2018-2019 Editor-in-Chief, Kajsa Vlasic, sat down with Internal Medicine physician and current JAMA Poetry Editor, Dr. Rafael Campo, during his recent visit to the University of Utah. His most recent publication, Comfort Measures Only, New and Selected Poems 1994-2016, was published in September 2018. He currently practices and teaches primary care medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. Join them for a conversation about his career as a physician-poet, the current state of medical humanities in the United States, how poetry can be a vehicle for teaching empathy, and why documenting experiences within healthcare can help us bear witness and not forget the patients who touch us and the time periods of our lives that shape the people we ultimately become.
KV: To begin, I’d love to hear your story about how you first began writing poetry. How did you become a physician writer?
RC: I started writing at a pretty early age. My parents were immigrants to the United States and so poetry was a way of maintaining a connection to our heritage. I always had a sense, even from an early age, that poetry had a healing potential — in the sense that it really did feel like a way to repair that fracture of being in a new country or being away from the homeland.
I attended Amherst College, a liberal arts college, and had several wonderful mentors there who really encouraged me to continue pursuing my interest in poetry while I was completing my pre-med requirements. I love science, but I also have always been passionate about stories and language — and poetry, in particular. I think I was really lucky to be in a liberal arts environment where the two were not viewed as separate. We can be very siloed in medicine, but in liberal arts settings we try to talk across disciplines and really learn from each other — which ended up being very wonderful for me.
I took a step away from poetry after I started medical school. I was at Harvard and had an experience there that was very focused on the hard sciences, with many amazingly talented scientists and researchers, but without much attention to the issues that drew me mostly to medicine. In some ways, I was more interested in thinking about the human condition: How do we make sense of suffering? How can we be present for people when they are at their most vulnerable? How can we bear witness effectively? A lot of those topics and themes were not part of my education in an explicit way. I ended up thinking I’d made a terrible mistake. I thought to myself, Why am I in medicine? This is not what I thought it would be. So I took a year off after the third year of medical school, the really intense shift to the clinical space, and instead focused on poetry.
I had some wonderful mentors at that time. I worked with Robert Pinsky, our U.S. Poet Laureate at the time, and also Derek Walcott, who won the Nobel Prize in Literature while I was studying with him. It was a really energizing and renewing time for me. I was then able to go back to medical school feeling like my batteries were re-charged and having learned that stories were valuable. Seeing it expressed through Robert and Derek’s work in some ways really helped me to re-think the value of poetry, especially in the medical context.
You recently published a collection of your poetry — Comfort Measures Only — and it’s a collection of your previously published work. What was that process like for you? Could you speak to the process of revisiting your writing and how you picked the pieces that went into the collection?
You know, it was quite interesting to re-experience my journey and think about poems I had written twenty years ago. Much of my work deals with identity issues and so, in a really wonderful way, going back through my previous work helped me to appreciate how much things have changed in our world.
I tried to select poems that reflected what was happening in medicine at the time they were written, but perhaps also pointed to the kinds of changes and kinds of progress that we have made as a profession in medicine — as well as our larger culture and in the U.S. more broadly. For example, it was really interesting to reflect on the HIV/AIDS crisis and how harrowing that time was, now that we are post-emergency. We still must remember that there are 40 million people on our planet who have HIV infection, most of whom will not have access to the miraculous treatments that prolong life. We have made really meaningful progress, however, and certainly here in the United States. It’s extraordinarily heartening — having been through the worst of it in this country, in some sense.
As I was making choices for what to include in the book, I wanted to not forget. I wanted to be sure that time of real despair, real crisis, was really represented in my work. I think poetry was, for me and people in communities most impacted by HIV/AIDS, a way of refusing to be silenced.
For many physician writers, one of the reasons for writing is that it’s a cathartic and reflective process. What are the current goals of your writing? How have they evolved throughout your career?
I think for me it’s plain hedonism: I just love to write. I love the pleasure of words and creating beauty and making art — out of language in particular. It’s really renewing for me. From the medical perspective, I do think we need to have some distance in our relationship with patients, of course. But sometimes that distancing can lead to a kind of disconnection from patients and a kind of removal of ourselves from the experience of suffering. I wouldn’t say that writing poetry for me is therapeutic, but I think it does really keep me in closer proximity to the experience of suffering that I witness in my patients. I think that’s a really important driver of my creative process.
My impulse to write is still a way for me to express aspects of myself that feel more silenced or constrained in medicine. There are so many kinds of silences and they are problematic for various reasons. We are still a profession that is not as diverse as we ought to be with the changes in the populations that we serve. So, yes, writing is a way of making those aspects of myself more visible, or at least part of the landscape of medicine. I hope to speak to the importance of diversity and wish that other physicians, medical students, and residents might encounter my work. I hope that my work speaks to the idea that we’re not so different that we can’t talk to each other, but that in our differences we see what is most essentially human about us. Speaking to each other across these differences, it’s not about proclaiming that I am X or Y. Instead, the experience of being in one community is, in some ways, not different from people in other communities. We all face mortality. We all are vulnerable in some sense. I try to represent that in my work and not emphasize the differences. I hope I can speak about what’s ultimately the same in all of us.
