authenticity and elegant prose - that the Pushcart tends to recognize.

In its 25th year, the Pushcart Prize publishes about 70 short stories, essays, memoirs and poems each year in an anthology distributed by W. W. Norton. Henderson and his five-person editorial staff in upstate New York review about 8,000 manuscripts. Nominations come from publishers of literary magazines across the United States. The Pushcart collection has no particular theme, Henderson said, other than to publish "anything that's great." Holman brings together that particular combination of experience and talent needed for a writer to coordinate a literary program as unique as Duke's. Six years ago, she and her husband - they now have a 5-year-old son - moved to Durham, and a year ago, she started working part time in the medical center's cultural services program.

Every Friday at noon, for instance, she serves as facilitator of the Osler Literary Roundtable, begun more than 10 years ago at the request of Dr. Francis Neelon, an endocrinologist who believes hospital patients and staff need time together to hear stories and poetry and read them aloud.

In addition, Holman coordinates the medical center's Write for You program, which she says is her main passion. The program was begun shortly before Holman arrived at Duke, when her predecessor made 20 journals available to pediatric bone marrow patients and their parents as a way to distract them from the grueling procedure. The children and their parents snapped up the journals. When Holman arrived, she found a popular program, but no journals and no funds to buy more.

"The response to the program was overwhelming," Holman said. "We didn't realize how successful it was going to be."

Immediately, Holman began contacting bookstores and presses, trying to convince them to donate journals. One publishing company sent over some bound diaries with locks, which the children loved. "They can lock the adults out and say whatever they want," she said with a laugh.

That sort of release from the stresses of a prolonged hospital stay and invasive treatments is hard to find. Often patients and their families - whether in the pediatric and adult bone marrow units, the pediatric intensive care wing or the heart transplant unit, all units where the journals are made available - can be stuck in a hospital, far from home, for a few weeks to a year, or even longer.

Patients often don't have the normal outlets available for stress release, such as talking to friends, Holman said. The journals help to fill the void.

Although these journals come as a gift with no strings attached, Holman offers writing help to anyone who wants it. Some children want to write poems but don't know how, so she teaches them. Others write letters to God or their pets, and want to talk with her about what they've written.

"I show them how to transform intense experiences or happy experiences into writing. If things come up that they want to talk to a professional about, I refer them. I'm the writing lady, cum social worker, cum pastoral services."

Even children too young to write often enjoy the process of keeping a journal. Holman helps them write down their thoughts by listening to their stories or poetry and recording them in the journal. She does this by walking them through the experience they want to write about: What does it smell like? Taste like? Feel like? After that, she transcribes their responses.

"When I read it back to them, they say, 'Wow! I wrote that?' We tack it on the bulletin board. When I come back, it opens up a window to talk about the hard stuff."

The hard stuff is told by people such as a 16-year-old boy, in and out of the hospital since he was a toddler. He told Holman he couldn't open up his hospital window and scream, so his journal became the place where he screamed.

Or the mother who told Holman she used her journal to "get it out without taking somebody out."

Or the suicidal girl who, after failing to respond to several psychiatrists, picked up a journal and started writing - and kept on.

Said Holman: "The frustration level is high when you're undergoing treatment in a hospital. You have to say yes all the time. I tell them, 'You can say no to me,' and patients love that."

Few patients or their families have said "no" to Holman when she has come to their hospital door.

"They work with me through what some would consider unbearable pain," she said. "They'll be having blood taken or vomiting while we're working together, but they want me to stay and finish the task."

Writing in a journal may help, in fact, with the healing process. A study published last year in the Journal of the American Medical Association showed a decrease in symptomatology among arthritis and asthma sufferers who kept a journal. Although Holman can't say whether Duke's journal program has induced quantifiable healing, she believes great worth exists in the writing process.

"I see the patients' faces brighten when I come in; I see stress being released."

Holman shares an affinity with her patients. Life with a schizophrenic mother was intense, she said, so she can empathize somewhat with patients going through intense experiences.

"I've dealt with plenty of mental health professionals over the years, but nothing has helped manage stress and transform pain like a blank piece of paper and a pen," she said. "Writing has been healing for me, and it can be for others. Writing can allow folks to take experiences they can't articulate and transform them into something beautiful that speaks to someone else.