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WHITE COATS AND TISSUE GOWNS: RECOGNIZING THE POETIC IN THE DOCTOR-PATIENT RELATIONSHIP THROUGH THE WORK OF DR. RAFAEL CAMPO
ISABEL DRAPER
E 369H English Honors Program The University of Texas at Austin
8 May 2020
Dr. Phillip J. Barrish English Supervising Professor
______Dr. Brian F. Doherty English Second Reader
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Abstract
Author: Isabel Draper
Title: White Coats and Tissue Gowns: Recognizing the Poetic in the Doctor-Patient Relationship Through the Work of Dr. Rafael Campo
Supervising Professors: Dr. Phillip J. Barrish, Dr. Brian F. Doherty
Our modern healthcare system faces many challenges including high rates of physician burnout and the current threat of the COVID-19 epidemic. The poetry of Dr. Rafael Campo shines a light on the difficulties, burdens, and opportunities that illness imposes upon the physician. In the first chapter, I discuss the potential reasons why Dr. Campo writes poetry. Examining the history of physician-writers and the purpose that writing can serve in a physician’s practice provides a foundation for understanding the relationship between the humanities and the sciences. In the second chapter, I consider the ways in which poetry is an ideal form for physicians to express themselves. The similarities between poetry and the forms which physician’s use to present information make poetry an ideal form for the expression of thoughts and feelings about the clinic. The culmination of this thesis is in the third chapter where I consider how Campo’s AIDS poetry demonstrates the potential for poetry to help him cope with the burden of caring for patients in an epidemic. Campo’s AIDS poetry is particularly relevant today as physicians, once again, face the challenge of caring for patients in a pandemic.
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Table of Contents Abstract ………………………………………………………………………………. 2
Introduction ………………………………………………………………………….... 4
Chapter 1: Why does Doctor Campo write? ……………………………………….…. 7
The Phases of Medicine: Recovering from Science……………………………... 9 The Need for Physician Writers……………………………………………...…. 15 Identity in Campo’s Poetry…………………………………………………….... 19 Recognizing the Physician’s Trauma and its Relevance to Poetry……………… 22 To Publish Poetry: In itself a Reason to Write?...... 25 Conclusion…………………………………………………………………...……27
Chapter 2: Poetic Form and Style in Campo’s Work………………………………...….29
Poetry and the Oral Presentation in Campo’s Work…………………………...… 31 Poetic Form and the Oral Presentation………………………………...…………. 41 Conclusion……………………………………………………………………...... 46
Chapter 3: Campo and AIDS Poetry: The Doctor/Patient Relationship in a Pandemic... 48
Mirroring within Campo’s Work……………………………………………….... 57 Situating the Personal in the Clinical…………………………………………….. 60
Conclusion…………………………………………………………………………….….73
Works Cited………………………………………………………………………………75
Appendix………………………………………………………………………………….80
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Introduction I was initially drawn to Dr. Rafael Campo’s work after reading it in a class that focused on the doctor-patient relationship. The professor gave us an assignment to read five poems from one of Campo’s books. After reading the assigned poems, I couldn’t stop. I read the entirety of the book. As an English major hoping to pursue a career in medicine, the marriage of science and the humanities in Campo’s work seemed to justify my desire to pursue both in my college coursework. Campo’s work is fascinating in its adherence to poetic form and its lyricism. It is also remarkable in its honest representation of what it means to be a physician working in the midst of a pandemic.
During the HIV epidemic, the link between the virus’ transmission and the LGBTQ+ community created a unique situation. Homophobes weaponized this connection to claim that the infection resulted from the judgement of God. Friends became sick and died. Initially, physicians struggled to understand what was happening to their patients. Organizations like ACT UP formed and organized protests to call attention to the need for treatments and healthcare for people with AIDS. For those of us born close to the new millennia, we could only wonder what was like to treat patients under these conditions. We can hope that our society has moved past the desire to affix morality to viral particles. Yet, the fear that pandemics incite creates a unique situation in which fake news and anxiety propagate quickly and with devastating consequences.
This pattern is repeating itself in the coronavirus epidemic. The current global pandemic has placed an enormous strain on communities and healthcare workers around the world.
Physicians in different parts of the world tell horror stories about patients languishing in hallways and corpses stuffed into makeshift mortuaries. Like the early days of treating HIV, the medical establishment must cope with an influx of critically ill patients without understanding
Draper 5 the exact nature of the beast that they are fighting. Additionally, the current danger that Covid-19 poses to healthcare workers necessitates a reckoning with one’s mortality and with what it means to be a physician. Campo’s work considers the commitment of the physician and questions what it means to work in a profession in which the donning of a white coat constitutes a commitment to prioritizing the care for the patient. Dealing with this reality and its chaos necessitates creating ways to cultivate resilience and to express the feelings that arise from treating patients with poor prognoses.
Looking to the writings of those who worked during past pandemics provides a glimpse into the process of building provider’s resilience and a compassionate approach to patient care even in extreme circumstances. While healthcare workers all face these challenges, the history of the physician profession and the current reputation of the profession make Campo’s writings particularly interesting. Campo’s writings show the difficulty of recognizing the humanity that the doctor and patient share. The physician’s voice in these poems is not that of a perfect human; the expressions of frustration, annoyance, exhaustion, and other negative emotions are authentic.
In preserving the authenticity of the speaker’s emotions, Campo’s poems become even more compelling and important. They provide a safe space for the physician to explore the effects of treating people intimately in the context of the physician’s own identity and history.
In my thesis, I will consider Campo’s poetry in light of its potential to help physicians cope with the struggles of modern-day medicine and treating patients in the midst of a pandemic.
I will analyze his choice to write formal poetry and its relationship to the oral presentation styles used in medical settings today. Ultimately, I hope to demonstrate how the synergy between poetry and medicine has the potential to help the modern clinician navigate the challenges of treating patients within a complex modern medical system.
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Chapter 1: WHY DOES DOCTOR CAMPO WRITE?
In “The Two Cultures and The Scientific Revolution,” C.P. Snow expresses alarm at the split of intellectual life into two polar groups, “at one pole... the literary intellectuals…[and] at the other scientists” (Snow 4). In observing the distaste which his scientific and literary colleagues at Cambridge have for each other’s work, he concludes that “this polarization is sheer loss to us all. To us as people and to our society” (12). Snow wrote of this cultural divide between the sciences and the humanities in 1961, almost sixty years ago. And yet, the two cultures endure and, in some instances, the schism between the two has even widened. In medicine, the manifestation of this divide arises in the tension between a purely scientific, detached medical practice and the competing push for human and narrative centered medicine.
Physicians who practice medicine and write literature, in any form, naturally bridge the divide between the two cultures as described by Snow. The tradition of the hyphenated physician-writer predates Snow’s lecture as writers have practiced as physicians and vice versa for centuries. John Keats, Anton Chekhov, Sir Arthur Conan Doyle, William Carlos Williams,
Richard Seltzer, among others, were all physician-writers. Their stories, poems, and plays inevitably blend the observational skills of a physician with a writer’s flair for language and style. These physicians all felt the need to write and to publish their work. The act of writing is an extension of the healthcare practice as it allows the physician to consider the patient’s point of view and, by extension, to advocate for the patient. In doing so, the physician has a space in which their voice and their understanding of the patient’s illness narrative can be heard on the page, safe from the encroaching pressures of paperwork, advanced technology, or any gaps in communication.
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Unlike John Keats or William Carlos Williams, Rafael Campo navigates his work as a physician-writer in the late 20th-century and 21st-century medicine. This age of medicine brings with it advances in using technology to treat patients, and it relies on a complex private and public health insurance system to pay for patient’s health care. Debates over the ideal configuration of the American healthcare system are intensely partisan and often ignore the importance of interpersonal communication as the basis of patient care. Even in this increasingly polarized environment, Campo believes that there’s a “false dichotomy” in the supposedly adversarial relationship between medical sciences and humanities (“Interview with Rafael
Campo”). While Campo’s poetry walks in the footsteps of the physician-poets who have come before him, his existence at the intersection of several identities- as a gay man, a descendant of
Cuban immigrants, and a physician who trained during the AIDS crisis- gives him a unique perspective on his clinical experiences. He expresses this viewpoint with candor and elegance in his poetry while demonstrating the ability of poetry to provoke therapeutic empathy and to encourage an important reflection process.
Campo’s willingness to write poetry about all aspects of his experience and identity also explores the impact which the doctor-patient relationship has on his development as a clinician, person, and advocate. It gives value to the physician’s emotional and psychological reactions that occur when engaging in the patient’s bodily and psychological ailments on a daily basis.
Campo’s choice to ground his poetry in his interactions with patients also recognizes the patient’s involvement as the first audience in any writing which the physician may produce.
Even when this writing focuses on the physician’s thoughts and perspectives, it can also provide space to recognize and call attention to the struggle of patients who have been marginalized in society. This reinforces the shared humanity between physician and patient. Thus, Campo’s
Draper 8 poetry pushes back against the pressure to maintain a clinical distance and explores the connection between the physician and patient.
The Phases of Medicine: Recovering from Science
The development of the physician profession occurred in a dramatically different landscape that lacked the resources of modern medicine. In the United States “before 1940…the major function of medicine had been diagnosis of disease; the therapeutic armamentarium was hardly impressive. With the exception of a limited number of medications (digoxin, thyroxine, insulin), immunization for a few infectious diseases, and surgical procedures, physicians had few means of coping with most infections, cardiovascular diseases, cancer, and many other illnesses of long duration” (Grob 1). The primary means of treating patients was through the use of limited pharmaceutical interventions and counseling the patient. After 1940, an explosion of medical advancements like the development of antibiotic drugs and new vaccines, among others, rapidly changed the capability of the physician to treat different conditions. Surgical interventions became significantly more refined and moved even farther away from their origins in the hands of a barber. Scientific advancement seemed to promise cures for all of humanity’s ills. An increased emphasis on scientific investigation and development threatened to overwhelm the previous focus on healing as a wholly human endeavor and to reduce the human into the numerical, the patient narrative into numbers on a chart.
Medical professionals before 1940 foresaw this tension between the scientific and human elements of medicine and the effect it would have on the doctor-patient relationship. Dr. Francis
W. Peabody, a respected researcher, medical educator, and physician, gave an influential lecture in 1927, in which he emphasized that “the most common criticism made at present by older
Draper 9 practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or, to put it more bluntly, they are too scientific and do not know how to take care of patients (Peabody). Dr. Peabody went on to claim that the practice of medicine “is an art, based to an increasing extent on the medical sciences, but comprising much that still remains outside the realm of any science.” He firmly believed that
“the whole problem of diagnosis and treatment depends on your insight into the patient’s character and personal life, and in every case of organic disease there are complex interactions between the pathologic processes and the intellectual processes which you must appreciate and consider if you would be a wise clinician.” Therefore, “one of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” This straightforward comment strikes at the heart of the issue of tension between the arts and the sciences; the two together should be used for the improvement of patient care. His emphatic defense of this stance suggests that an emphasis on scientific investigation threatened to overcome a focus on the human elements of medicine when he gave this lecture, decades before post-World War II scientific advances continued to push the humanities from the medical establishment’s consciousness. The promise of resolving all illness through science threatened to overcome Dr. Peabody’s simple statement concerning the “essential qualities of the physician.”
No one is born a physician; we learn to become doctors. Today, the process of acquiring the qualities and knowledge to be an effective physician is a long one. In the United States, physicians must complete college, medical school, residency, and, in some specialties, a fellowship. Thus, physicians are lifelong learners by virtue of their profession. In the past, the primary method for learning how to treat patients was apprenticeship. Other physicians taught the younger generation the science of medicine as well as the conduct and behavior needed to
Draper 10 care for strangers. This process of learning from observing the behavior of others physicians is still an integral part of medical education today. For physicians, there are two curriculums: the overt curriculum found in the many years of classroom and the hidden curriculum learned on the wards while shadowing other physicians. This hidden curriculum occurs in trainees’ observation of actual interactions between physician and patient and in the comments which the physician makes to the trainees.
The hidden curriculum varies based on the medical culture of the time and the preferences of the physician teaching the student. This notion of medical education “refers to medical education as more than simple transmission of knowledge and skills; it is also a socialization process” (Mahood). This process of “socialization occurs in corridors and call rooms, outside formal learning environments;” it is not subject to the same administrative policy changes that formal education is. Some physicians fear that “as students move from undergraduate to postgraduate medical training, not all transformations are positive.” In describing the results of the hidden curriculum, “several themes recur...the loss of idealism, the prominence of hierarchy, the adoption of a ritualized professional identity, and emotional neutralization” (Gaufberg). Thus, the social atmosphere and standards of the medical community greatly influence and shape the new generation of physicians-in-training. Attitudes acquired through this hidden curriculum requires a more thorough examination to understand how they affect the doctor-patient relationship and the quality of patient care.
Campo’s poetry often examines the lessons that he has learned from this hidden curriculum and their effect on his approach to patient care. An increased distance between the patient and the physician is one of the most cited products of the hidden curriculum. This emphasis on maintaining clinical distance and a professional demeanor may come at the cost of
Draper 11 an increased indifference to the humanity of the patient and an exclusive focus on the objective facts of the patient’s case. Campo repeatedly examines the effects of this distance on his interactions with patients and on himself. His poem, “Technology and Medicine,” illustrates this distancing as the physician gradually becomes one with the technologies which present a barrier to his relationship with the patient:
Technology and Medicine The transformation is complete. My eyes Are microscopes and cathode X-ray tubes In one, so I can see bacteria, Your underwear, and even through to bones. My hands are hypodermic needles, touch Turned into blood: I need to know your salts And chemistries, a kind of intimacy That won’t bear pondering. It’s more than love, More weird than ESP- my mouth, for instance, So small and sharp, a dry computer chip That never gets to kiss or taste or tell A brief truth like “You’re beautiful,” or worse, “You’re crying just like me; you are alive.”
In this poem, the progress of medical science- the x-rays, scans, bloodwork, and so on- prevents the physician from seeing himself as fully human. His reliance on technology to treat the patient results in his gradual transformation into one of those same cold machines. The physician sees too much data but it is only of a specific kind. It is a kind of intimacy that reduces the patient to numbers and salts and the physician into a kind of machine. In this relationship, neither the physician nor the patient retains their humanity. Their shared humanity, “a brief truth,” becomes a bittersweet close to the poem rather than a central detail of the relationship between the doctor-patient relationship. The poem’s portrayal of technology demonstrates how an over-reliance on this kind of data fails both the physician and patient.
Maintaining a normal and respectful relationship in the face of technology’s growing influence returns the narrative of the patient to a more equal footing alongside objective
Draper 12 measures like blood pressure and heart rate. Understanding the details of a patient’s story and cultivating a trusting relationship in which those details can be shared allows for a more effective medicine, one which recognizes the humanity of both parties. Within Campo’s poetry, “the prospect of regarding relationship as an organizing principle…points to the value of the humanities’ interdisciplinary perspective and methodology as a means of understanding the dynamic nature of the relationship in the contexts of cultural change” (Jones 138). Thus, centering the relationship at the core of the medical encounter creates a more resilient one which may evolve in the face of changing medical challenges like those presented in a pandemic.
Sadly, the current model of the doctor-patient relationship fails to realize this potential.
Under this model, the physician cannot fulfill all of the emotional and narrative needs of the patient while also tending to their own emotional needs. The difficulty is that “when the patient asks for love and life, the doctor can recognize this, but is bound, paralyzed by an inability to give anything back, leaving a troubled silence. The poignant irony of the patient’s perception of the physician as a lover and a life- giver is paralleled in the doctor’s sadly futile identification with the patient” (267). The failure of this aspect of the relationship evolves in large part due to the foundations of the physician profession. At its core, “medicine is…unmistakably, a world of power where some are more likely to receive the rewards of reason than are others” (Starr 4).