I really connect with that right now. It’s been so interesting being on the residency interview trail this last year. There is diversity amongst medical students nationally, but it’s also been dawning on me how much lack of diversity there is within medicine — most notably from a socioeconomic perspective. To be able to reach the level of being a physician, and having the opportunity to carry immense knowledge and skillset moving forward in our communities, requires money. It’s been a pretty humbling experience for me and makes me think, moving forward, how do we shape that landscape? How do we change it? How do we give voice to people who would broaden the shared common experience of what it is to be human and help people through suffering?
Yes — and that really is the foundation of empathy, right? We are fundamentally the same creatures. We feel pain in the same ways, we experience joy in the same ways. Our points of origin and our distinguishing characteristics are superficial in some ways. Again, I have always felt that our differences can help us appreciate even more what we have in common. In this particular moment, there is so much technology and science is even more ascendant. It’s hard to even have real conversations with others these days. With social media — I don’t want to sound like some sort of luddite — I do think it poses some interesting kinds of problems. How do we continue to foster community and a sense of connectedness when, in some ways, we are overly-connected, yet we communicate in two-line tweets? How do we have that kind of conversation that you’re describing — where we think about these kinds of issues in a deeper way? I think poetry can be a part of that.
I feel like there is a growing push within national medical education to include medical humanities in the curriculum. How do you feel the world of medical humanities has changed over the course of your career? I’m sure you have some interesting perspective as you’ve moved from being a medical student to a resident to a physician — and now teach poetry as a medical professor.
I think it’s changed in a lot of really important ways. Doing this originally, as much as I was seeking a kind of connectedness and communion with others, made me feel very alone. There were not a lot of people exploring medical humanities and certainly not many people writing poetry. There were not many physicians writing from their experiences working within medicine. So I think there has been a proliferation of voices and, as an academic discipline, there has been some really incredible work by people, like Rita Charon and others, who are proposing the humanities having purpose in the world of medicine.
But also in a rigorous way, what does narrative teach us about how we listen? How do we construct different kinds of stories? How do we use our own kinds of metaphors within medicine? Even, thinking about literary criticism and techniques that come from the humanities disciplines, how can those be applied in medical discourse? I think there’s a greater rigor around using or discussing the humanities within the medical context. That’s really exciting, too. I love creation. I love how poems and narratives can tell us stories. I am also interested in how they tell us stories, how they teach us, how we respond to them, how we learn from them, and how they shape our thinking as well. So I think that kind of work is equally valuable, if not more so, than the act of creating stories.
It’s also exciting to see the medical humanities migrating into other fields, too. It’s not just medicine. Other care providers are thinking about the humanities and the relevance of the humanities in their disciplines.
One other thing that seems newest of all of these developments is that there is more of a focus on wellness and, not just among our patients, but amongst physicians. There are a lot of interesting possibilities. I don’t think the humanities can be a Band-Aid: Oh, you’re burned out? Write a poem. But, can the context of the humanities help us make sense of the broken systems and critique the kinds of systems we have in medicine that are contributing to burn-out? When we think about the humanities, we think about morality. We think about ethics. We think about power dynamics. Who gets to tell the story? A lot of those themes are relevant to why medicine as a profession is harming doctors and creating a lot of problems for us in terms of working within the system. I feel like we’re just beginning to think about the application of the humanities in medicine. I’m really hopeful for the future.
I’m hopeful for the future, too. I’m hopeful that maybe we can incorporate the medical humanities more into the culture of medical wellness. I feel like I’m having more and more conversations with my peers about trying to figure out ways to meet the wellness needs on an individual level as trainees. It gives me hope that we’re actually having conversations about it and it’s no longer this stigmatized, back-closet idea.
Or that the struggle should be handled by sucking it up and dealing with it. “I went through it, so you’re going to go through it, too.” That’s really not a useful response. We really need to think about how we can make medical training really serve the needs of our trainees. Sometimes I have students say, “Oh, this is so wonderful, but I’m not being challenged because everyone is acting too nice.” It’s a shocking expression of how broken our system really is that we have inculcated this idea that you deserve to be mistreated in order for you to feel that you’re learning. It’s so perverse. Some kind of critique of that is necessary. I think it is a reflection of the moral problems of medicine currently. If it’s all about money and reimbursement and expertise and cloning the next gene, there’s so much that’s lost in what doctors have to content with day to day. I think the medical humanities can help us ask those kinds of moral questions and help us really think, as a profession, about what kind of profession we want to be. Are we an industry? Are we like any other profession? That’s a valid question to ask and maybe that’s what medicine should be. Maybe the humane work should be shifted to social workers or to chaplains. Maybe doctors shouldn’t be capable of showing emotion. But I think people come to us for care — not just for our expertise and a cure. They come to us for so much more than that.
You use poetry as a vehicle for teaching. What does this look like for you? How do you interact with students and how do you use poetry in medical education?
