Rafael Campo’s sixth poetry collection, Alternative Medicine, was published by Duke University Press in late fall of 2013. Like The Enemy and his earlier books, it deploys a dazzling pharmacopeia of received forms to treat a wide range of identities and situations, including the vocation of healing; immigrant experience; the challenge of sustaining romantic love and marriage to another man in a homophobic culture; and teaching and mentoring from both sides of the desk. Author of The Desire To Heal, a compelling book of essays concerning poetry and medicine, Campo is also finishing a third nonfiction collection, Can We Save the Art of Medicine?: Essays on the Humanities, Culture, and Medicine.
Campo’s honors include a National Poetry Series Award, Lambda Literary Awards, a John Simon Guggenheim Fellowship, the Annual Achievement Award from the National Hispanic Academy of Arts and Sciences, a Pushcart Prize, and the Sheila Motton Book Prize from the New England Poetry Club. He is also the recipient of the Nicholas E. Davies Memorial Scholar Award from the American College of Physicians, given for outstanding humanism in medicine. A graduate of Amherst College and Harvard Medical School, he currently teaches and practices general internal medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, where his medical practice serves mostly Latinos, gay/ lesbian/ bisexual/ transgendered people, and people with HIV infection. He is also on the faculty of the Lesley University Creative Writing MFA program. His poetry and prose have appeared in anthologies such as Best American Poetry and in numerous periodicals, including Boston Review, Kenyon Review, The Lancet, Los Angeles Times, The Nation, New England Journal of Medicine, New York Times Magazine, The New Republic, Paris Review, The Progressive, Salon.com, Slate.com, Threepenny Review, Yale Review, and the Washington Post Book World. Wheeler and Campo spoke in Boston in the spring of 2013.
Lesley Wheeler: You just performed a poem called “On the Wards” during a panel celebrating The Bellevue Literary Review. It’s from your new collection, Alternative Medicine, which I’ve been reading in typescript. The kindness of that poem particularly struck me. “On the Wards” considers simply looking, paying attention, as a mode of healing.
Rafael Campo: Sometimes, in my experience on the wards, in the very busy medical world, we believe we don’t have time to fulfill one of the primary functions of the healer: to bear witness. Part of bearing witness is actually seeing the person sitting in front of you in the clinic or lying in bed in the hospital. From the poet’s perspective it’s important as well, seeing in that detailed, focused way, noticing the bruise where the IV has been placed and the other ways the body is marked by the experience of illness.
That translates also into attentive listening: not only how we gaze upon our patients who aren’t accustomed to being seen anymore, but how we attend to their voices. And that gets to the larger issue of how biomedicine silences the patient, appropriates the narrative, translates it into medicalese, locating us ever further away from what that person feels, what we see in her face, the ways her body is altered by what we’re doing. It’s to me one of the great gifts of being a poet in the medical world: to always be reminded of how important that acuity of observation and listening truly is in our work. I certainly feel it helps me be a more effective healer.
The particular encounter in that poem seemed at first like an interruption. I was briefly intersecting with a whole narrative of illness that I couldn’t possibly know because I didn’t know this patient, she was just alone on a gurney, no one else around, late at night. Then suddenly as I looked her and saw how beautiful she was, I felt myself to be a participant in what she was going through—I was a witness to her experience and I needed to do more than avert my eyes. I needed to look at her and form that connection, however fleeting it might be.
Wheeler: You joked at the reading about your work being dark and depressing, but one of the most salient aspects of your writing is its compassion. You’re constantly noticing how beautiful other human beings are, how worthy of love, and you’re always considering the intersections between your story and their stories. Part of that ongoing mission is exploring what doctors really feel as they face sickness in others. Starting with your first books of poetry and prose, you’ve written about the eros of the doctor-patient relationship. In Alternative Medicine, there’s a poem, “Reforming Health Care,” about feeling grateful to be needed, and another, “The Performance,” about an experience of joy in a children’s cancer ward. Would you talk about the role of a healer’s emotions in your project?
Campo: That kind of presence or engagement is central to what I’m hoping to do. We tend to work in silence in medicine. We silence our patients, we silence ourselves. I think of when the endotracheal tube goes in, and the patient can’t speak, and there’s a palpable sigh of relief amongst everyone in the operating room: okay, now we’re in control, we’re not going to have to listen to the patient’s perspective, we’re going to focus. That’s very telling.
Our culture at large does some of the same kind of work, silencing those who are in pain, who are suffering. Yet patients remind us that silence equals death. During my medical training days, that SILENCE=DEATH slogan was something I heard at Act Up rallies, and I remembered that was something Audre Lorde had said too.
We need as physicians to be participants in these narratives, share them with our patients. There’s a pervasive belief in the medical profession that if we don’t distance ourselves emotionally, our judgment will be clouded, we won’t be able to make the right decision about the emergency intervention that needs to happen. And even beyond that, there’s anxiety around the issue of who really owns the narrative of illness. I think some physicians worry if they share in these narratives they’re appropriating them in a different way, as compared to simply translating them into medicalese. There is, unfortunately, some writing by doctors that aggrandizes the physician at the expense of the patient. These are all contributing factors to why we distance ourselves. And of course we’re trained very explicitly at medical schools and in residencies to distance ourselves, not to engage emotionally. “Just the facts, just the data,” is the mantra. All of these factors conspire to remove us from the experiences of our patients. We have to resist actively the impulse to avert our eyes, to shield ourselves from what our patients feel, to subtract from their humanness by focusing on the heartless, purely fact-based narratives we record in their charts.