The desire to solidify physician’s authority, to define the profession, and to assert the professional status and authority of physician led to a reliance on certain practices like clinical distancing.
Being emotionally detached and distancing oneself from the patient reinforced the idea of the physician as somehow different and superior to the patient. The othering of physicians allowed them to attain authority and power as individuals and professionals. As a group, they
Draper 13 gained sovereign authority over themselves. Physicians regulate their own rules of conduct and of training the next generation. In medical education, physicians learn emotional detachment as a tool to aid in being more objective and more effective in their clinical decisions and actions.
Campo’s poetry questions the utility of clinical distancing and repeatedly suggests how refusing to recognize the shared humanity between the physician and patient actually inhibits the physician’s ability to be effective in the clinic. His work also suggests how the encroaching pressure of other forces on the space allocated to the physician and patient also work together to impede the doctor-patient relationship. The rising influence of third-parties like pharmaceutical companies, insurance companies, and technological advances pressure the physician to be more like a machine: seeing more patients, making no mistakes, and producing more revenue.
Combating this pressure as well as the foundational roots of the physician profession necessitates a pushing back, a rediscovering of the innately human connection between two people. Reading and writing makes space for this human connection on the page itself and in conversation about the work. Writing provides a potential avenue for recovering the emphasis on the humanities lost in the push for scientific advancement.
The Need for Physician Writers
Writing poetry or prose requires that physicians utilize skills which are similar to those used to diagnose and to treat patients. Observation, note-taking, and analysis are all important aspects of treating patients. However, writing poetry requires an extension of these skills beyond what is required in the clinical setting. I focus on the writing of poetry and its utility in large part because of my belief in its power to encourage the distillation of narrative into a concise, image- focused form as well as its potential to encourage important moments of self-reflection. Campo’s poetic work constitutes a fascinating example of the potential for poetry to function as both an
Draper 14 outlet for the physician—sometimes self-reflective, sometimes cathartic, often both— and a means of advocating for the patient.
Campo contemplates the reason for the existence of physician-writers in the following poem:
Why Doctors Write A doctor writes an order in the chart. A doctor writes prescriptions to be filled. A doctor writes the patient’s history in order to record it in the chart. A doctor writes because she must. She writes prescriptions that to patients seem like cures. A doctor writes the mystery of death in stark abbreviations: DNR-- do not resuscitate--and DNI. A doctor writes prescriptions for more pills. A doctor writes because he must, because he watched another patient die last night. A doctor wrote an order in the chart: DO NOT INTUBATE, which the nurse transcribed. A doctor writes invisibly upon a patient’s chest, the stethoscope’s black curl like punctuation, breath like poetry heard almost lovingly. A doctor writes because she must, because she can’t deny the body speaks, and what it tries to say is more than what’s recorded in the chart. A doctor writes because he can’t prevent the heart attack, because he can’t stop death no matter what new pills he might prescribe. A doctor writes an order in the chart. A doctor writes a poem that no one reads. A doctor writes because he must, because not one of us can stop the final cure. A doctor writes because she tried to stop but couldn’t. Nurses question orders; night falls mercilessly again. Doctors write because they must, because the ICU is like a dream we think we can decode. A doctor writes a poem in the chart, though none can read its invisible lines, or understand the mystery of death.
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In this poem, Campo outlines why physicians already write to fulfill the requirements of their jobs while suggesting additional things that encourage them to write outside of their normal medical practice. The poem features a blend of short and long sentences. The shorter sentences take up a single line while longer ones are divided by enjambments and stress specific ideas.
Shorter sentences often state a physician action- “a doctor writes an order in the chart.” Longer lines expound upon the purpose of writing in the physician’s work- “A doctor writes because he must, because, / he watched another patient die last night.” The shorter lines provide the first glance, the obvious action. Longer lines delve into the more complex emotional life of the physician. This difference in detail in itself is a reason for physicians to write. Even deceptively simple aspects of their jobs like writing prescriptions belie more complicated and emotional issues. The action of prescribing pills does not fool the doctor into thinking that he can conquer
“mystery of death.” Rather, the act of writing itself is part of the process of coping with the inevitable mortality of his patients; “not one of us can stop the final cure,” death. The juxtaposition of shorter statements with longer expositions demonstrates the layered aspects of common physician actions. Understanding the nuance to these procedures allows the physician to cope with the mortality of his patients as well as himself. Thus, the poem advocates for physicians to write, to delve into this deeper level of detail hidden beneath the surface needs of the clinic and of the patients.
Certain acronyms in the poem appear in all caps, including “DNI,” “DNR,” and “ICU.”
Out of all of the acronyms used in medicine, Campo chose these three, each is associated with patients who are likely near the end of life. The only one which is later spelled out is DNI: DO
NOT INTUBATE. The emphasis on this acronym showcases the moment when physicians
Draper 16 receive and convey explicit instructions from the patient to do nothing. Powerless to do anything for the patient, the physician can only write.
Interestingly, the first pronoun used to describe the physician is female. This first identifier within this poem pushes back against the stereotypical conception of the physician as a white male. Physicians of both genders share the need to write. The female physician writes prescriptions “that… seem like curses” but still she persists. The next pronoun referring to the physician is male, five lines later. The identification of the physician is shared between genders, their concerns here are universal, not specific to either male or female. Physicians are equally capable of treating patients and performing their duties regardless of their gender identification.
Campo’s simple pronoun choice denotes an openness and progressiveness in considering the role of the physician to be accessible to all, regardless of gender identity.
Through other stylistic choices, Campo suggests more nuanced aspects of the physician’s struggle to write. The poem repeats “A doctor” at the beginning of 15 out of 36 lines. In reading the poem out loud, there’s a certain fatigue in this repetition. The need to retain this professional identity competes with the urge to write. The title of ‘doctor’ loses its meaning throughout the poem while the meaning of what it is to write evolves as the reasons for its place in a physician’s life evolve. This is not a poem about the patient, it is entirely about the physician. The poem considers the ways in which writing cares for the doctor. In doing so, it provides a space for thinking about the elements essential to the physician’s resilience in the face of a career’s worth of patients asking for help in healing.
Within the poem, there are also repeated images of physician’s failures. Writing becomes a way to turn losses into a product. Against the inevitability of death, the physician knows they can do nothing. But, they can write to process the chaos they witness while creating a space that
Draper 17 considers the difficulties of caring for others. The writing may be ineffective; it may provide insufficient comfort. It may languish in a cluttered corner; others may not read it. But, it’s an outlet for the physician first, and for some an irresistible one. Through writing, the physician can find poetry in the mysteries around him, “like a dream we think we can decode.” The willingness to evaluate the environment opens the physician to details that can be taken for granted. This broadens the physician’s ability to empathize with others. Writing poetry can result in a “cultural humility [which] incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations” (Jones, 117). The need to write for physicians- to write prescriptions, to write case reports, to write research presentations, and/or to write stories- is an essential aspect of their professional occupation. Writing about one’s clinical experiences beyond standard practices helps the physician to improve their ability to practice as healthcare professionals. Writing for the physician is as much about the process as it is about the final product. In carefully observing the world around them, they can learn to cope with the realities in which they find themselves helpless or unheard. They can shape their own understanding of what it means to be a physician, to wear a white coat, and to treat patients in some of their most vulnerable moments.
This urge to write also becomes a means of extending the physician’s understanding of the patient’s identity. Writing occupies space and allows the physician to consider the full scope of experiences which may affect the patient’s behavior and clinical presentation. Eric Cassell, a professor of healthcare policy and research, discusses approaching a personhood’s ‘topology’ including their:
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personality and character (potentially altered by an illness, for example, or found to be inadequate in confronting the illness), a past (including previous experiences with illness and physicians), life experiences and meanings attached to them, family ties, cultural background, familial and social roles, relationships with others, connectedness on the basis of political beliefs, proficiencies, customary ways of doing things — familiar ways of living in the world, corporeal uniqueness and equilibria of bodily comfort, a “secret life” of aspiration and dreams, a ‘perceived future’ [and] a ‘transcendent dimension’(1982, 642– 643)
Appreciating this topology naturally aids in considering the patient’s ailments as parts of a whole person rather than as only parts.
The ability to interpret the things that happen to us as narrative shapes our ability to cope with the events of life. In her book of essays, Joan Didion asserted that “We tell ourselves stories in order to live…. We look for the sermon in the suicide, for the social or moral lesson in the murder of five” (Didion 11). For physician-writers, the utility of telling stories is two-fold, it is a way to build resilience and to find lessons in the sometimes chaotic clinical environment. Stories streamline the events of the clinic and help force order upon bits and pieces of information collected from charts, lab reports, and conversations with patients. They also aid in the construction and maintenance of a sense of identity, personal and professional, in the midst of intense pain and emotion.
Identity in Campo’s Poetry
For the physician and other healthcare workers, the hospital environment can become all- consuming. The hospital lights shine at all hours of the night and patients need care around the clock. Stepping into an exam room requires the physician to pack away his or her personal feelings in order to pay attention to the needs of the patient. This environment can threaten to swallow the physician’s sense of self. The “biomedical model [of medicine] conceptualizes
Draper 19 medical treatment ‘simply as applied biology,’ where caregivers are required to function primarily as scientists who focus ‘on things to do for a particular disease that are measurably effective’” (Jones 167). This leaves little room for the stories and feelings of the patient or the physician. Yet, for any individual, he or she “can only answer the question “What am I to do?” if they can answer the prior question “Of what story or stories do I find myself a part?”’
(MacIntyre 189). The individual physician’s direction becomes clear only if they can understand from where they’ve come. Thus, understanding one’s origin and purpose becomes a key part of the resilience needed to care for and to make decisions on behalf of the ill.
Going back to the beginning, rooting one’s identity in an origin story, helps create a solid foundation for the physician. Campo demonstrates the importance of his identity repeatedly in his poetry as he considers what effect his past has on his ability to treat his patients. In an interview, Campo replies to the question: “Where does Rafael Campo begin?”
I was born in Dover, NJ to immigrant parents; my father is from Cuba, and my mother is Italian-American. My parents loved Cuban poets, especially José Martí. They used verse to foster in me a connection with the country that was no longer possible for us to visit. Though they were grateful for the opportunities and freedoms that drew them to America, at times they were homesick, and imaginative poetic language was from an early age presented to me as a way of repairing wounds. I started writing poetry myself to make sense of this loss of homeland, and how to be part of a new world where I felt “different” (“Interview with Rafael Campo, MA, MD, DLitt (Hon)).
Here, Campo has integrated his parents' immigrant history with his love of writing poetry. Intertwining the two demonstrates poetry’s essential function as “a way of repairing wounds” left in his family history. These wounds involve his sense of belonging and identity in the world even before he enters the professional environment of the medical community.
Becoming a physician and attending respected northeastern schools could not suppress this brewing identity crisis. Instead, it complicated his sense of identity and pressured him to conform to a homogenous concept of what a physician should be.
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When Campo was a young physician, the profession was still overwhelmingly white, and male, and either straight or in the closet. His awareness of this homogeneity allowed him to understand the effect of being a physician on his sense of authority and of belonging. As a physician:
The M.D. after my name, so long interposed between me and the world of the infirm, that professional appendage sheathed in protective latex, an anti-penis designed to keep me disengaged, sexless, AIDS-free, and possibly straight- M.D., the brusque abbreviation of My Desire, only served to heighten my guilt. Not only was I improbably aligned with a medical bureaucracy that denied me; I was also shamefully powerless to cure (The Poetry of Healing, Campo 140).
Even as he may try to claim a professional distance from his patients, there is no power in the titles or pedigree which he accumulates. Rather, he finds a need to create a space to explore his feelings and to assert his identity to himself and to the conformist pressures of the medical profession. Poetry satisfies this need. In his collection of autobiographical essays “The Poetry of
Healing,” he reflects on his compulsion to write poetry:
My parents, my premedical advisers, my colleagues in medicine, and even some of my poet friends all have wondered why I am compelled to write poetry, and especially why I bother with so called formal poetry. They want a clear answer, as much as I do. I have been trying to answer this question for as long as I can remember. It is the surgery I have been performing on myself since I began writing poems, as if I too required assisted breathing the way the patient undergoing an operation to remove a malignant tumor requires the temporary artificial imposition of the innate breathing rhythms. I hear this question as an echo of the external world’s ongoing question of me…. ‘Identify yourself,’ this question demands, ‘who are you? (Campo, The Poetry of Healing, 102).
In highlighting the pressure to self-identify, Campo identifies poetry as a potential tool for freeing himself from this urge to conform. Giving voice to his experiences through his poetry allows Campo to assert himself as who he is rather than who others would have him be. Within his poems, he can exist simultaneously as a gay man, the son of Cuban immigrants, and a physician. He has the space to explore the consequences of these identities on his relationships with his colleagues, his patients, his loved ones, and himself as well as on his need, as a
Draper 21 physician, to write. Poetry becomes a place where the physician can consider how their identity and that of their patients affects both parties’ ability to communicate and to participate in a healing doctor-patient relationship. This opens the clinical space up to the world outside and expands the influence of this relationship.
Recognizing the Physician’s Trauma and its Relevance to Poetry
Trauma, in this project, is understood as “[involving] intense personal suffering, but… also the recognition of realities that most of us have not yet begun to face” (Caruth 3). Closure is not necessarily the acceptance of an event, but an extended understanding of the event’s reality that allows the survivor to confront the chaos of traumatic memories. Through rationalizing and ordering traumatic memory into narrative, the memories can be interrogated, processed, and shared. The confrontation of memory facilitates closure, giving rise to an understanding of the traumatic events in the context of one’s own life and of history.
In the title essay of The White Album, Didion asserts that we create order from chaotic memories via the “imposition of a narrative line upon disparate images or by the ‘ideas’ with which we have learned to freeze the phantasmagoria which is our actual experience” (Didion
11). A phantasmagoria, a sequence of real or imaginary images like those seen in a dream, could consist of one’s recollections of a traumatic experience. They could also occupy the lines of a poem. Creating narrative from the memories of “those realities that most of us have not yet begun to face” can have a healing effect in providing space for processing and understanding
(Caruth 3). Writing can foster a sense of control over the uncontrollable and give the unspeakable a place on the page.
Working in healthcare exposes the doctor to some of the worst and best moments of the human experience. The physician’s work demands vulnerability from the patient. The physician
Draper 22 must become intimately familiar with the rhythms of the patient’s body, the heartbeat, the gurgle of peristalsis, among others. Physicians witness a patient’s pain and can carry their own trauma as a result of these encounters. Retelling these stories in some form, literary or otherwise, provides a low-stakes space for understanding one’s experiences. The stories themselves can become a living thing, a representative of the physician-patient experience independent of either party. As people reflect on their life, they can “retell stories to an effect different from an earlier telling, sometimes reflecting explicitly on that earlier telling and sometimes adapting the story as if it were being told for the first time” (Frank 16). As Frank states, everyone can find comfort and has likely found it in the process of retelling an experience, changing it, and molding it into a more communicable narrative. Recognizing the disparate parts of a story and bringing them together is a useful skill for taking control of past events and finding comfort.