One of my favorite things that I do is lead a reflective writing workshop for my students. We usually gather once a month and a group of 15 students or so comes to my home. Usually we have a meal together (I love to bake!) We usually have a text, or several texts, that we read together and reflect on as a group. Then we write together. I love this because we get outside of the clinical space entirely — literally, because we’re in my home, but also metaphorically, because by exploring poems we’re in a different mode than we are on the wards. I love hearing my students’ responses to the poems and then reading what they write. It’s always extraordinary. It’s not necessarily about craft, but about process. At the end, it’s more about creating a space where people feel they can raise their voices.
I also teach a variety of other courses. There’s a course called “The Developing Physician” where we also do some reflective writing and explore texts. It’s done in a seminar setting where we discuss the texts in relation to topics that many consider unteachable — like empathy and compassion, professionalism, end of life, and the difference between healing and curing. Again, some of these themes traditionally have not received any formal attention in our curriculum.
I guess what I love about it most is that I get to know my students as people. I get to know about their families, their hometowns — even their pet goldfish! It’s really gratifying because that’s the joy of this work — being people together — and by presenting myself as a fellow human I hope that models a different way of being in medicine. We’re not just robots, we’re not just technicians, we’re not just in our white coats in disguise. We’re people. All of us.
What are your words of wisdom for medical students, soon-to-be residents, or anyone in the medical field as they move forward as physician writers?
First and foremost, keep your stories alive inside you. There are a number of ways of doing that. I think the most important way, keeping in mind how busy residents are, is to try to make some time for reading. Even if you don’t have the time to get out your journal and write a poem or a story, reading can be equally sustaining in that sense.
I would also share that it is not an either-or. You can be an accomplished, well-read diagnostician. You can nail the twelve things on the differential and you can still be engaged with the humanity of your patients. Don’t accept the message, if you are exposed to it, that one is more important than the other. They can happily co-exist and you don’t have to sacrifice one to excel at the other. That goes both ways, but I think for interns and residents it’s important to hear that you can stay alive — whatever your passion may be. Maybe it’s film, maybe it’s parenting. Stay true to those passions. You don’t have to sacrifice them to be a good doctor. It’s not an either-or.
The following question pertains to myself just as much as my peers. I know I have classmates who are fearful of poetry. Adding to my previous question, what are your words of wisdom, your recommendations, for physician writers who are fearful of broaching the field of poetry? I think poems are such a great way to share stories — but it’s a daunting field within writing.
It really is! Don’t bring with those experience from high school where you had that awful teacher who told you it’s all code language. We are, many of us, scarred by those kinds of experiences. I think the best poetry is utterly accessible, especially to people in medicine broadly, because it’s so visceral and physical.
The meter. When you start to hear the rhythms within poetry, you start to recognize they are the same rhythms that are present in our bodies that you hear through your stethoscopes. Poetry is actually the most gripping in admitting us to what it has to offer us.
I guess I’d say, leave those preconceptions or biases or awful memories at the door. Try it. Read it out loud. Read it in a group. Go hear a poet read. Hearing a poem in a poet’s voice can totally change it because the geography of the poem can often be off-putting. We’re not used to seeing these weird shapes or short lines. Where does the emphasis fall? If you can go hear a poet read, let the poet voice it for you and then you can start to experience it more on the page yourself.
Don’t be afraid of it. Because our time is limited as well, we can read a poem in a relatively short period of time. You can even write one in a relatively short period of time. Or you can, at the very least, get a draft in. So it kind of fits into the spaces of our very busy lives in a way that an 800-page novel doesn’t.
Oh yes, are you referencing to the giant stack of books next to my bed that is always waiting for me?
Ahh, the iconic stack. That can be demoralizing it itself, can’t it? There are some poets, especially some contemporary poets, who are writing very deliberately to be vexing, to be disrupting, to challenge structure. Maybe don’t start with those poets. Maybe as you get into poetry more, try reading those poets. They’re doing some really interesting and cool things, but starting there can feel more daunting. They are trying to challenge us in how we receive language and what language does.
Who would you recommend? And who are you currently reading?
I’m actually going back and reading [Walt] Whitman now. I have a colleague who is doing a series on PBS about Poetry in America and she’s doing an episode on Whitman. We were talking about him recently. He actually worked as a volunteer nurse during the Civil War tending to wounded soldiers and one of my favorite poems of his is called “The Wound Dresser.”
For contemporary poets, there are so many who have addressed the idea of illness in ways that I find so compelling and relevant for medical students and residents. Marilyn Hacker has written about her experience with breast cancer. I think her poems are intensely musical. They are formal and correspond to the idea that most people have about what poetry is. It will feel perhaps more familiar to people who don’t have as wide a familiarity with poems. They are very narrative and tells stories.
Mark Doty has written about HIV/AIDS and has a very accessible form. It restores your faith in the possibility of there being beauty in the world when you read his poetry. The poems are just so beautiful and so moving. When we spend a lot of time in the grim hospital world, I think it’s nice to see beauty.