I also want to represent myself as the speaker of my poems as just as human, just as conflicted and flawed and joyous and depressed as any of us are. And some things we experience in the hospital are joyful—the births of babies, when someone is cured, when the bandages come off and someone sees again, those are ecstatic moments. We ought to participate empathetically in those as well.
Wheeler: Working with HIV patients has been a vocation for you and a major subject of your writing across genres. Will you talk about why?
Campo: To some extent it relates to my personal identity as a gay Latino man and feeling deeply connected to two communities devastated by this disease. I’m also skeptical of the biomedical model as to the cure, the solution to this pandemic. Just recently we’ve been hearing about a baby cured of AIDS: “Isn’t that miraculous?” As wonderful as such a story is, as tremendous as the medical advances have been in the treatment of HIV infection, we have to remember there are aspects of human suffering medicine will never be able to explicate away. Yes, HIV and AIDS treatment appears to be a tremendous success story. Yet there are still forty million people around the globe infected with HIV, most of whom are going to die because they do not have access to or can’t afford the cost of our life-prolonging therapies. HIV and AIDS is one of those territories in which we’re reminded both of the incredible power of the biomedical model and also its persistent limitations.
Also, this notion that we’re post emergency now, that the pandemic is over, that we need to concentrate on other things—it’s extraordinary that can even be contemplated! We certainly have not cured AIDS and we certainly haven’t prevented its ongoing transmission either. There are still so many lessons to be learned and so many silences to be overcome. It’s also still a stigmatized condition here in the US and elsewhere—I think our eagerness to forget about AIDS is on some level an expression of our continuing fear of a disease still attached to powerfully negative metaphoric thinking, as Susan Sontag describes so insightfully in her essay “AIDS and Its Metaphors.”
Wheeler: In thinking about your recurring subjects, including HIV and AIDS, I wonder how and why you choose one genre or another to approach the material.
Campo: In some ways the poems develop much more viscerally—a lot of my encounters with patients, mediated through the amplified listening of stethoscope, or through the X-ray vision of imaging technologies, take shape more easily through poetry. The essay is more work for me, although I hope my essays capture some of the lyricism I hear and observe in the body. Prose for me is more aligned with the explanatory gestures of biomedicine, which I suppose I resist in so many ways. I go to the poem first because of the complicated relationship I have with the narrative prose line. I feel myself to be more vexed when writing an essay. I want to be showing and not telling, although of course the best essays do that too.
Poetry comes to me much less arduously. It has something to do with empathy, too, I suspect. I’ve been told so many times by cynical colleagues in medicine when I try to bring poetry onto the wards that empathy can’t be defined, can’t be explained, can’t be narrated—yet it does seem to be enacted in the best poems. When we read or hear a poem that’s truly effective, we feel what the speaker’s feeling, we experience an entire immersion of ourselves in another’s consciousness. It engulfs us, takes hold of us physically. Its concision demands the participation of another in order to achieve completeness, to attain full meaning. It’s harder to achieve that effect in prose, to offer the same empathetic embrace. There are probably prose writers out there, though, with the completely opposite experience!
Wheeler: I’ve actually been reading recently about world-building in fiction. I’m really interested in poetry with this immersive effect, but all the analysis of how literature absorbs readers into alternate worlds concerns prose, novels—long forms, basically. I’ve been trying to get my head around how immersion works differently for poetry readers, when the work of literature is relatively brief.
Campo: 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 exclusive province of poetry. Certain aspects of poetry, though, are particularly inviting to empathetic experience.
Wheeler: I think you’re right that rhythm has a lot to do with it.
Campo: And the use of enjambment, too—when you jump from one thought to another it feels physically embodied in the line breaks. That, to me, is very gripping, utterly thrilling. I’m given over to the poet’s intuition, I’m perceiving through the poet’s senses meaning that is expressed entirely wordlessly. Also, the very shape the poem takes on the page, the ways in which lineation speaks to us through implication—the poem is so specific in its deployment and arrangement, and always reminds me of how precisely our own bodies are organized, how in biology form follows function.
Wheeler: To stick with the essay as a form for a little longer—are there particular essayists you feel inspired by?
Campo: I love poets’ essays in particular. Randall Jarrell. Adrienne Rich. Derek Walcott. Robert Pinsky. Mark Doty’s work: he’s a superb essayist and memoirist as well as a poet. I think of his work on HIV and AIDS; Atlantis is a book I go back to so often.
More in the medical realm, Richard Selzer’s essays are extraordinary—empathy factories as well, frequently funny, always unsentimental, as he so expressively conveys patients’ narratives through the essay’s form. Danielle Ofri, Cortney Davis, and Abraham Verghese are other examples of medical writers whose essays I find compelling. Older standbys I often revisit include Virginia Woolf and Susan Sontag.