Campo considers the ways in which poetry heals him as he says that, “there is no medication to cure me, and only boxes of my own construction to contain me, whose walls allowed me to smash against them my own head” (Campo, The Poetry of Healing,119). For him, the construction of formal poetry gives him a structured space in which he may release his emotions. He uses many different forms in his work like the pantoum in “Without My Coat”
(2013), the villanelle in “A Death Perplexing” (2000), the sonnet in “The Distant Moon” (1994), and others. Each of these forms has specific guidelines which Campo plays with as he writes.
Ironically, he finds formal poetry freeing; he can “scream in [his] voice like hands all over their golden words and grammatical rules, in the same way [he] had once dreamed of touching them”
(120). Poetry is an equalizer; “Spanish and English [are] immediately the same” (120). In the written word, there is a space for honesty and reflection which the physician cannot always find.
Within the bounds of this formal poetry, Campo can make meaning and order from his emotions.
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In allowing him an outlet to consider his emotions, Campo’s poetry “precisely registers the force of an experience that is not fully owned,” in Cathy Caruth’s words describing trauma
(Caruth 5). His work’s “transformation of the trauma into a narrative memory that allows the story to be verbalized and communicated, to be integrated into [his] own, and others', knowledge of the past, may [cause the loss of] both the precision and the force that characterizes traumatic recall" (7). This loss constitutes a closure obtained through the creation of narratives about the traumatic memories, one based on control. The ability to control when one recalls the traumatic memories and the ability to reduce their disturbing, intrusive attributes allows for closure. For, if
“we are to live ourselves there becomes a point at which we must relinquish the dead, let them go, keep them dead” (Didion, The Year of Magical Thinking, 226). The memory may ultimately dull itself in his mind as a whole while remaining enshrined within the poem with its original force and detail. Utilizing the poetic form helps to preserve some of the ephemeral aspects of the original memories. Importantly, poetry allows for the retention of rhythm, enjambment, and emphasis in a way that narrative may lose. Campo’s stylistic choices in choosing a particular poetic form or using figurative language allow him a greater degree of control over the reading experience.
To Publish Poetry: in Itself a Reason to Write?
Choosing to publish poetry can be an altogether different journey from writing it only for oneself. Putting work out into the world, especially that which reflects on difficult or controversial subjects, opens up a conversation which can evolve independently from the author.
In a way, this sharing has the potential to turn poetry into a form of advocacy. The work can spread an idea or encourage a conversation independent of the author. Additionally, the complex
Draper 24 nature of poetry requires careful reading and analysis which forces the reader to consider, slowly and intentionally, the meaning of the work.
Of course, art can be created simply for the sake of art. In reading Campo’s work, the reader confronts the elegance of his poetry immediately. The experience can be immersive, the intentional stress on different words throughout the poem leads the reader through the work.
Susan Sontag argues that “a work of art encountered as a work of art is an experience, not a statement or an answer to a question. Art is not only about something, it is something. A work of art is a thing in the world, not just a text or commentary on the world” (Sontag 30). Sontag’s argument here presents an interesting counterpoint to the function that Campo’s poetry serves for him. Campo’s poetry demonstrates how politics and social issues can be inextricably linked to the need to create art. The aesthetic dimension of his formal poetry is crucial to his writing.
However, for Campo, both the use of aesthetic form and the need for reflection are inseparable from the other functions that his poetry serves. His work constitutes an experience, a statement, and an answer to his own questions about what it means to be a healer while sharing his humanity with his patients.
Reading about the physician experience illuminates the doctor-patient relationship in a new light. Above all, this work humanizes the physician. Removed from the professional superiority of the white coat, the physician’s voice in Campo’s poetry reveals the shared humanity between the patient and physician.
What the Body Told Not long ago, I studied medicine. It was terrible, what the body told. I’d look inside another person’s mouth, And see the desolation of the world. I’d see his genitals and think of sin.
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Because my body speaks the stranger’s language, I’ve never understood those nods and stares. My parents held me in their arms, and still I think I’ve disappointed them; they care And stare, they nod, they make their pilgrimage
To somewhere distant in my heart, they cry. I look inside their other-person’s mouths And see the wet interior of souls. It’s warm and red in there—like love, with teeth. I’ve studied medicine until I cried
All night. Through certain books, a truth unfolds. Anatomy and physiology, The tiny sensing organs of the tongue— Each nameless cell contributing its needs. It was fabulous, what the body told.
When discussing the experience of being ill and of caring for those who are ill, metaphors and reality blend to express the hidden underbelly of the physician experience. Witnessing
“illness...the night-side of life, a more onerous citizenship” daily stresses the physician (Sontag
3). As a human, the physician may understand that “everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick… sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place” (Sontag 3). But, treating and providing comfort to individuals dealing with illness constantly exposes the physician to the truth that “It was terrible what the body told.” The knowledge of this reality transforms the body into a thing with the potential to harm and to contain “the desolation of the world.” The body becomes something to fear and to revere. In writing his poem “What the Body Told,” Campo can give voice to his experience of studying these painful contradictions of the body. His parents' bodies shielded him from strangers when he was younger. But now, as a physician, the truth of the body reveals itself in textbooks and patients. This truth is both terrible and fabulous. These
Draper 26 contradicting adjectives bookend the poem itself and represent the daily dichotomy which the physician must navigate in their work and their psyche.
Publishing this work allows others to benefit from the hard-earned realization of an experience physician. Putting work out into the world allows it to create space for conversations about difficult and complex topics like the horrible and wonderful things that the human body can create. It allows for the physician-writer to treat potential readers with poetry, thus; it expands their scope of practice and potential for advocacy.
Conclusion
For Campo, poetry is rejuvenating. After coming home from having his blood drawn prior to an important biopsy, he writes “thirty-two sonnets...piled to the left of the typewriter and
I was breathing rapidly. My heart was pounding so urgently it was like a fist on a table. My fingertips tingled where they had struck the lettered keys over and over again. I had a terrifically fat hard-on. I was filled with a sense of my own well-being; I felt restored to health” (Campo
252). Writing poems allows him to express his stress about his own health. This cathartic process is as crucial to his recovery as the surgery which later removes the dysplastic tissue causing his pain. Writing provides a map of the ills which modern medicine still cannot touch and begins to bridge the gap between the sciences and the humanities.
Campo answers the question of ‘Why Does Campo Write’ in his own autobiographies and poems. The artificial divide between the humanities and the sciences can be significant, he responds to it repeatedly in his work and in his persistence as a physician-poet. Yet, the determination with which Campo crosses this divide makes analyzing his work both a fascinating and meaningful pursuit. He, like many of his colleagues in the medical humanities,
Draper 27 has pioneered a novel approach to the challenges of modern medicine by returning to the age old tradition of physician-writers.
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Chapter 2: Poetic Form and Style in Campo’s Work
In medicine, the need for effective and efficient communication shapes the format in which healthcare providers communicate with one another and use to train the next generation of healthcare professionals. The goal for these students of learning to navigate complex clinical situations requires that they understand how to communicate in the formats and medical jargon specific to their profession. This, in many ways, mirrors the skills needed to read and to write formal poetry.
Those writing poetry must wrestle with the challenge of integrating time, memory, and feeling into a concise and structured format just as the physician must be able to present the patient’s status and relevant medical history quickly and effectively. Transforming stories into formal poems combats the reality that “people choose stories, but they have less choice about the principles that set their choosing” (Frank 25). In adhering to form and tradition, the poet willfully reorganizes, orders their selected narrative, focuses on certain images, and selects the best form for conveying their story. Choosing words that express a given meaning and adhere to the desired form can be challenging. Making a selection seem natural requires that the poet be “a master…who persuades us that his general metrical choice is the only thinkable one for his poem” (Fussell 92). It also necessitates that the poet, like the physician, be well versed in highly specialized vocabulary. Just as the physician might use medical terminology to describe the condition of a patient, the poet may describe a poem with language specific to the poetic tradition.
The dictates of poetic tradition can be compressed into the rhyme and meter of as little as a single line. The type of foot, combination of word sounds, imagery, and other poetic elements can be mixed together to create unique and complex poems. Poetry can intimidate, the imagery it
Draper 29 contains is precise and powerful. In the past, “if a man had something important to say, he said it in poetry; it came natural to him, and it was received naturally” (Garrod 14). The rhythmic nature of poetry aligns well with bodily rhythm and makes it a powerful form for discussing the human body and psyche. For “people who love [poems, they] use them as sorts of internal maps or orienting devices. In an internal landscape full of chaos and surprise, a poem becomes an anchoring place, a way of marking where you've been and considering where you are” (Campo,
Rafael and Mark Doty). Poetry’s careful segmentation allows for the careful placement of stress within a given image. In the hands of each individual poet, this potential can be formed into something concrete, magical, and comforting. For the physician-poet, it allows for the reinterpretation of the language of medicine as something rhythmic and beautiful as well as functional.
Like formal poetry, medical communication and analysis often follow a pre-given structure. Medical communication focuses on clinically relevant facts: the name, height, weight, and medical history of the patient. This kind of storytelling encourages a concentration on distance and objectivity. As a result, in the medical profession, “We're so defended. We're so guarded. We have our white coats. We have our professional distance. We have our objectivity.
We're armed with our science and our scientific studies” (Campo, Rafael and Mark Doty). Poetry has a unique ability to ameliorate the tension between the need to be professional and the need to understand one’s own reactions to what is encountered in the clinic. Putting poetry on a blank page creates a space independent of the clinical environment. It allows for the reinterpretation of the language of medicine as something rhythmic and beautiful as well as functional.
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Poetry and the Oral Presentation in Campo’s Work
The process of writing a poem in itself requires a pause and a reduction of a narrative into a version which includes only those details that the poet deems most relevant. Wordsworth said that “poetry is the spontaneous overflow of powerful feelings: it takes its origin from emotion recollected in tranquility.” In considering the powerful effect of processing emotions calmly and logically, Campo comments on how “when we share a poem, it's extraordinary because literally the discussion shifts to How am I implicated? How do I see these injustices, these disparities through the lens of my own experiences” (Campo and Doty, “Expanding the time we have with
Patients through poetry”). These questions demonstrate how poetry can expand the discussion of a particular topic even when presenting a narrative in a compressed and shortened form. The distillation of images into an ordered sequence of thought inherently requires a focusing on the important elements of a story.
The images which the poet chooses to include, the division of lines, the creation of stanzas, and, more generally, the particular form of the poem provide an opportunity for the reader to ask these questions and to decompress the poem’s narrative. For the physician writer, reading and writing poetry forces the physician to reflect on experiences and feelings that may be uncomfortable or unprofessional and present them in a controlled way.
Formal poetry, in particular, accomplishes this goal as it imposes order over the process of writing and requires that the poet utilize certain patterns in their work. The use of form also extends a hand backwards to the generations of artists who have endeavored to arrange their thoughts within the dictates of a certain pattern. In doing so, formal poetry requires that the poet recognize and write in direct relation to, if not always strictly follow, the rules set forth by this poetic tradition. Choosing the appropriate form that fits the intention of the poet requires
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“knowing how to use them appropriately in different situations to produce the effect… good stories can create’” (Frank 17). Writing a sonnet versus a haiku has important implications the meaning of the poem. For example, the sonnet’s own identity “as that form that ‘has always stood at the imagined intersection of the romance languages and English’ that thus appeals to
[Campo’s] own linguistic heritage and mirrors his own dual identity in language and culture” is an intentional choice for Campo in writing “The Distant Moon” (265). This poem has four sonnet-like stanzas and investigates the relationship between a physician and patient. In “The
Distant Moon,” the physician questions his connection with a male patient with AIDS and his success in treating him in his final days.
The questions that the poet asks themselves in the course of writing are similar to those asked in medical training. These questions focused on identifying the most relevant parts of the narrative and presenting them to others in a specific format. Early on in medical training, students learn the importance of identifying what is relevant to the patient’s maladies. Because of the scientific bent of allopathic medicine, this often encourages a focus on the illness rather than the patient. Telling the patient’s whole story may be deemed medically relevant in healthcare settings which use this story as a primary tool for treatment, but its importance extends beyond those settings. For all patients, “the narrating of the patient’s story is a therapeutically central act, because to find the words to contain the disorder and its attendant worries gives shape to and control over the chaos of illness” (Charon). The patient may narrate their story to the healthcare worker who admits them or to the resident who pre-rounds on them before returning with their attending.
This story will be reorganized and digested again and again into a format that is easily repeatable for medical staff and that highlights the issues deemed medically relevant. The patient
Draper 32 does not consistently have the opportunity to tell their own story and, in doing so, to advocate for themselves. Instead, the traditional form of communications which medical staff use take center stage in shaping and sharing the patient’s narrative within the clinical space. These forms include the admission note and the oral case presentation. The admission note “contains more information than presented in the oral case presentation” as “it serves as a reference document for current and future providers to understand everything currently known about this patient”
(UW IM Residency). The oral presentation “pulls the essential facts from an admission note which are required for listening providers to understand the patient’s presumed admission diagnosis or diagnoses” (UW IM Residency). This forms a bridge between different providers working on the same patient as it serves as a starting point for the basic information needed to understand the current status of the patient.
The oral presentation style prioritizes filtering through the patient’s story to reorganize medically relevant information in as concise and direct a format as possible. Different physicians have different preferences for how this information should be presented. This requires that trainees be flexible in their presentation skills as their “individual supervisors (residents, faculty) often have their own (sometimes quirky) preferences regarding presentation styles” (UCSD).
Stereotypically, shorter presentation styles are associated with medical specialties which stress brevity and efficiency, like surgery. Even with the understanding of variation, there are specific forms which medical students and residents learn in an attempt to standardize and to provide structure to their presentations. One of these forms, the SOAP presentation “stands for a very useful note-taking format:
S – Subjective (how the patient feels physically)
O – Objective (vitals, physical exam, labs)
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A – Assessment (brief description of how the patient presented and a diagnosis)
P – Plan (what will be done to treat the patient)” (Kaplan)
The information needed to fill this template can often be found in bits and pieces in the patient's chart, in the words of the patient, and in the stories of the patient’s family members or loved ones. Collecting these shards of narrative is an important skill that physicians-in-training learn and practice often. Medical students watch and learn the steps to identifying relevant information when taking a patient history. Residents often pre-round on patients before going on rounds with Attendings in order to practice collecting the information that they will then present in a group. Learning these forms of communication from observation and practice allows medicine, as a profession, to pass down its traditions to each generation of new clinicians.
One of the oft repeated bits of wisdom that I have heard while shadowing, from patients and providers alike, is that the number of errors increases around the shift change as the handoff of patients is limited by the lack of effective communication about the patient’s current status, events during the shift, and plans for future treatment. There is a need for this type of communication that lies at the center of compassionate medical care. The need to record and efficiently communicate is central to the mission of caring for others.
While shadowing physicians, I have personally seen the versatility of a single folded piece of paper in the physician’s white coat. The little blank square becomes full of notes on particular patients, to do lists, and reminders about different symptoms and their presentation.
This pocket notecard habit is a learned one, passed down from attending to resident to medical student again and again. This is a form, a prescribed outlet for the overflow of details in the physician’s mind during hospital rounds. There are variations of this form. The physician may have learned to use a spreadsheet generated by the hospital as the notecard, they may have also
Draper 34 learned to talk oral notes as they walk to the next exam room in an attempt to increase the efficiency of their clinic. There are many variations of note taking strategies that have evolved from the personal preferences of physicians. However, they all have the same intention; they are the creation of the physician's own personal code, a shortened version of the formal presentation of patient information which they make to their colleagues.
