Interview with Rafael Campo, MA, MD, DLitt(Hon)

Rafael Campo, MA, MD, DLitt(Hon)
In an interview with thirdspace, physician and poet Rafael Campo talks about writing, medicine, and his experiences as an openly gay medical student. An internal medicine doctor at Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School, Dr. Campo published his first book of poetry during the first year of his residency training. To date he has published 6 books of poetry and 2 books of essays. His writing has won numerous awards, including the Pushcart Prize, Hippocrates Open International Prize, the National Poetry Series Award, and Lambda Literary Awards in both Poetry and Memoir categories.

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.”

What was your formal education like?
I attended Amherst College, which has strong connections to one of our most important American poets, Emily Dickinson. Robert Frost taught there, too. Poetry was taken very seriously there. My liberal arts education also encouraged us to cross disciplines, so I majored in both English and in Neuroscience. It was at Amherst where I first began to imagine a life that merged my interests in arts and medicine. I came to Harvard for medical school, and did my residency training at the University of California, San Francisco.

Was medical school all that you had hoped for?
Actually, when I first arrived at Harvard, I thought that maybe I made a mistake. I was dismayed that at medical school there was so little exploration of issues such as social determinants of health, empathy, compassion, and the nature of suffering. These were the kinds of questions that compelled me to enter the medical field, so encountering a strict biomedical model of education was troubling to me.

How did you deal with that disappointing experience?
Actively writing and journaling helped me very much in dealing with the stresses of medical training. There are many areas in medicine that are scary and threatening, and nobody talks about them.

Would you share one of those scary experiences with us?
When I was a student, the raging HIV and AIDS epidemic in the United States elicited a lot of complex reactions and feelings in both patients and doctors. We didn’t have many therapies to offer, and the people primarily impacted by the virus at that time were from the LGBT community and those using illicit drugs. Since under the biomedical model physicians were not specifically trained to provide dignified and empathic care to all patients, this situation challenged them to connect with people they knew little about, and whose lifestyles they may have harshly judged. I was an openly gay medical student, so I found myself in some ways personally implicated. I can’t tell you how many times I heard on rounds very hateful kinds of speech about patients, using derogatory terms to describe them or their sexual behaviors, and it was personally very painful to be present during those moments. It was difficult to overcome that silence and to respond to such harmful ways of thinking about patients.

That sounds traumatizing. How did you cope?
I wrote. I spent a lot of time thinking about whether I should disclose to patients that I was gay. One of the poems I wrote during internship explored this issue of my coming out to a patient with end-stage AIDS. In the end, I decided to tell some of my patients. What I found was that this was very empowering to them. They felt we were in this together, and this strengthened our therapeutic alliance. Coming out and being open with my patients has helped me become a more effective doctor.

How was this received by the attendings and other medical training supervisors you had at that time?
I was “talked to” a lot. I remember many times when I was told by the attendings that I was “too soft,” that I “identified too strongly with patients,” and that I should work on setting proper boundaries. But my own experience then and now showed me that doctors went so far in the other direction – rejecting feelings about patients, not acknowledging them, and assuming we knew best because we were the medical “experts” – that this distancing was, in fact, damaging to patient care. However, hearing discouraging comments over and over, the type of This is going to be a problem for you, made me question if I should even pursue medicine after my 3rd year in medical school.

What made you decide to stay with it?
I took a year off and pursued a master’s degree in writing. That was a tremendously important experience for me. All those pent-up emotions, all those stories that had been pushed aside because I was told that I didn’t have time for them -- all of that flooded out of me. Through dedicated writing, I recognized that the human aspect of caring for patients was central to my view of healing and medicine,
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.

from Comfort Measures Only: New and Selected Poems, Duke University Press, 2017 (in press)

and that healing and medicine were central to my work as a poet and a writer. Pursing a master’s in writing also helped me dispel this notion that I would have to keep the creative and scientific parts of myself separate. I realized that, in fact, these two parts were intrinsically bound and necessary for one another. I felt reenergized to return to completing my medical degree, and to bring my art with me. Since then I have been able to defend that space in my brain, in my emotional life, and in my day-to-day work as a medical doctor.

You bring up an interesting point that the relationship between medical sciences and humanities often seems adversarial.
I think that’s a false dichotomy. Sure, if somebody is having an arrhythmia, that isn’t a time to read the patient a poem. However, more often than not, in our work as medical doctors, our interest in and familiarity with contexts in which people deal with illness are critically important in delivering optimal medical care. When I see myself in the experience with my patient, whether it is in that this person is also gay and has dealt with homophobia, or that this person too dealt with rejection from his family, I can go into that encounter with a sense of a truly meaningful stake in the relationship. The patient is not just a list of problems to be solved and the next step in the algorithm for treating hyperlipidemia, or the next antiretrovirals to choose given this resistance pattern. Those are important questions clinically, but in terms of giving meaning to the work, having that sense of identification with the patient – something that we can develop and nurture through art - we can combat burnout and cynicism.

Please tell us about your writing practice.
I write every day, regardless whether I’m exhausted or feel like I have 8 million other things to do. I realized that every time I engaged in writing a poem, I was reconnecting with my empathetic self, which helped me when I went back to the clinic. I found that preserving that space inside of me and in real time has made me a much better doctor for my patients, and kept me renewed in the practice of medicine. So many of us come to medicine enthusiastic and idealistic, wanting to do good for other people, only to find that medical training beats that out of us in so many ways. We see many terrible things: pain, suffering, death. We see derogatory communication and disconnectedness from patients modeled for us by our peers and supervisors. If we don’t take time to reflect on this -- to ask: Why was this so difficult? What pain of mine did this patient remind me of? -- we fall prey to frustration, fear, and anger. We can know what the next chemotherapy regimen is, but unless we do that in the setting of caring for the person we are facing, we risk thinking about these diseases merely as pathophysiology and not the consequential life-changing experiences that they are to our patients, and really ought to be for us, too. We are all ultimately going to be patients one day. We’re not immune to any of the health conditions that we often so dispassionately treat.

Any words of advice for aspiring writers in medicine?
I’d like to encourage students to add writing and reflection to the list of all those other priorities they have. This kind of engagement is essential to becoming the best doctors they can be. Narrative and stories remind us of our humanity. It should not be scary to us. It is empowering. It gives meaning to the world.