COLUMN ONE
In age of COVID, doctors search for meaning in poetry
Medical journals see surge of entries on pandemic experience
Dr. John Patrick Murray was determined to help, to stop the wailing and to confront his fear of the unknown — a condition that is well-known to anyone on call in the ICU.
Like many physicians, Murray, who practices hospital medicine at the University of Chicago medical center, writes about his research for medical journals. But it was his experiences as a frightened resident treating patients in the ICU that moved him to capture those moments in an unexpected way — through poetry.
“Bouquet,” inspired by several of Murray’s ICU experiences, allowed him to imagine a parallel universe in which flowers can heal. It was published last year in the Journal of the American Medical Assn., or JAMA.
Some doctors seek a public audience to share their work, gathering in formal groups at teaching hospitals or medical schools. They contribute to poetry collections or literary journals and, upon occasion, publish books of poetry.
But medical journals are increasingly the top choice for doctors who believe poetry is the best way to capture the fragility, tenacity and universality of the human experience. During the pandemic, some of those journals have been deluged with submissions.
“In medicine we encounter situations where our patients are at some of the most meaningful moments in life, whether it be attending births or at the end of life,” says Dr. Rafael Campo, poetry editor of JAMA and a physician at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.
“I think that’s why JAMA really began to publish poetry, which often does address these single moments in our lives that really illuminate the human condition.”
There’s no shortage of worthy material, says Campo, who writes poetry and has won a National Poetry Series award as well as a Guggenheim Fellowship.
Especially now.
The outpouring of offerings during the coronavirus outbreak is likely “a reflection of how we are struggling to make sense of all of this when we don’t have the cure, we don’t have the vaccine [and] we don’t have treatments that are really lifesaving for most of these patients,” Campo says.
The most striking theme in recent submissions? Isolation. “We want to be able to come home and be close to our loved ones, to feel their support and to be sustained when we’ve had a long, long day in the ICU or in the hospital,” he said. “And then yet we’re told we can’t … we have to wear these masks, we have to maintain physical distancing.”
Dr. Jack Coulehan, a poet and a frequent judge of poetry contests for doctors and medical students, says he routinely encounters poetry that deals with intense experiences such as “dissecting the anatomy cadaver or the first patient death they attend.”
Medical students in particular frequently write about “the fear or the sense that they may be losing their humanity or becoming less sensitive to people and to emotions,” says Coulehan, professor emeritus at Stony Brook University.
Despite the poets’ heartfelt sentiments, however, the gatekeepers say that not all submissions are worthy of publication.
“We have so many people who are knocking at the door all of the time who just can’t write poetry,” says Dr. Michael LaCombe, poetry editor at the Annals of Internal Medicine and a doctor of internal medicine and cardiology in Maine.
“It’s the hardest gig there is in creative writing.”
The best poems, LaCombe says, are concise, have vivid imagery and, most importantly, are told from a universal point of view.
“I try to choose those that give me chills in the nape of my neck or bring me to tears.”
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At JAMA, Campo says, “the poetry section is really among the most popular sections in the journal.” Some of the submissions receive up to 5,000 views when they’re first published online, and that number increases over time, he says.
Dr. Richard Rosenthal, a psychiatrist at UCLA’s David Geffen School of Medicine, can attest to that interest. When his poem “Hands-on” appeared in JAMA in 2018, it was read 1,300 times the first day it was published online. Some of his academic research articles, he says, garner only a fraction of that initial audience.
Coulehan says his poems can generate more — and more meaningful — letters than his research reports or essays.
“I will get emails from people who like it, or say that it hit a nerve,” he says. “When you publish a regular scientific article, hardly anybody ever gives you a personal response.”
Campo says there’s a physical quality of poetry that makes it a particularly powerful medium for physicians.
“Poetry allows us to hear the beating of the heart,” he says. “It allows us to really immerse ourselves fully in another person’s voice,” and it allows doctors to connect with patients on a more personal level.
Coulehan has seen the healing effect of poetry firsthand.
He recalls a patient who began having hallucinations after gall bladder surgery. The patient’s appearance led other doctors to assume he was an alcoholic in the throes of withdrawal.
“Well, he wasn’t,” Coulehan explains. “It was actually a reaction to the anesthetic. He was very, very angry with his surgeons because of the way they treated him and what they thought about him.”
Afterward, Coulehan wrote a poem, “I’m Gonna Slap Those Doctors,” from the patient’s point of view.
“When it came out, I gave him the poem, and he was so moved and delighted that for years he had that page folded up in his wallet and carried it with him,” Coulehan says. “And it really, I think, allowed him to resolve that anger that he had for his treatment.”
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As she read, she says, “I would watch my co-workers in the ICU just close their eyes, and this peace would come over them.”
Poetry has helped her become a better listener when she’s with her patients.
“There’s as much importance in what they don’t say as in what they choose to tell you,” Mathieu says. “That’s much more similar to poetry than it is to prose, where somebody has carefully crafted a specific narrative that they want you to follow.”
She, too, is seeing more poems about the pandemic come across her desk — and she has turned to poetry and journaling as a way to deal with her feelings about being a healer during the outbreak. “The poetry that I’m writing, I don’t think is very good poetry,” she said. “It’s more like I’m turning to that as a way to make sense of the many emotions that have been going through my mind…. I’ve been using poetry as a kind of solace.”
Dr. Colleen Farrell, a resident in internal medicine at Bellevue Hospital and NYU Langone in New York City, tried to integrate the study of poetry into her medical training.
Though she met some resistance from faculty members, she found that discussing poems with her peers helped humanize the topics — such as depression — they were studying.
“People are intimidated by poetry because it’s not necessarily clear what it means,” says Farrell, who started a medical humanities group on Twitter called MedHumChat. “I think people in medicine like getting the right answer.
“I like creating a space where people feel like there is no right answer,” she added.
Becoming comfortable with uncertainty is important for doctors, Campo says. “We don’t always have all the answers, and that’s OK.
“There are limits to what we know and what science can do,” he adds, “yet we still have so much we can do for patients to comfort them and to help them heal.”