Frameworks like the SOAP presentation outline mentioned above are taught in an effort to standardize certain communication practices and to move towards the ultimate goals of maximizing positive patient outcomes and minimizing preventable clinician errors. This is a very specific kind of storytelling with a specific purpose. Like the SOAP presentation outline, the framework of a formal poem can provide a structured and traditional manner of recording and analyzing an overflow of information. However, the information may include the emotions that well up as a result of caring for others. The poet uses poetry as a means of “experimentation with the material of life- the poet is trying it this way and that; he wants to see how it runs” (Garrod
36). Campo’s poetry features several poems which satirize this specific storytelling style. These satires likely reflect Campo’s time spent working as a resident with high acuity patients and highlight potential issues inherent in medicine’s focus on efficiency in communication. The following stanza shows how Campo utilizes the medical presentation format in his work and demonstrates potential issues with this format.
I. Mrs. G. The patient is a sixty-odd-year-old White female, who presents with fever, cough, And shaking chills. No further history Could be elicited; she doesn’t speak. The patient’s social history was non- Contributory: someone left her here. The intern on the case heard crackles in Both lungs. An EKG was done, which showed A heart was beating in the normal sinus
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Rhythm, except for an occasional Dropped beat. An intravenous line was placed. The intern found a bruise behind her ear. She then became quite agitated, and Began to sob without producing tears. We think she’s dry. She’s resting quietly On Haldol, waiting for a bed upstairs.
The stanza almost follows the form of a sonnet. With its sixteen lines, it deviates slightly from the fourteen-line format of the traditional sonnet. Each line has the requisite five iambic feet of a sonnet. Three out of the final five lines rhyme. Still, the poem does not follow the prescribed rhyme scheme for a sonnet exactly. Each of the eleven statements in the poem contain instances in which the failure of love or of compassion harmed the patient in question.
The poem follows the guidelines of SOAP, but choosing to use the sonnet form makes a subtle and important point about the failure of love. Campo follows the formal presentation but also demonstrates how inadequate it is in the number of questions which the reader may have.
This specialized presentation attempts to shorten and to convey information in the most effective and replicable manner possible. The poem foregrounds the repeated translation of formal medical language into something more direct and honest: ‘someone left her here.’ Thus, the poem reveals the euphemisms medical language can create, which not only flatten but obscure meaning to all but a select few medical professionals. To those unfamiliar with its jargon and chosen formats of communication, this specialized vocabulary becomes an obstacle which can only be surmounted with interpretation of a medical professional or with the aid of Google.
Campo’s satirizing of the medical presentation format highlights the communication barriers built into medicine. Here is the language, the cadence even, of the medical establishment in the formal statement of the patient’s age and gender- “The patient is a sixty-odd-year- old/White female, who presents with fever, cough, /And shaking chills.” Campo then re-purposes
Draper 36 this medical vocabulary to create a more empathetic and detailed description of both the patient’s and the physician’s condition. He highlights how the patient described has been left alone in the clinical environment and cannot speak to advocate for herself. She has been injured, something or someone hit her and left a bruise behind her ear. These more detailed descriptions follow the objective facts and assessment of the patient and indicate the moment at which the stanza deviates from the standard medical presentation format. The subjective portions of the stanza allow the physician to ponder the loneliness of the patient and her condition.
At the conclusion of the poem, the patient is under the control of the clinical environment and the physician may finish the stanza on a controlled image, that of her resting after taking a dose of an antipsychotic. Haldol, the antipsychotic, also completes and actively enforces her silence at the close of this stanza. The physician is not exceptional, in many instances, he cannot even be called empathetic. However, he takes note of the details which the traditional presentation might ignore. In doing so, Campo calls attention to how the first step in treating a patient empathetically is identifying the details of their condition that people may ignore.
As a poet, Campo’s skill is in part his capacity to show the instances in which caring for other people threatens to overwhelm the physician’s professionalism. Even in the moments in which the physician is unable to speak kindly about a frustrating case, he is human. In fact, one could argue that these moments of weakness are characteristic of humanity. The points in
Campo’s poetry in which the physician’s exhaustion is palpable reminds the reader that an advanced education and a white coat cannot negate the most basic of human reactions. The following stanza from “Ten Patients and Another” exemplifies a different, more negative, side of the shared humanity between the physician and patient and shows the breaking points within standard professional communication.
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VII. F.P. Another AIDS Admission. This one’s great: They bring him in strapped down because he threw His own infected shit at them- you better bring Your goggles!- and a mask, we think he’s got TB. He’s pissed as hell. Apparently, He wants to die at home but somebody Keeps calling 911. A relative Back home in Iowa, or some damn place. Just keep him snowed with Ativan- believe You me- you do not want to get to know This fucker. Kaposi’s all over, stinks Like shit- incontinent of course. How long Before you get down here? Because his nurse Is driving me insane. Of course we got Blood cultures….yeah, a gas- OK, I’ll stick Him one more time. The things you do for love.
The stanza notably differs from the previous one in that the voice is that of a healthcare professional speaking casually to another unidentified health professional over the phone. This is not a report which the physicians would record or give in front of a group. Instead, it serves as an informal relay of information and an expression of frustration and exhaustion. Only initials identify the patient in the title and the label as yet another case of AIDS dehumanizes the patient further. Here, a cardinal flaw in the traditional distillation of medical information presents itself.
The focus on the patient’s illness predisposes the frustrated physician to view and refer to the patient as merely an unpleasant collection of symptoms. Useful medical information is interspersed within negative and informal descriptions. The patient is strapped down, has AIDS, may be positive for tuberculosis, has Kaposi’s sarcoma, and is on a high dose of Ativan, an anti- anxiety drug. The speaker uses descriptors that do not belong in the traditional medical presentation like “shit,” “this fucker,” and “insane.” This is an overwhelmingly negative stanza that honestly represents the sometimes frustrating reality of treating patients.
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Placing these negative emotions on the page allows for compassion towards the physician as well as the patient. The frustration and exhaustion in the speaker’s voice in “F.P.” denote the burden of caring for patients in difficult situations. The AIDS crisis produced an onslaught of patients in difficult circumstances with extremely poor prognoses. Here is the physician stressed and unable to help the patient. In communicating with his or her colleague, there is a fundamental breakdown in professional communication as the need to share professionally relevant information competes with the need to express the physician’s emotions about the situation. The two desires cannot be expressed together in a professional relationship, it results in a biased and offensive presentation of the patient’s status. Having an outlet to express negative feelings outside of the clinical space allows for the preservation of a professional and empathetic demeanor. The overwhelmingly negative content of “F.P.” emphasizes the importance of providing equal space to the difficult aspects of treating patients. The physician’s honesty demonstrates that he is not a hero and reminds the reader that the physician is vulnerable to the same overflow of negative emotions which are often associated with the patient’s experience.
The accessibility and candor of Campo’s poetry is essential to its charm and effectiveness.
Much of his work is deceptively simple. Yet, it taps into “the competence that human beings use to absorb, interpret, and respond to stories” in its ability to effectively distill intense images from incredibly complex clinical experiences (Charon 1897). Campo muses on the potential relevance of traditional poetic forms to medicine and empathy in an interview which he did with the
Morning News:
Maybe it has to do with the rhythms of the body. Meter and other gestures peculiar to poetry so much evoke the physical body. That can be the opening that allows us to enter into another physiology. I always think of my professor at Amherst College who said novels are empathy factories. I thought, no, that’s poetry! Poetry is the empathetic gesture, the flash of recognition. Of course, we experience empathy through the rich fiction we love so much, by means of character development and all the ways stories are unspooled—empathy is not the
Draper 39 exclusive province of poetry. Certain aspects of poetry, though, are particularly inviting to empathetic experience.
As Campo explains, poetry, unlike prose, encourages a different kind of analysis and engagement. In a sense, it forces us to exit a narrative frame of mind and to embrace a different perspective- of the world as a series of images. Poetry goes to the root of what formed the basis of medicine: the rhythms of the body and death, the final silencing of somatic sound. Treating and detecting illness involves an engagement with these rhythms: the beating of the heart, the gurgling of peristalsis, the whistling of air in the lungs, and others. Physicians describe this rhythm in their notes; medical students learn what ‘a crackling’ in the lungs is. This bodily rhythm has rules in the same way that formal poetry does. Because poetry “can be the opening that allows us to enter into another physiology,” so too is it useful for rediscovering the overlooked stories of those neglected in our society and, by extension, in clinical environments.
The discovery process allows for an intense process of recognition; the physician can recognize themselves in the fears and plights of their patients. Providing a structured outlet for exploring and engaging with these less professional thoughts and desires allows for introspection and reflection. Reading and writing formal poetry can be particularly useful for physicians accustomed to communicating in a specific and purposeful manner.
Poetic Form and the Oral Presentation
The similarities between formal poetry and the traditional oral medical presentation make it an ideal format for Campo to reflect on treating his patients with AIDS and HIV. In writing formal poetry about his experiences treating these patients and about his experiences as a gay man, Campo “[confronts] an overwhelming challenge in determining how aesthetically to represent love, given the tragic nature and the gruesome imagery associated with [AIDS,] the as-
Draper 40 yet-incurable disease” (McPhillips 85). Writing formal poetry is an aesthetic choice which contributes to the meaning of his poems. Campo also appreciates “the muscularity of formal verse, the way it can wring meaning from the patchwork cloth of my life, one that I still fear might wear itself out from scrubbing the messy floors of a society desperate for homogeneity”
(Campo 116, The Poetry of Healing). Formal poetry is a form of resistance for Campo as the strength of inherited forms allows him to resist the pressure to conform to society’s homogenous vision for what a physician should be. Instead, he can express himself and his unique perspective on what a physician can be through the accepted forms of generations of poets.
Much in the same way that the SOAP presentation guidelines structure aspects of medical communication, the evolution of these forms over time gives meaning to the form in which
Campo chooses to present a given narrative. Campo exploits this for the purposes of his own poetry. He believes that “to write formal poetry is sometimes even a way to sew myself into the body of traditions from which I sometimes feel excluded” (Campo 116). In particular, he finds that poetry brings him closer to the Cuban traditions of his family from which he feels divorced.
For “if I can make English rhyme and sing…maybe I can touch the gleaming shell that rests on the beach of my Cuban heritage” (117). The lyrical and imagery-laden nature of his English poetry allows him to reach towards the cadences of the Spanish language from which he feels distanced. Even as he speaks of poetry as something which has power over him and which comforts him, the creation of this work is something under his control. It allows him to reclaim the time, emotions, and culture that has been lost to him in the process of assimilating into both the culture of America and that of modern medicine. In an interview with Campo, Mark Doty expressed a similar sentiment:
The stories, the incidents you can't remember or you don't give voice to, are in some way always in charge. The ones that you can remember, you can say, and when you say something, it
Draper 41 may go away. Poetry does not cure trauma or dispel it, but it puts you in charge in some different way. You make a form for the experience and have some control over it; you give it a beginning, middle, end, you give it a meter. And you've made that thing which becomes a map, a place to stand. And because you have a place to stand, trauma [or illness] might do damage to you, but you have a room of your own, a space of your own. (Campo and Doty, “Expanding the Time we have with Patients Through Poetry”)
Here, Doty explains and reinforces the point that poetry in itself is not the end to an emotion or feeling. Instead, it provides a means to impose control over chaotic experiences. The control the physician-writer exercises over the words on the page stands in stark contrast to the chaos which the physician-speaker deals with in Campo’s poetry. The physician in these poems often struggles to find ways to help the patients meaningfully as he realizes that the solutions he can produce from his prescription pad and procedural skill set will do little against the structural inequities and unfortunate coincidences which lead patients to seek his help. Recognizing his helplessness necessitates the development of a coping mechanism. To feel effective in the midst of chaos, the physician must have a space in which they can effectively help their patients, or, at the very least, think about ways to help them.
Writing formal poetry is the ultimate exercise of control within poetry. Its creation requires an understanding of the history of each form as well as the exact elements which it contains. In many cases in his poems, Campo chooses a recognizable poetic form or genre but also chooses to break slightly with it. An example can be found in the poem below.
The Changing Face of AIDS: V. Elegy for the AIDS Virus
How difficult it is to say goodbye to scourge. For years we were obsessed with you, your complex glycoproteins and your sly, haphazard reproduction, your restraint in your resistance, how you bathed so slight yet fierce in our most intimate secretions. We will remember you for generations; electron micrographs of you seem quaint already, in the moment of our victory.
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to living honestly. The honesty you taught was nothing quite as true
as death, but neither was it final. Yes, we vanquished you, with latex, protease inhibitors, a little common sense— what’s that, you say? That some remain at risk? How dare you try to threaten us again! Of course, you’d like to make outrageous claims that some behaviors haven’t changed, that some have not had access to the drugs that mask your presence in the body. Difficult it is, how very sad, to see you strain (no pun intended) at response—our quilts, our bravest poetry, our deaths with grace
and dignity have put you in your place. This elegy itself renounces you, as from this consciousness you’ve been erased. The love for you was very strong, the hot pursuits so many of us reveled in— but what once felt like love was really not. I hardly know what I will find to hate as much as I have loved and hated what you brought to bear upon my verse, the weight of your oppression and the joys of truth. How difficult it is—to face the white of nothingness, of clarity. We win!
This poem’s title proclaims its form: an elegy. Drawing on the history of this form gives the reader a preview of what the poem will contain. While the elegy is associated with loss or mourning in modern times, “in antiquity the meter is used for a range of subjects and styles including the kind of combative, promiscuous love presented in the poetry of Propertius,
Tibullus, and Ovid” (Braden 397). The nuanced history of the form reflects the complexity of the above poem. In it, Campo uses apostrophe to address the HIV virus directly. The use of apostrophe and the initial lines repeated use of ‘you’ alludes to the format of the ode and complicates the mourning of the virus. Within the first two lines, he renames the virus as
‘scourge’ and labels it as a negative thing. This descriptor lends an aggressive intensity to the
Draper 43 poem’s address. Yet, the relationship between the speaker and the virus is a love-hate one. The speaker was obsessed with the virus ‘for years;’ the virus gave the speaker a job and a goal, its eradication.
Even so, the speaker understands that the virus has caused unspeakable pain and suffering.
The beauty of the description used to mourn the virus suggests that the speaker has found something to admire even in the pain that the virus inflicts on his community. At this moment of triumph, the reader finds bittersweetness in the declaration of victory. The complex and beautiful descriptions of this virus belie its ability to persist in the consciousness and bloodstreams of millions of people around the world. The “outrageous claims” of the virus are entirely possible and suggest that this elegy is premature. Its complexity stands in stark contrasts to the simple measures, “latex, protease inhibitors, a little common sense,” that have made this elegy possible.
Declaring victory over the virus may make these measures less effective as those who fought against the virus relax their defenses. The vanquishing of the virus also comes with the potential for losing the excitement of fighting against something bigger than oneself. This is a death hymn for a virus whose effect on society will likely endure. Thus, the layered history of the elegy as a form and the subtleties of Campo’s descriptions of the virus complicate and complement the resulting meaning of the poem.
In choosing to write formal poetry, Campo connects his work to a larger history of form and coopts the traditions of the establishment for his own work. In refusing to adhere fully to his chosen form in many of his poems, he questions what it means to write poetry about his medical experiences.
In a way, the process of writing and then reading formal poetry is accordion-like. To write formal poetry, information and images must be gathered and then compressed into the chosen
Draper 44 form. The focus of lyric poetry, as opposed to epic, is less on character development or straightforward plot and more on the creation of images. This emphasis on image and description compresses aspects of the narrative into their informational pieces and requires some degree of inference and analysis to be interpreted fully. These images convey feelings and sensory information, among other things to the reader. Narratives traditionally warrant the inclusion of a beginning, middle, and end. Poetry does not necessarily require this same narrative resolution.
Instead, it involves the compression of images and feelings into segmented stanzas and, in formal poetry, a particular form.
Writing poetry requires space, time, and quiet. The creation of rhythm and meter on the page, particularly ones that adhere to a given form, requires concentration. In writing, there is a restorative quality to the pace of thought needed to record words on the page. Racing thoughts may only be recorded as quickly as fingers can type or pens can write. The feelings incurred in the process of writing helps direct the exercise itself. In choosing a form, “common wisdom says that the poet must choose the suitable form for the subject, where the mind and the language are at one. Wisdom says appropriateness is all: The form must be capable of the same gesture as the feeling” (Peacock 70). The emotions which arise in writing contribute to the original intention of the poem and expand it. This allows for poetry to advocate for both the physician and the patient.
An expanded meaning contributes to the quality of poetry which ensures that “every act of valuing the voice of another person, of really hearing it, listening to it, taking it seriously, sharing it is an act—well, it's a blow against the empire” (Campo and Doty, “Expanding the Time we have with Patients Through Poetry”). In the medical setting, fighting back against the urge to homogenize the experience of having or treating a specific illness is an essential part of this fight against the establishment.
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Conclusion
The patient carries their illness narrative into the exam room, thrusts their story at the physician and asks to be cared for. The form that this conversation takes may vary based on the patient’s ability to communicate as well as on the doctor’s ability and willingness to listen.
Within the doctor-patient relationship, the patient may ask many questions of the physician like
’Can you help me? Can I be healed? How?’ Having these questions answered is an essential part of the healing process. It gives the patients closure while providing the physician with a sense of having accomplished something, of being useful. In situations in which the physician cannot answer these questions, the loss of control can threaten to overwhelm them.
Within poetry, the individual poet may control, or at least endeavor to control, the rhythms of language and the images described in their work. Therefore, the creation of poetry provides a safe harbor for the tumultuous mind. Both reading and writing poetry requires a focus and level of analysis that engages and aids in the processing of the phantasmagoria of images that we encounter every day. For physicians on the front lines, harnessing some control in the face of uncertain prognoses and indifferent pathogens preserves their ability to continue caring for others to the best of their ability.
Thus, it is in the midst of crises of unfamiliar proportions and origins that the ability to create and to control poetic language becomes powerful. At our most uncertain points, the potential for formal poetry to connect to generations of artists who have used the same forms enables the physician to engage with a different kind of scholastic tradition and to claim a modicum of control back from the uncertainty of illness.
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Campo and AIDS Poetry: The Doctor/Patient Relationship in a Pandemic
In 1981, five cases of homosexual men with pneumocystic carinii pneumonia, a rare form of pneumonia normally found only in severely immunosuppressed patients, were reported by Drs. Michael S. Gottlieb, Joel D. Weisman, et. al in the June 5, 1981 edition of the CDC’s prevention morbidity and mortality weekly report (“Thirty Years of HIV/AIDS: Snapshots of an
Epidemic.”). This was one of the first signs of the AIDS epidemic in the United States. By 1981,
U.S. clinicians had identified the disease as “characterized by a decline of immune function and of T cells, and notably CD4 T cells and by 1982 the identification of risk groups then called the
‘4 H's’ (hemophiliacs, heroin addicts, homosexuals, and Haitians)” had occurred (Gallo). While these risk groups would guide clinicians in screening patients for risk factors, they would also form the basis of racist and homophobic attitudes towards patients with AIDS.
In the midst of this bigotry and concern about a deadly disease, Campo began to work as an internal medicine resident at the University of California, San Francisco Hospital in 1992. A graduate of Harvard Medical School, he had taken a year off to study creative writing. But working in San Francisco was an altogether different experience from seeing patients on the wards in Boston.
In San Francisco, four percent of the population was infected with the virus (Gibson).
The situation in healthcare settings was dire. In reflecting on his first year treating patients there he said, “there was no time for sharing stories—I mean, there was little we could do to help these people ...and the range of emotional responses to that kind of helplessness sometimes expressed itself in really hateful behavior toward the people who were dying” (Gibson). This environment was incredibly difficult for a young, gay, and Cuban physician who saw himself in the patients
Draper 47 dying in the wards in front of him. He describes how he shut down emotionally while treating patients until his experience at the San Francisco Gay Pride Parade in June 1993.
Seeing “activists from [AIDS coalition] ACT UP chanting ‘Silence equals death’ made him feel “the power of community, how our voices join us, that we would not be erased.” It reinforced his connection to the LGBT community that was striving to combat the effects of this virus on their community (Gibson). He credits this experience with returning him to poetry and to changing his approach to his clinical practice to “be more vulnerable and open in clinical encounters...he is the physician, but also the poet, the gay man, the Latino, the striving second- generation immigrant, a husband, a brother, a person possessed of all his memories and knowledge and feelings- imperfect, but fully human” (Gibson). Writing poetry provides an outlet distinct from the clinical environment and an avenue for exposing the inner workings of the doctor-patient relationship to those on the outside of it.
In the midst of an epidemic, the ability to communicate the experiences of those suffering from the disease and those attempting to save them becomes an important opportunity for activism in itself. Campo’s poetry is ideally suited as another form of expression which differs from the oral presentation given at the bedside and the prose-style of a traditional report of a medical encounter. The qualities of poetic compression discussed in the previous chapter lend themselves to demonstrating how the hostile socio-political environment around the HIV/AIDS crisis negatively impacted and limited the doctor/patient relationship. Additionally, the use of formal poetry contrasts with the struggle to develop effective treatment protocols in the early days of the pandemic; utilizing known forms to describe the fight with an unknown viral foe provides some comforting control. Much of Campo’s HIV-AIDS poetry also underscores the insidious effect that bigotry could have on the doctor-patient relationship as the struggle to treat
Draper 48 patients in the midst of a chaotic surge of patients threatened to erode the foundations of this relationship.
This bigotry prevents the full realization of the potential for the doctor-patient relationship to aid both the physician and the patient in coping with illness. Through the practice of medicine, the doctor may come to know their capacity for caring for another human being’s mental and physical needs in a medical encounter. The physician will additionally see “his or her reflection in the patient's gaze and comes to wonder about what matters for himself or herself”
(Charon 1881). For the patient, they “will see themselves in their doctor's gaze [and] not only will come to know what is the matter with them biologically but will come to wonder what matters to them, what their fears and strengths are” (1881). Through this relationship, “both doctor and patient accrue a gallery of self-portraits, capturing time coursing across the surface of their lives…..[and] this vision endures, deepens, becomes contradictory and complex, enables a rare view of the self” (1881). Yet, outside of the medical humanities, the understanding of the potential for reciprocal recognition is often overlooked in favor of more traditional approaches to the doctor/patient relationship.
In the past, more conventional approaches to the relationship dominated the medical profession as physicians were taught to use their own judgment in order to act in the best interest of the patient. Under this paternalistic model, “the general practitioner listens to the patient, believing that a doctor who appears to listen is a more effective doctor…[and] genuinely wants the best for the patient, but believes that patients often need to be guided firmly through the decision-making process as they do not always know what is best for them” (McKinstry 340).
This approach prioritizes the doctor’s view of what treatments would best benefit the patient as well as the community. In the midst of an acute situation like the HIV epidemic, determining the
Draper 49 correct course of treatment for the patient and for the community rather than according to the patient’s own wishes becomes incredibly tempting.
At first glance, this seems to fulfill the need for beneficence which is “one of the fundamental ethics” of healthcare (Kinsinger 44). The physician “is obligated to, always and without exception, favor the well-being and interest of the client” (44). However, the potential failure to inform the patient of all consequences of a particular treatment or of the full range of treatments creates a potential for the wishes of the patient to be ignored completely. This would inherently go against the ‘interest of the client’ even as it, in the eyes of the paternalistic physician, would potentially be best for the patient and the community. While this model has become less prevalent in recent years, its legacy has given credibility to the tradition of viewing the physician as inherently more knowledgeable about the patient’s condition than the patient themselves.
Patients carry their illness in their own body just as they accumulate their illness narratives. These stories “give form- temporal and spiritual orientation, coherence, meaning, intention, and especially boundaries- to lives that inherently lack form” (Frank 2). Medicine does acknowledge the relevance of the patient’s story in the context of medical history. Narrative medicine places the patient’s story at the center of the patient-physician encounter. Charon describes this interaction as follows:
“As a patient meets a physician, a conversation ensues. A story- a state of affairs or a set of events - is recounted by the patient in his or her acts of narrating, resulting in a complicated narrative of illness told in words, gestures, physical findings, and silences and burdened not only with the objective information about the illness but also with the fears, hopes, and implications associated with it” (Charon, Narrative 1898)
The pressures of treating patients in the midst of an epidemic can threaten to eradicate the ability to have this kind of conversation. Considering the needs and narrative of each individual
Draper 50 patient becomes somewhat of a luxury in the face of overwhelming numbers of dead and dying patients. Observing and processing all of the components of the patient’s narrative as described above necessitates the creation of space safe from the bias of the rest of the world. This may be a particularly challenging task in the context of a situation like the HIV epidemic. But, this kind of communication has the potential for reciprocal recognition to be realized. The doctor recognizes the humanity that they share with their patience and can draw strength from this link to continue treating the patient empathetically and compassionately even in the face of daunting diagnoses and external bigotry. In Campo’s poetry, there are instances in which his shared sexual identity with many of his patients with AIDS and HIV becomes the basis of his desire to connect with them and to recognize the aspects of himself which he sees in them. There is a tension to this shared connection as he personally understands the challenges and weight of navigating a world which may object to this specific part of oneself. While his poems do empathize with patients with whom he does not share as deep of a connection, they lack the strain present in his AIDS and HIV poetry as this shared identity is so inextricably linked with the virus itself.
At the core of Campo’s AIDS/HIV poetry is a tension between the physician’s desire to identify with the patient and the obligation to maintain a prescribed professional distance and demeanor. The mirroring between the physician and patient and the expressions of the physician’s regret over his inability to communicate openly demonstrate the effects of this stress.
Campo’s poetic work features a spectrum of patient-physician interactions with varying degrees of communication and empathy. This representation of different doctor-patient relationships further stresses the difficulty of maintaining a professional distance while still recognizing the shared humanity of the doctor and patient. The strain of remaining empathetic while adhering to
Draper 51 a modern model of medicine which focuses on the biomedical is particularly significant when treating patients whom society often ignores.
The repeated failures of communication in Campo’s poetry emphasize the need for an approach centered around the interactions of two individuals rather than the dictates of modern medicine. The inadequacy of modern medicine often prevents the patient from disclosing their narrative and from finding comfort in this recitation. Campo’s poetry provides space for reflecting on this failure and considers how communication between the physician and patient finds further complications in the hysteria surrounding the virus and the bigotry aimed at those who contract it.
The popular culture’s reaction to HIV created an added layer of shame around a positive diagnosis of HIV. Even the initial terms used to describe AIDS, “gay-related immune deficiency” (GRID) or “gay cancer,” labeled the virus as something explicitly connected to gayness. At the time, homophobia was still legally justified in states like Texas and in the military. (Homosexuality would be illegal in Texas until Lawrence v. Texas in 2003.) Campo’s poetry reckons with this burden of the bigotry existing outside of the clinical setting. His work also considers the ways in which this hatred infiltrated the hospital and affected the behavior of his fellow physicians and other healthcare professionals.
Within Campo’s poems, the repeated breakdowns of communication stop short of fully realized reciprocal recognition in Campo’s interactions with his AIDS/HIV patients. Instead,
Campo uses several techniques to indicate the turmoil within the doctor/patient relationship. In some instances, he candidly expresses the physician’s own lack of comfort through the speaker’s voice. In others, he stresses the connection between the physician and patient through the mirroring of symptoms and feelings. Overall, his poems stress the frustration of the physician,
Draper 52 whose job often entails “the ability to know the patient and yet not be known,” while navigating the stress inherent in this position of authority (Henderson 270). The conditions of a pandemic like the HIV epidemic only serve to magnify this difficulty in doing this work in a compassionate and efficient manner.
Even as the physician attempts to maintain the proper professional boundary, the reality of their shared identity and experiences threatens to erode this line. The professional distance and more paternalistic style of medicine can buckle under the weight of a physician’s repressed feelings and from the burden of acknowledging the patient’s full narrative as Charon describes.
One of the techniques which Campo uses to communicate this stress is a fragmented call-and- response style repetition exemplified by his poem “Lessons not Learned During Medical
Training” from Comfort Measures Only: New and Selected Poems.
Lessons not Learned During Medical Training His father said that when he told him, it was like treason. We guessed it would be over soon, after we trach’ed him. I learned the procedure: See one, do one, teach one. The stars above the parking lot seemed to be thinking as I left the hospital; when something somewhere was taken, an alarm went off. I remember he joked he felt turned on when he undressed in my exam room. I thought, it’s sacred this time we have on earth, as they gave out tokens (lapel pins with his picture) at the funeral. Leaves talking in trees, in the sweet breeze that seemed to be mistaken, beneath a sun that hadn’t lost its faith in God. Try not to cry, I said to myself, but no one heard me. It took him years to come out, he told me, and he’d tried once to kill himself before. He said he knew it sounded trite, but he always fell for messed up, married, probably straight guys. I liked one of the med-surg nurses, or so I pretended. His sister flipped through People at his bedside. Trains run on time as they always do, and life becomes tiresome. As his mother read a poem, I wished I could trade me for him. I try to picture his green eyes, ear-to-ear grin; I see my funhouse face in his polished coffin. My tears come, but they warned us not to feel anything. I betray them.
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This poem’s stream of consciousness style indicates the tumult of the physician’s thought process surrounding the death of his patient. The thoughts expressed are fractured in the same way that a traumatic narrative would be. These traumatic narratives “[involve] intense personal suffering, but… also the recognition of realities that most of us have not yet begun to face”
(Caruth 3). In many ways, the process of thought depicted here represents a response to the physician’s experience of losing a patient who he felt shared similar experiences.
Personifications of his inanimate surroundings repeatedly disrupt his reflections on his patient.
This personification reflects the physician’s feelings; the ones which he feels uncomfortable with voicing: the stars think about theft, the leaves talk, the sweet breeze is mistaken, the sun hasn’t lost faith in God. The world moves on even as he remains fixated on the memories of his patient and the things that they shared.
This fixation precedes the breaking through of his emotions with “Try not/to cry.” The patient’s expression of regret about not being able to come out and his subsequent admission of being suicidal colors the physician’s statement two lines later about pretending to like one of the med-surg nurses. The patient cites falling in love with inaccessible and straight men is the source of some of his pain even if it sounds “trite.” The physician tries to relate to the patient by pretending to have a crush on a straight male nurse. In this moment of mirroring, the physician attempts to bond with the patient over their shared struggles with sexuality. Their shame over this struggle to come to terms with who they are and what they want connects the doctor and patient beyond the traditional bounds of the doctor-patient relationship. Yet, they cannot take comfort in recognizing this shared experience as homophobia and fear separates the two from having a completely honest conversation about their lives and desires aside from the jokes they share and the few details included in the poem.
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The ambiguity in the poem underscores this inability to communicate. In just the first two lines, the speaker uses ‘it’ twice to refer to two different things. This ‘it’ in the first line could be either the patient’s sexuality or his illness. In the second, the ‘it’ seems to be the patient’s life as the clause ‘after we trach’ed him’ hints at a worsening medical condition. This repeated vagueness indicates the stress which the patient, physician, and other family members are experiencing. Although these three parties share aspects of the same burden, the physician knows that he “learned the procedure.” In some ways, the outcome of the procedure rests on the physician’s shoulders even though the patient will live with the consequences.
The poem also lacks a structured or rigid form and contains near-rhymes at the end of some but not all lines. Ironically, this lack of form mirrors the physician’s own inability to follow the rules of proper behavior and professional distance which his medical training attempted to teach him. Everything around him hints at the failures of this traditional approach and of the lessons that he learned about navigating the doctor/patient relationship. The expression of feeling, as his crying does at the end of the poem, represents a final failure of learning the so- called correct lessons in medical training. The adage of “See one, do one, teach one” cannot help the physician respond to the patient joking that “he felt turned on/ when he undressed in my exam room.” In failing to be honest with the patient about his own sexuality, the physician misses an opportunity to dispel this tension that the patient expresses.
Rather than acknowledging the desire as a byproduct of their shared identity, it becomes another source of stress for the patient, expressed as a joke. As much as there is a failure of doctor-patient communication within this poem, there is also a failure of the medical system that should have taught the doctor how to navigate this relationship and his feelings better. The physician refuses “to respond to another’s words, mediated by the probing questions of sexuality
Draper 55 and identity; where there is redemption, there is a recognition of what the other is, including and beyond such categories as sexuality and identity” (Henderson 276). Within “Lessons not Learned
During Medical Training,” neither the physician nor the patient finds redemption in the recognition of their commonalities. The potential for redemption is curtailed by the patient’s deteriorating condition and the physician’s own medical training. The reciprocal recognition fails in large part due to the tension between the physician’s desire to confide in the patient and the voices from his medical training in his mind which reminds him of the need to feel less.
Mirroring within Campo’s Work
The stanza, “XII. Towards Curing AIDS,” from the poem, “From Songs for My Lover,” exemplifies the mirroring which may occur between the physician and patient. The intimacy of the doctor-patient relationship is such that the actions of one affect the other. Campo demonstrates their effect on one another repeatedly in his poems.
XIII. Towards Curing AIDS I slap on latex gloves before I put My hands inside the wound. A hypocrite Across the room complains that it’s her right To walk away-to walk away’s her right As a physician. Lapidary, fine My patient’s eyes are overhearing her. He doesn’t wince His corner bed inters Him even now, as she does: he hasn’t died, but he will. The right to treatment medicine Denied is all the hollows here: along His arms, the hungry grooves between the bones Of ribs. As if her surgeon’s thread through the skin- The rite of obligation overdue- Could save him now. I close the wound. The drain Is repositioned. Needles in his veins, I leave him pleading, There’s too much to do.
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The first line identifies a physical barrier between the doctor and patient, the latex gloves which he slaps on before beginning his examination between. The next line is intrusive, the physician’s actions go into the literal body cavity of the patient. Yet, the other physician identified in this poem removes herself more decisively from the patient. She refuses to treat the patient, as she fears his disease. The twice repeated “to walk away” and “her right” questions the validity of the physician’s statement and suggests that the second physician disagrees with the first’s right to refuse to provide care. This repetition also indicates a transition into the world of the patient as the second physician shifts to describing the effect of this rejection on the patient. The patient’s
“eyes [overhear] her” as “His corner bed inters/Him even now.” The patient’s body language mirrors the actions of the physician and highlights the tenuous connection between the two of them even as the physician denies their relationship for fear of the HIV virus.
The figurative language present in the poem reflecting the patient’s body indicates the damage that this “hypocrite” inflicts upon the patient. The actions of a second physician, the presumed voice of the poem, can ultimately do little to reverse the damage caused by his colleague’s fear. The physical and social boundaries lying between them prevent the reciprocal recognition which would allow both physicians and patients to be fully present and human in their relationship.
In the midst of intense pain and suffering, the challenge of answering how to build a supportive doctor-patient relationship is difficult. Recognizing shared humanity becomes secondary to the demands of the body. This is not a novel notion, and pledges like the
Hippocratic Oath attempt to resolve this dilemma. In this pledge, physicians promise that “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability” (Lasagna). Just like the poem, the
Draper 57 oath foregrounds the physician’s voice. Interestingly, the doctor who refuses to treat the patient is a “hypocrite” who likely swore the Hippocratic oath upon graduating medical school. “Her right” supersedes the promises made in the covenant that she swore to fulfill. The second physician is not the hero in this story. Yet, his observations and treatment of the patient recall the line of the oath: “I will remember that there is an art to medicine as well as a science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug” as the oath pledges. The poem demonstrates how physicians who deviate from the promises made in the Hippocratic oath affect their patients. Referring back to the stanza’s title, the journey towards curing AIDS is more complex than just finding a curative medication. A fuller healing would involve remembering the basic tenets which form the basis of the medical profession and code of conduct.
Society imposes other barriers between the patient and physician in the form of shame and stigma. These limit the willingness and ability of the two parties to communicate honestly.
In the case of HIV, shame and stigma has dogged doctor-patient communication since its discovery. AIDS and homophobia have been inextricably linked since the discovery and naming of the virus. The struggle to escape this link echoes throughout Campo’s poetry as he examines what it means to be a healer and to be human. He questions the limitations of the relationship in showing their failures. To see the intense suffering of another human is difficult. Yet, when this suffering could be your own, when you have more in common with your patient than not, the difficulty intensifies. The distance between physician and patient shrinks as the physician recognizes him or herself in the patient, like looking in a mirror.
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Situating the Personal in the Clinical
In “The Distant Moon,” the physician’s identification with and distance from the patient change as the poem progresses. The stories told by the patient and the voice of the physician entwine and weave into each other. Unlike “Lessons not Learned During Medical Training,” this poem leaves space for a dialogue between the patient and physician. The two of them participate actively in a longer-term relationship unlike the unnamed patient in “Lessons not Learned
During Medical Training.” In showing the progression of the patient’s illness in “The Distant
Moon,” Campo creates a space that allows for the exploration of the relationship between the physician and patient.
I Admitted to the hospital again. The second bout of pneumocystis back In January almost killed him; then, He'd sworn to us he'd die at home. He baked Us cookies, which the student wouldn't eat, Before he left--the kitchen on 5A Is small, but serviceable and neat. He told me stories: Richard Gere was gay And sleeping with a friend if his, and AIDS Was an elaborate conspiracy Effected by the government. He stayed Four months. He lost his sight to CMV.
The patient is an active participant in each interaction featured in the poem. The patient bakes cookies that the medical students refuse to eat and the patient tells elaborate stories and conspiracy theories about HIV at the start of the poem. There is a marked distance between the realities of the patient and the healthcare professionals. The doctor relies on science to dictate action, the students avoid the imagined threat of contaminated cookies out of fear, and the patient turns to conspiracy theories as a solace from the reality of living with HIV. The actions of each affect the others and emphasize the gradient that exist on the spectrum of approaching illness.
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One of the interesting threads in the poem is that the patient’s stories gradually incorporate the physician’s as the poem progresses. The two voices become intertwined as the distance between the two shrinks. The gradient of approaches becomes less relevant as the physician and patient come together and as their bodies begin to mirror each other. Yet, this mirroring never becomes an explicit recognition as the physician restricts himself within his professional role and does not disclose his identity with his patient. Instead, the physician simply feels the strain of providing care while restricting himself to a professional role.
In these lines, the patient creates his own myths about his disease. In this myth, AIDS, while still a hidden and stigmatized disease, affects even the most masculine and famous of men and is a conspiracy. A plague which brings this much pain to him and to his community cannot be anything other than a coordinated and hateful plan. The enjambment which divides his declaration about the origins of HIV highlights the disjointedness of the patient's logic. The patient’s journey into this kind of fantasy is stayed with the poem’s transition into the description of his actual condition. His stories cannot allow him to escape reality; “He lost his sight to
CMV.” This abbreviation creates a barrier for uneducated readers. Those who would understand the significance of this have either researched the condition and its abbreviation or have a medical background.
The maintenance of the linguistic barrier adds to the complexity of what the physician goes through in diagnosing and treating a patient. The writing of these poems relies on the reader’s previous medical knowledge or willingness to google abbreviations like “KS” in the context of a poem about a patient with AIDS. The refusal to translate these medical terms for the uneducated reader forces them to step into the medical world. Just as the physician identifies with the patient, the reader undergoes the same process of identification with the physician’s
Draper 60 voice. Henderson comments that “within Campo’s poetry identity and realization do not remain ends in themselves but, in the context of medically-oriented poems, become a means towards expressing the physician's imperative: curing” (Henderson). Drawing the reader into the mind of the physician through the use of first-person pronouns heightens the struggle inherent in the effort towards healing another person.
The physician faces a complicated dance of remaining professionally distant and engaging with the patient in some of their most intimate moments. In the second stanza of "A
Distant Moon,” this tension becomes even more apparent as the boundary between the two people wears thin. The struggle to maintain professional boundaries while acknowledging the shared humanity and experience of the physician and patient becomes apparent and more difficult.
II. One day, I drew his blood, and while I did He laughed, and said I was his girlfriend now, His blood-brother. "Vampire-slut," he cried, "You'll make me live forever!" Wrinkled brows Were all I managed in reply. I know I'm drowning in his blood, his purple blood. I filled my seven tubes; the warmth was slow To leave them, pressed inside my palm. I'm sad Because he doesn't see my face. Because I can't identify with him. I hate The fact that he's my age, and that across My skin he's there, my blood-brother, my mate.
This stanza begins with the image of a blood draw. As the transmission of HIV occurs with the exchange of blood and other bodily fluids, the image of taking blood is like taking a piece of the illness itself. The information and viral particles that this blood contains make it both valuable and incredibly dangerous. Their relationship is grounded in this transaction. The physician is “his girlfriend now,” “His blood brother,” “‘Vampire Slut.’” Theirs is a bond forged
Draper 61 in blood, the taking and giving of it. The physician manages his subtle reply even as he knows that he’s “drowning in his blood.” Yet, the ironic truth of the patient’s statements resonates with the physician.
The wrinkling of brows could indicate confusion, commiseration, or suppressed laughter.
This ambiguity of the physician’s reaction to his patient enhances the power of his following statement of sadness. He mourns his inability to express a connection and “is paralyzed by an inability to give anything back, leaving a troubled silence. The poignant irony of the patient’s perception of the physician as a lover and a life-giver is paralleled in the doctor’s sadly futile identification with the patient” (Henderson 267). Thus, the absurdity of the patient’s comments juxtaposed with the inability to share the truth of his similarities with the physician emphasizes the difficulty of participating in doctor-patient relationships. It also hints at the continued struggle to overcome the boundaries lying between the two of them, in this stanza visually represented by the mask the physician wears.
The progression of the poem continues with this theme as the distance which the physician maintains begins to break down with the procedures that he must perform for the patient. The gown, gloves, and masks are all necessary barriers between the two people. They protect the physician from any risk of infection and they protect the patient from anything that the physician may bring into their hospital environment. Yet, these same barriers prevent an identification between physician and patient. One that could perhaps help the patient feel less alone. Because after all “he’s my age, and that across/ My skin he’s there, my blood-brother, my mate.” Ending the stanza on “mate,” rather than a different word is an interesting choice.
Referencing a more romantic relationship in the midst of a somber and professional setting
Draper 62 highlights the difficulty of this situation. The third stanza explores this grey area of existing in a doctor-patient relationship which some would deem unprofessional or not distant enough.
III He said I was too nice, and after all If Jodie Foster was a lesbian, Then doctors could be queer. Residual Guilts tingled down my spine. "OK, I'm done," I said as I withdrew the needle from His back, and pressed. The CSF was clear; I never answered him. That spot was framed In sterile, paper drapes. He was so near Death, telling him seemed pointless. Then, he died. Unrecognizable to anyone But me, he left my needles deep inside His joking heart. An autopsy was done.
The end of the second stanza highlights the inability of the physician to connect with his patient.
Yet, in the third, the patient comments on the doctor’s demeanor. The physician is called “too nice”- this must indicate that something is wrong with the doctor, not that there is something wrong with the standards of medical behavior. Being nice, in the patient’s eyes, indicates queerness. The previously thought impossibility of a physician being queer is tempered by Jodie
Foster’s being a lesbian. With the opening of possibilities, the doctor and the patient begin to mirror each other. The spinal tap elicits tingling feelings down the spine of the physician. Even though “The CSF was clear,” the physician cannot find the hope for the patient. He cannot even give the patient reason to hope for any other outcome other than the inevitable one. Indeed, he died. The only pause between choosing not to give hope and the patient’s death is “then,” an almost clichéd and ineffectual placeholder between the two.
The effort of concealing good news in light of the inevitable end leaves “needles deep inside” the physician. Their common queerness connects them and blurs the line between the physician and patient. Yet, this “homosexuality functions not as an erotics of desire but as an
Draper 63 erotics of compassion. Where there is guilt in ‘The Distant Moon,’ there is a refusal to respond to another’s words, mediated by the probing questions of sexuality and identity; where there is redemption, there is a recognition for what the other is, including and beyond such categories as sexuality and identity” (Henderson 276). The needles are inside both the patient and the physician.
The projection of one’s condition onto the other emphasizes the overlap between their two experiences while simultaneously exposing the limits of their ability to communicate. This is a frustrating empathy, one where the two intermingle with no clear resolution or even purpose.
“An autopsy was done” but the results of this autopsy are not relevant to the poem. The autopsy is merely the standard operating procedure following the inappropriate connection between physician and patient. Nothing further can elucidate the connection between the two. The communication and potential for reciprocal recognition have already failed.
IV I'd read to him at night. His horoscope, The New York Times, The Advocate; Some lines by Richard Howard gave us hope. A quiet hospital is infinite, The polished, ice-white floors, the darkened halls That lead to almost anywhere, to death Or ghostly, lighted Coke machines. I call To him one night, at home, asleep. His breath, I dreamed, had filled my lungs--his lips, my lips Had touched. I felt as though I'd touched a shrine. Not disrespectfully, but in some lapse Of concentration. In a mirror shines The distant moon.
This final stanza reflects on the bond between the physician and the patient. The stories which the two read together almost refer back to the conspiracy theories that the patient told in the first stanza. Now, the stories that the two share are more established, more accepted in traditional society. Richard Howard, an American poet, gives them hope. In an ironic twist, the
Draper 64 actors within the poem find solace themselves within the lines of a poem. In this sharing of comfort, the poem unites the two of them even in the midst of the cold hospital environment.
This setting provides the transition within the poem to the last intimate exchange between the physician and patient: the sharing of breath. Here, the diversion from the sonnet-like form becomes interesting. Subverting the purpose of the traditionally romantic poetic form for the description of a professional relationship stresses the difficulty in navigating the boundaries inherent in this doctor-patient interaction. These oft-depicted boundaries are not just a figment of the physician’s imagination. They are enshrined in the cold setting of the hospital and the inevitable journey of each patient towards his or her death.
In caring for the patient, the physician attempts to safeguard the patient from death. But, as evident in this poem, the reality for many patients is that they need someone who can shepherd them through the journey of accepting their inevitable demise. “In all of medical practice, the narrating of the patient’s story is a therapeutically central act because to find the words to contain the disorder and its attendant worries gives shape to and control over the chaos of illness” (Charon). In my interview with Campo, he stated that he didn’t want to portray physicians as heroes or perfect people. Rather, he makes a concerted effort to portray the physician as a whole person as flawed as anyone else. The physician voice in “10 Patients and
Another” is frustrated and tired. Campo’s poem “Ten Patients And Another” presents the medical cases of eleven patients that Campo encounters over an unclear period of time. The stanzas within the poem initially mimic the format of an oral presentation of a patient: they include information about the symptoms and salient details of the patient’s case.
Details about their family life, their lived experiences of trauma, their socioeconomic status, their sexuality, and their race arise in different combinations to provide vivid depictions of
Draper 65 these individuals and to hint at their lives outside of their interactions within the healthcare system. The relationship and boundaries between physicians and patients are clearly defined at the start of the poem. As the poem progresses, this boundary gradually breaks down and invites questions about the effectiveness of the boundary at facilitating the best care for the patients.
Thus, Campo’s use of ambiguous pronouns and vivid imagery both highlights the divide between physician and patient and questions its validity.
Campo dedicates each stanza to a singular patient. The title of the stanza names the patient or provides a descriptor for them. Some patients simply have initials while others bear names that suggest their cultural background. The first patient, “Mrs. G, ''presents with fever, cough, /And shaking chills.” The speaker can neither name her nor determine the exact cause of her seemingly generic symptoms. The abuse which she may have suffered is similarly concealed behind her ear. The patient is ultimately treated with Haldol, an antipsychotic after she “Began to sob without producing tears.” The inclusion of medical jargon and medication names like
“normal sinus/Rhythm” and “Haldol” contributes to a sense of strict removed professionalism; the speaker does not translate this medical language for the reader. This indicates that, perhaps, writing this poem is not meant to benefit those without knowledge of the significance of these medical terms. Rather, those who understand the burden of discovering the abuse in their patient’s history may relate to the situation depicted in this stanza.
The format of the first stanza bears remarkable similarities to an oral presentation that one physician might give to another. Its format emphasizes the distance of the speaker from the patient as it foregrounds the patient’s symptoms before hinting at their history. The dehumanization of the human into a patient is stressed by the slight departure from the format of a typical oral presentation. The speaker cites the fact that “The patient’s social history was non-
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/Contributory: someone left her here.” In a normal presentation, the last clause likely would not have been included. Even as the physician is removed and distant from the patient, her pain and history cannot be ignored; they contribute to her symptoms and needs for treatment. She was abandoned as discussed on page 31. She sobs silently without producing tears. There is an issue here that Haldol cannot fully cure but the physician either does not or cannot investigate this further. There is a professional distance to be maintained. The salient facts of the case will be presented in a similar way as they are in this stanza. The first stanza sets the tone for the poems’ presentation and potential interrogation of the boundaries traditionally built into the physician- patient relationship.
As the stanzas trudge onwards, the cold and removed voice of the speaker begins to break down. The histories of the patients become more fleshed out as the boundary between the physician and the patient begins to break down. As the imagery communicating the patient’s pain and history become more intense, the use of pronouns that refer back to the speaker becomes more frequent. The speaker becomes more involved and invested in the fate and history of the patients.
V. John Doe An elderly white male, unresponsive. Looks homeless. Maybe he’s been here before: No chart. No history. His vital signs Were barely present, temperature was down Near ninety, pressure ninety over palp; The pulse was forty, best as they could tell. They’ll hook him to a monitor before They warm him up. I didn’t listen to His lungs- I bet I’d hear a symphony In there. I couldn’t check his pupils since His lids were frozen shut, but there were no External signs of trauma to the head. They found this picture of a woman with Two tiny kids still pinned inside his coat.
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It’s only three A.M. The night’s young. If He’s lucky, by tomorrow he’ll be dead.
In the fifth stanza, the first “I” appears in reference to the speaker's failure to examine the patient fully. In this moment of both failure and arrogance, the physician chooses to avoid listening to the lungs and assumes what he would hear based on his previous experience.
Additionally, the physician wishes death for his patient, his experience makes him cynical about the patient’s prognosis.
The process of healing for the patient, both physically and emotionally, would involve recovering from the “external signs of trauma to the head” and the potentially painful past with the “woman with/Two tiny kids.” This nonconsensual intrusion into the patient’s life stresses the power of the physician and the need for him to act both sympathetically and reasonably. Campo brings the poem to a close with the lines “It’s only three AM. The night’s young. If/He’s lucky, by tomorrow he’ll be dead.” In this perversion of the physician’s usual fight against death,
Campo decisively breaks away from the archetype of the removed and professional physician.
Rather, the speaker, the assumed physician, invests himself enough in the patient to understand that struggling against fate would bring more pain than comfort. He wishes the patient peace rather than struggle. The physician’s investment in the patient’s well-being seems to increase in the following stanzas.
The seventh stanza is titled “Manuel.” This stanza was actually the inspiration behind my choosing Campo as the focus of my thesis. I believe it’s a pivotal moment within the poem, as the boundary between the physician and patient shifts dramatically. This patient is also unique in his vulnerability and needs for someone else to speak for him.
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VII. Manuel In Trauma I, a gay Latino kid- I think he’s seventeen-- is getting tubed For respiratory failure. “Sleeping pills And Tylenol,” I translated for him As he was wheeled in. His novio Explained that when he told his folks about It all, they threw him out. Like trash. They lived Together underneath the overpass Of Highway 101 for seven weeks, The stars obstructed from their view. For cash, They sucked off older men in Cadillacs; A viejita from the neighborhood Brought tacos to them secretly. Last night, With eighteen-wheelers roaring overhead, He whispered that he’d lost the will to live. He pawned his crucifix to get the pills.
In the previous five stanzas, the patient was identified with either the phrase “The patient is” or with the injury/illness that brought them to the physician. This stanza is different. Until the end of the second line, the reader’s only information about why the patient is even the subject of this poem is based on his sexuality, his ethnicity, and his presence in Trauma I. Predictably, this combination of identities is the primary contributing factor to the patient's condition. This stanza also features a second patient, the boyfriend, for whom the physician translates. Just like the later ones, this stanza calls out the structural issues within our society which bring people to the physician and create the need for a physician-patient relationship.
The relationship between physician and patient in this stanza has also altered dramatically in comparison to that seen in the first stanza. The physician is not just an observer and prescriber of medication. Rather, he actually translates for the patient through the voice of the boyfriend.
The physician, the speaker, is both a member of the medical team and the one who can speak for the young men, the novio and the patient. Although the patient himself is voiceless, silenced by
Draper 69 his decision to buy the pills to end his life, his novio can speak to the pain they have experienced.
The imagery here is vivid, medical jargon is barely present.
Understanding the depth of this stanza requires cultural sensitivity rather than medical knowledge. Grasping the significance of the crucifix in the Catholic faith would allow the treating physician to understand the depth of the patient’s desperation and the strength of support that will be needed to help him through the healing process. The role of the physician here is to recognize the validity of the patient’s pain as much as it is to save his life. Here, the quality of the physician-patient relationship hinges on the physician’s cultural sensitivity and ability to empathize.
“Ten Patients and Another” provides important insight into the gulf of experience which may exist between the patient and the physician as well as suggesting areas that could improve this relationship. These stanzas skillfully illustrate the tension which the physician may feel as he/she/they see the pain and histories of their patients play out in the exam room. They invite difficult questions about the limits of the physician’s duty to intervene and to maintain a clinical distance. Illustrating the difficulty of some of the interactions required of a physician on a daily basis deepens our understanding of what it means to practice the healing arts. Putting these interactions into the metered and compressed form of a poem forces us to consider why the speaker maintains distance through medical jargon and references to the traditional oral presentation.
Formatting this poem in a manner that satirizes an important aspect of medical training and communication strikes at the distance falsely inserted between the physician and the patient.
There are moments in the stanzas in which the compassion of the physician seems to wear out.
Showing the strain of caring for people in their worst moments demonstrates a level of
Draper 70 compassion towards the physician as well as the patient. At the time, the burden of treating patients with AIDS wasn’t in the complexity of the treatment protocols. In the early days of the
AIDS epidemic, physicians like Victoria Sharp claimed that "I could have taught my brother the architect how to do AIDS medicine. [There] was nothing to do until your CD4 count hit 200, and then Bactrim” (128). With few treatment options, physicians were almost helpless. The difficulty of treating these patients involved stepping into a different role as a physician: one which required constant damage control and the ability to remain calm when dealing with unexpected challenges.
Campo’s poetry demonstrates how the boundaries between the physician and patient can make these different roles difficult to navigate. Throughout his poetic works, there are multiple references to the AIDS virus and to treating patients with HIV and AIDS. Several other notable poems are “Wednesday HIV Clinic,” “The Four Humours,” and “V. Elegy for the AIDS Virus,” among others. These poems describe similar issues within healthcare which prevent the reciprocal recognition which Charon identifies as ideal for deepening the physician-patient relationship.
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Conclusion
Fundamentally, “the secret of the care of the patient is in caring for the patient” (Peabody
882). Yet, the basic aspects of medicine are often the most difficult to cling to in the chaos of the clinical environment. Caring for patients under normal circumstances can stress even the most experienced of physicians. In the midst of an epidemic, the strain of treating illness becomes magnified. Bigotry, fear, and exhaustion threaten to widen the gulf between the patient in need of care and the physician struggling to fight a microscopic adversary.
Campo’s work challenges the reader to consider the burden that the provider carries in each patient interaction. His poetry suggests that, perhaps, in spite of all of the outside influences
and professional standards that the physician must navigate, the real difficulty of the doctor-
patient relationship lies in maintaining a genuine, empathetic, and productive connection between two people. At the core of this relationship is the willingness for two people to listen to
each other: for the physician to hear the patient’s narrative, to analyze it, and to provide a
constructive and effective treatment plan. The patient, in turn, must be willing to listen to the
physician, to disclose the history of their illness honestly, and to refrain from blaming the
physician for the failings of the body and of the healthcare system as whole. Campo’s poetry
does an exceptional job of portraying the interactions between these two parties while also
considering the forces which may interfere with this relationship.
Writing poetry can be a prophylactic measure against the frustration and anxiety that accompany working in the healthcare field. For the physician, poetry creates a space in which they may express both the negative and positive realities of being privy to their patient’s intimate and vulnerable moments. More than other forms of narrative, poetry can provide a refuge from the deluge of information that the physician encounters. Narratives stripped down to their
Draper 72 essential components, contained in ordered stanzas, and imbued with the rhythms of the body can provide a comforting space to consider difficult aspects of healings, living, and dying.
Reading Campo’s work has become a shelter for me, too. While navigating the process of preparing to begin medical school in the shadow of an epidemic, I turned to Campo’s lines. He addressed the threats that bigotry and fear can have on the doctor-patient relationship decades before newspapers reported on hate crimes against Asian-Americans in 2020 and on the scores of healthcare workers dying from COVID-19. Aspects of his poetry seem clairvoyant in our current situation. These similarities suggest the persistence of certain challenges in the doctor-patient relationship. They emphasize the need to learn the history of the physician profession in order to understand the reasons behind the traditions and practices that exist in clinical environments today. If we forget our history, our roots in the ages when physicians believed that miasmas caused disease, we are doomed to repeat the painful process of recognizing our mortality.
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Works Cited
1. Bayer, Ronald, and Gerald M. Oppenheimer. AIDS Doctors: Voices from the Epidemic.
Oxford University Press, 2002.
2. Braden, G., and E. Fowler. "Elegy." The Princeton Encyclopedia of Poetry and Poetics,
edited by Roland Greene and Stephen Cushman, 4th ed., Princeton University
Press, 2012, pp. 397-399. Gale eBooks, https://link-gale-
com.ezproxy.lib.utexas.edu/apps/doc/CX2388000353/GVRL?u=txshracd2598&si
d=GVRL&xid=de3c5ee1. Accessed 7 Mar. 2020.
3. Campo, Rafael. Interview by Ivana Viani. Thirdspace, 19 Jan 2017,
http://thirdspacejournal.org/rafael-campo.
4. Campo, Rafael. Comfort Measures Only: New and Selected Poems, 1994-2016. Duke
University Press, 2018.
5. Campo, Rafael, and Mark Doty. “Teaching Physicians Not to Be Afraid of Poetry.”
JAMA, vol. 320, no. 15, 16 Oct. 2018, p. 1520., doi:10.1001/jama.2018.13760.
6. Caruth, Cathy. Trauma: Explorations in Memory. Johns Hopkins Univ. Press, 1995.
7. Charon, Rita. “Narrative Medicine.” JAMA, vol. 286, no. 15, 17 Oct. 2001, pp.
1897–1902., doi:10.1001/jama.286.15.1897.
8. Charon, Rita. “The reciprocity of recognition--what medicine exposes about self and
other.” The New England journal of medicine vol. 367,20 (2012): 1878-81.
doi:10.1056/NEJMp121078
9. Didion, Joan. The White Album. Simon & Schuster, 1979.
10. Erin, Nelson. “What M3s Need to Know for SOAP Oral Presentations.” Kaplan Test
Draper 74
Prep, Kaplan Test Prep, 19 Sept. 2019, www.kaptest.com/study/usmle/what-m3s-
need-to-know-for-soap-oral-presentations/.
11. Finch, Annie. After New Formalism: Poets on Form, Narrative, and Tradition. Story
Line Press, 1999.
12. Frank, Arthur W. Letting Stories Breathe: a Socio-Narratology. University of Chicago
Press, 2012.
13. Gallo, Robert C. “A reflection on HIV/AIDS research after 25 years.” Retrovirology vol.
3 72. 20 Oct. 2006, doi:10.1186/1742-4690-3-72
14. Garrod, H. W. The Study of Poetry. Oxford University Press, 1936.
15. Gaufberg, Elizabeth H., et al. “The Hidden Curriculum: What Can We Learn From
Third-Year Medical Student Narrative Reflections?” Academic Medicine, vol. 85,
no. 11, Nov. 2010, pp. 1709–1716., doi:10.1097/acm.0b013e3181f57899.
16. Gibson, Lydialyle. “The Physician-Poet.” Harvard Magazine, Harvard Magazine, 1 May
2019, www.harvardmagazine.com/2019/05/poetry-medicine-doctor.
17. Gokak, Vinayak Krishna. The Poetic Approach to Language. Oxford Univ. Press, 1952.
18. Goldberg, Charlie. “The Mental Status Exam.” UCSD's Practical Guide to Clinical
Medicine, The Regents of the University of California., 2018,
meded.ucsd.edu/clinicalmed/mental.htm.
19. Grob, Gerald. The Deadly Truth: A History of Disease in America, Harvard University
Press, 2002.
20. Henderson, S. W. "Identity and Compassion in Rafael Campo's "The Distant Moon"."
Literature and Medicine, vol. 19 no. 2, 2000, p. 262-279. Project MUSE,
doi:10.1353/lm.2000.0025.
Draper 75
21. “Interview with Rafael Campo, MA, MD, DLitt (Hon).” Thirdspace, Harvard Medical
School and Harvard School of Dental Medicine, 19 Jan. 2017,
http://thirdspacejournal.org/rafael-campo. Accessed 17 Feb. 2020.
22. Jones, Therese (Ed.), Delese Wear (Ed.), Lester D. Friedman (Ed.), et al. Health
Humanities Reader. New Brunswick: Rutgers University Press, 2014. Web.
Retrieved 13 Feb. 2020, from https://www-degruyter-
com.ezproxy.lib.utexas.edu/view/product/538064
23. Joos, S K et al. “Patients' desires and satisfaction in general medicine clinics.” Public
health reports (Washington, D.C. : 1974) vol. 108,6 (1993): 751-9.
24. Kinsinger, Frank Stuart. “Beneficence and the professional's moral imperative.” Journal
of chiropractic humanities vol. 16,1 (2009): 44-6. doi:10.1016/j.echu.2010.02.006
25. MacIntyre, Alasdair. After Virtue, Bloomsbury Publishing, 2013. ProQuest Ebook
Central, https://ebookcentral-proquest-
com.ezproxy.lib.utexas.edu/lib/utxa/detail.action?docID=1224225.
26. Mahood, Sally C. “Medical education: Beware the hidden curriculum.” Canadian family
physician Medecin de famille canadien vol. 57,9 (2011): 983-5.
27. McKinstry, Brian. “Paternalism and the doctor-patient relationship in general practice.”
The British journal of general practice : the journal of the Royal College of
General Practitioners vol. 42,361 (1992): 340-2.
28. Lasagna, Lois. “The Hippocratic Oath: Modern Version.” Austin PBS, Public
Broadcasting Service, www.pbs.org/wgbh/nova/doctors/oath_modern.html.
29. Peabody, F. W. “The Care of the Patient.” JAMA: The Journal of the American Medical
Draper 76
Association, vol. 88, 19 Mar. 1927, pp. 877–882.,
doi:10.1001/jama.1927.02680380001001.
30. Savulescu, Julian. “Conscientious Objection in Medicine.” The BMJ, vol. 332, no. 7536,
2 Feb. 2006, pp. 294–297., doi:10.1136/bmj.332.7536.294.
31. Shufro, Cathy. “Doctors Who Write.” Yale Medicine Magazine, Yale School of
Medicine, 2012, medicine.yale.edu/news/yale-medicine-magazine/doctors-who-
write/.
32. Snow, C. P. The Two Cultures and the Scientific Revolution. Cambridge University
Press, 1961.
33. Sontag, Susan. Against Interpretation and Other Essays. Dell Publishing, 1966.
34. Starr, Paul. The Social Transformation of American Medicine. Basic Books, 1982.
35. “The Discovery of the Double Helix, 1951-1953 | Francis Crick - Profiles in Science.”
U.S. National Library of Medicine, National Institutes of Health,
profiles.nlm.nih.gov/spotlight/sc/feature/doublehelix.
36. The University of Washington Internal Medicine Residency. UW Internal Medicine
Residency- Oral Presentation Guidelines. The University of Washington. PDF
file.
37. “Thirty Years of HIV/AIDS: Snapshots of an Epidemic.” AmfAR: Making AIDS
History, AmfAR, 2011,www.amfar.org/thirty-years-of-hiv/aids-snapshots-of-an-
epidemic/.
38. “Timeline of Discovery.” Timeline of Discovery , The President and Fellows of Harvard
College, 2020, hms.harvard.edu/about-hms/history-hms/timeline-discovery.
39. Wordsworth, William. "Lyrical Ballads." The Broadview Anthology in British Literature:
Draper 77
The Age of Romanticism. Eds. Joseph Black, et. Al. New York: Broadview Press,
2010. 223-239. Print.
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Appendix
Interview with Dr. Rafael Campo
10 November 2019
Isabel Draper:
I always think it’s interesting looking at present-day literary figures versus past ones.
Because in the past, you have to go into the HRC and find a little bit of a letter between two people. But, now there are so many things that we can look at. There’s one poem that you wrote that made me want to write my thesis on your poetry. In “10 Patients and Another,” there’s this
stanza called “Manuel,” you end it with the lines “he whispered that he lost the will to live/ he pawned his crucifix to get the pills.” As a bit of a lapsed Catholic and someone who works with
youths with lived experience, it hit me in the gut. I was struck with the amount of social commentary and detail that you packed into two lines, so I have just a few questions about how you write this style of poem. I also have a few questions about the tradition of physician writers
as a whole.
In writing this poem in particular, it seemed as though you were satirizing the oral presentation style. When you’re writing poems like this, how do you decide to satirize bits of the
medical practice and then honor different parts?
Rafael Campo: Yes, that’s a great question and I think the medical idiom is in many ways very compressed and very focused, I suppose you could say. I’m interested in how writing that kind of
idiom using medical terminology, using some of the structures that are inherent in how we communicate medically about patients can really resonate with what I’m interested in in terms of
Draper 79
making poems. Similarly, in poetry, you know we strive for concision. I’m very interested in
particular in formal poetry or in received form. Writing within constraints is something that
attracts me. One of my interests in writing that a particular series of broken sonnets was to do
something that I like to do in parallel and in poetry in general which is pushing back against
those constraints.
In a way, it is a critique of you know what silences are present in medical
communications. There’s a lot that goes unsaid or that’s implied in how we speak in medicine.
Sometimes those are implicit judgments or implicit bias or stereotypes or shorthand for ways in which we see people, patients who are different from us. I wanted to push back against some of
those ways of thinking about patients and push back literally against some of those formal constraints and see what could be accommodated, what more could be said, or understood about people who are suffering through recasting some of that very structured and formulaic language from the medical record in poetic terms. I think that’s one of the things that I was playing within that sequence of poems and also you know to think about writing those poems in sort of broken
sonnet form and to my mind, that’s a way of implying a kind of love really for my patients for
people who are suffering that doesn’t get accommodated usually in sort of standard medical
practice. I was really interested in that particular interplay in the broken sonnets which try to
express a kind of love for these patients and a kind of respect for their dignity and at the same time wrestles with what can be said in not just the medical record but even in a poem. What are
the limits to what we can say? I was really interested in that kind of tension as well. Even in
poetry and in love poetry there are things that are unspeakable, things that we can’t really say and that's really the gestures in language and again. Some of those silences, some of those things
Draper 80 that are unsaid can communicate meaning themselves. I don’t know if I’m going too far astray of
what you’re asking.
ID: No, this is all very helpful.
RC: That’s a little bit of what I was trying to do in those poems. I guess you know another way
in which they’re critiques of medicine or in a way sort of satires of medical diction or medical
language. I often feel that in medicine we sort of weaponize language. We sort of use medical-
ese. We use these terms that patients cannot understand that keep them at a distance, that keep
them at bay, that assert our expertise, our knowledge, that in some sense make us as physicians
in our minds perhaps superior to our patients and so I wanted to in those poems really try to elevate the voices of people who are suffering, whose dignity often isn’t honored by the kinds of language that we use. That again is often meant to subvert them or diminish them or to distance ourselves from them. That was another attempt in those poems to really again try to think about
the poem as a different kind of stethoscope: how can we really listen more attentively to our
patients and not let that sort of medical jargon drown them out, not let that medical jargon
oppress them, suppress their voices. So, that was another, in a way, a satire of what we do in
medicine. That kind of language that we use is in many ways dehumanizing our patients.
Juxtaposing what in my mind is the most humane kind of language, poetry, with that
dehumanizing gesture of medicalese, of this jargon that half the times even other doctors don’t
understand, was another thing that I was trying to accomplish in those poems.
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ID: Well, one of the interesting things in thinking about writing poetry about medical encounters is you condense the patient’s original story and present them. There’s a condensing down to the
salient details and then you have this expansion if you pay attention to the personal details that
they present. Then, you are doing it again in the poetic form. In doing that, how do you respect
the patient’s story? I guess also one of the things that I’m thinking about along that vein is: are there individual patients who inspire some of these poems? Are they composites? Are they from
cases that you read about?
RC: You know, I think that’s a good question too. We do always have to be very mindful in any kind of writing what we do in medicine including writing what we do medically in the chart and
in other kinds of medical writing about appropriating the patient’s story. I certainly was
cognizant of that when writing those poems in particular. I did not want to take those stories away from those patients, those people that lived them. At the same time, one of the things that
we do in medicine that I think is different from what I was doing in those poems is that we
obscure our own agency. Again, that sort of medical language, that depersonalized objective
language of the observer, of the scientist, is perhaps more problematic than the act of actually
appropriating the story.
What I was hoping to do in these poems was to also to own my presence in those poems
and to own up to my own complicity in some of the silences and in some of the ways in which
some of the judgments and some of the distancing that those poems enact as well. It’s really important for physician writers, in particular, to be acutely aware of our own agency and our own
presence in these stories and not run away from that. That’s part of what happens in clinical
writing and in our clinical interactions with patients. We don’t want to be human in our
Draper 82 interactions with patients. We want to shield ourselves. In some sense, it’s a way of averting our
gaze from the suffering that we can’t bear or that we just want to explain in terms of
pathophysiology or data that actually isn’t sufficient in really telling the story of human
suffering. It’s a really important question. How do we represent ourselves in relation to these
stories as healers, as care providers? You really could write an entire book about how doctor
writers have represented themselves in their stories about the clinical over many years. We
touched on a few examples a moment ago. But, I do think that is a really difficult issue as well
because we certainly owe it to our patients to represent them as truthfully and as honestly as
possible without disclosing specific details about specific patients.
The way I think about my poetry about patients is that they are, in a sense, composites.
They are. Every detail in anything that I write is true and is in some sense documentary. I always am very mindful of not sharing information in a way that a patient could pick up a poem and say oh my gosh that’s Doctor Campo writing about me. In the rare instances that I have written very specifically about a specific patient, I always ask permission. That’s another way to think about
your question, too. Any clinical encounter is really a collaboration in many respects and is a
shared experience. If I feel or if I felt in the past that this is a story that I want to tell in its entirety, in that kind of detail, specific detail, then collaborating with the co-writer of the story is
critically important. Asking permission and then showing what we’ve come to together to the
person is very important before it’s been published before it goes to a more public audience.
That’s the way I think about it.
There are so many doctor writers who are the heroes of their own narratives. I really
resist. I try to present myself in my writing as an antihero. I’m very conscious of my own
limitations, the limitations of biomedical knowledge certainly, and me as a conduit of that
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knowledge. But, also my limitations as an observer, my limitations as a fellow participant in
these stories. None of us is perfectly empathetic or absolutely faithful to every detail of every story. It’s especially important for me a doctor writer but for doctor writers more generally that
we acknowledge those shortcomings, those veilings, those human foibles that we all have, and
that’s another way of embracing our own humanity and being in some sense fellow travelers
with our patients who are similarly human
ID: Absolutely. In “Manuel,” there’s a moment where the physician translates for the patient’s
boyfriend. I was thinking about the physician as part of the conduit for communication and for
accessing better care. But, then also because you’re part of that collaborative relationship, how
do you navigate self-disclosure or self-identifying with something that the patient may be experiencing? Also, you have this reputation as a poet, you have all of your poetry which some
of it seems very personal. How do you in the clinic manage that with your patients?
RC: Yes, that’s another great question. I guess a couple of things come to mind. One is that presenting myself openly and honestly and making myself vulnerable is part of how any of us as
human beings can be present empathetically with other people, certainly in the experience of
illness. People are dealing with pain, depression, and many things. We see them suffer within
medicine by showing ourselves as conflicted as unhappy, as angry, and, sometimes, as erotic
beings. That is again a kind of antidote to that automatic reflex distancing that is taught in
medical school. While I would never want a patient to feel burdened by my conflicts, distress,
and sadness, I do think that it’s actually potentially therapeutic for patients to see the people caring for them as human beings like them in a really profound way. There’s actually comfort in
Draper 84 that. That’s been my experience with my patients. I don’t mean to speak for them. But, my sense is in caring for them that we share so much that gives meaning to our relationships. I don’t think
that it’s a burden for them, that it’s something that they have to do. Although, I do often
recognize how my patients actually take care of me. That’s something that’s really often
overlooked in medicine, that that impulse to care for another person is present even in people who themselves need care. By being vulnerable and by being open and honest about who I am, I allow people who often feel disempowered or helpless to provide that kind of care to be joined in that way with your doctors who need care who need the human connection too. I don’t know if I
answered your question
ID: No, you did
RC: But that’s, that’s the way I think about it.
ID: This may be a specific question but I was reading through some sources about clinical
research in the HIV epidemic and they were talking about how the primary care physicians would get very creative about stockpiling medication like AZT to get around high prices. I was
just wondering if you could talk a little about your experience with that. Were there moments
when you navigated working against a system but also within a system?
RC: Yeah, that was a really harrowing time for many of us. There’s a really difficult paradox for
me in some respect. Medicine, science, and all of these sort of objective ways about knowing about illness do actually save lives and do actually bring new technologies and new medications
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to bear on illnesses that are often or were often fatal. So, there is a kind of difficulty for me as someone who believes in the healing power of empathy and the human connection that I have to
sort of begrudgingly admit that at times these interventions and treatments actually can be lifesaving for our patients too. I like to ultimately come to the conclusion that it’s not an either or
that medicine is an art and a science, that they are complementary pursuits, that yes, there is
power in marching in the streets and shouting you know “silence equals death” and using language, using the power of the voice to heal in terms of community, but also to drive some of
the scientific advances that actually can suppress the HIV virus in an individual patient’s
bloodstream and increases the C4 cell count and allow them to survive opportunistic infections that were lethal. The two in the best practice of medicine; they can really be complementary and
can be joined. They are not mutually exclusive at all.
ID: I always thought the HIV epidemic was an interesting moment in medical history because it almost took us back to a pre-antibiotic era of medicine. Thinking about the things that people had to do to deal with that kind of pain, do you feel that the medical humanities, like putting a name on this field, has changed the way we think about the legitimacy of physician writers or is it just
putting a name on something that already existed?
RC: I think in some ways that by naming it and by making it more formally a discipline it does
empower more of us to do this kind of work, especially when viewed from the medical or
clinical perspective where we are so data-driven. We are so rigorous about our proofs and our
methods. So, making the medical humanities a discipline unto itself enables people within
medicine to grasp it in a more concrete way and to really think about it perhaps more critically
Draper 86 and investigate how it might be useful in medical education settings or in clinical settings. It does
in some sense legitimize it in the clinical sort of world or in the medical world. From the
standpoint of humanists, I think it perhaps helps bridge this gap between the humanities and
medicine. Humanists are often viewed somewhat suspiciously by people in the sciences as you probably have read. You know CP Snow and the two ways of knowing about the world are very different and they have to be very different. I think having interdisciplinary fields can help us to bridge that gap and help us to see that our methods are not all that different or at least that we are engaged in a similar sort of project which is: how do human beings construct the world? How do
we understand ourselves in relation to the world that surrounds us? In that sense, in a very profound way what science and the humanities and what the arts do really isn’t all that different.
So, looking from a humanist perspective there is a kind of value in bridging that divide so to
speak
ID: This is just a kind of unrelated question but I know you learned from Sedgewick at Amherst
and I was wondering what it was like to be around her as she was starting queer theory
RC: You know, it was incredible and that’s a great segue from talking about the medical
humanities which is kind of discovering itself as an interdisciplinary field. Working with Eve was just incredible, to be a witness to a whole new discipline within the humanities. She invented queer studies. I guess I can’t say single handedly. But, she was so central to imagining this whole
new method, in a sense, this whole new critique, this whole new literary theory. That was just
thrilling. I think that did inspire me in many ways to imagine myself as someone who could
potentially make connections or think outside of those sort of narrow confines of very strict
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biomedicine versus poetry, that there were ways that the two could be joined and could talk to
each other through that and through conversation achieve a deeper kind of meaning and a different kind of knowing, certainly within medicine. She really inspired me to try to do that and, of course, along the way she helped me to see myself as someone who wasn’t necessarily made up of these different sorts of categories or identities but was in fact a kind of conglomeration of them. Not that they existed separately, but they were all synthesized in who I was as a student, as a thinker eventually. That really was empowering to have that kind of example and to have that kind of imagination to guide me and inspire me. She was just amazing and she was just a genius.
I mean the way that she was extraordinary. She ironically suffered from breast cancer, ultimately
died of breast cancer and was also interested in this intersection between literary thinking,
literary critique, and medicine. She wrote about her experiences of breast cancer and, in many
ways, that also inspired me because she lived much longer than her prognosis. That suggested
that intellectual engagement with that illness and the writing she did about it both creative
writing and advocacy writing, really sustained her.
ID: So those are actually all of my questions, thank you so much. I think Molly is here to take us
to dinner.