Wheeler: A question I’d noted down for myself, and perhaps you’ve already answered it to some degree, concerns the essay versus the poem: what you find hospitable and what you find difficult about each genre. Clearly metrical poetry is a congenial mode for you. I’m thinking particularly about that writing binge you describe in The Desire to Heal—that section startles me every time I reread it—when you describe drafting thirty-two sonnets in one long sitting.
Campo: That was a binge! The floodgates opening.
Wheeler: Poetry comes to you fluently.
Campo: I wonder if it has to do with a primal impulse in me that goes all the way back to childhood: hearing poems in Spanish and wanting to make an imaginative journey though those poems to a place that was so forbidden to me, Cuba—this homeland at once the center of the universe and yet inaccessible. Through poems I was first able to contemplate that kind of impossible journey. Which is not to say that the poems are truly easier—in some ways they’re more difficult because of the tremendous power they seem to have over for me—but perhaps I’m drawn to them more instinctively.
I wonder if my affinity for poetry is also rooted in music, again something I heard at a young age that was a way of making an imaginative journey to a taboo place. I’m so drawn to formal structures in poetry, the music of it. People say writing in forms can be so difficult but for me it’s the opposite experience. There’s a fluidity to writing poetry that feels of a piece with remembering, storytelling, the earliest narratives of my own life. My parents read poetry to me as a young child, patriotic poems by José Martí, in a deliberate attempt, I think, to foster in me some kind of connection to Cuba.
I encountered prose as an art form later, when I was struggling with English versus Spanish and becoming conscious of the tensions between the two languages in my head. In late adolescence, early adulthood, I really resisted Spanish. I wanted to speak a masterful, polished English—not “ESL English,” English as a second language. I wanted to be unquestionably American. Now I’ve come back to an appreciation of the musicality of Spanish. I want to embrace its place in my life. Perhaps this struggle still works in me as well: I have a fraught relationship with English as a prose medium, while Spanish can be a mystical place I always want to get back to, to recover, to rediscover in poetry.
There’s also my writing process as a doctor: I don’t have hours and hours of time available to write. Poems take place in day-to-day life, between caring for patients, in the midst of witnessing, in the immediacy of the ER. An essay can’t happen in those moments; I can’t jot down the outlines of one on the back of a prescription pad.
Wheeler: Like William Carlos Williams! Do you really write poems on prescription pads?
Campo: Often I do. Although electronic medical records make that harder; we have so little paper around these days. But the spaces for writing are brief in the practice of medicine. Even when I journal, what comes out of it is usually a poem. I have an impulse to prune away rather than add on: there’s so little time, both literally and in the larger existential sense, I find myself having to cut to the essential experience. I can’t seem to escape the sense of the clock in my exam room ticking away as my patient speaks, as if measuring lives.
Wheeler: You were just speaking about the Spanish language as a place you try to get back to. You’ve been negotiating an imaginative relationship to the country of Cuba since your first books. Has your relationship to the idea of Cuba changed over the years?
Campo: It has, although in other ways it’s been static and constant. The static aspect is the notion of it as a forbidden island: it’s only ninety miles away but yet can never be visited. It’s an impossible place, a lost dream, a mirage—that paradox is still real for me. What’s changed, I suppose, is how I see Cuba paradoxically as an invitation, as a new, undiscovered territory. As an adult I can now form my own opinion about the revolution and my family’s history as exiles. I can begin to see Cuba as a more complex place, full of a vibrant culture that’s intensely attractive and appealing, familiar as it is unimaginable. The music, of course, but also the literature: I’ve been interested again in José Martí’s poetry lately, reading it not as I used to, as an expression of patriotism for a free nation that doesn’t exist anymore, but as living verse, intensely musical, ruefully philosophical, so much more than a mere expression of a politics.
I more actively contemplate visiting these days. I hope that one of those anchors of my old way of seeing Cuba, my family, changes enough that I can make that journey with them.
Wheeler: In the critical reception of your work so far, you’ve been treated more often as a physician-poet and a gay poet, perhaps less often as a Latino poet or a formalist. How do you see yourself fitting into the very complicated field of twenty-first century poetry? What are the benefits and disadvantages of those labels, anyway?
Campo: I see myself primarily as an aspiring poet. I studied with Derek Walcott, who told us we’re never poets until we’re dead, and even then not all of us will achieve that distinction: that’s the paradigm! All of these identities are at once enriching—they speak to each other and I hope I engage in a kind of internal dialogue fruitfully—but at the same time their conflicts can lead to difficulties. What draws me primarily to the act of writing is the pure pleasure of it, not the desire to express a specific political view or identity. For me this pleasure has mostly to do with empathy, with that opportunity for connection with fellow human beings across the many categories of identity that can be used in other ways to divide us. When we are joined in the music of our bodies, when we are able to recognize in the voice of another our own joy or anguish or vulnerability, we experience comfort—we are not alone.
It’s interesting to compare my more marginalized identities with the others: in particular, the experience of being gay and Latino with the experience of being a male physician. Perhaps those various vantage points allow me some insights into how power works. Inhabiting all of those worlds, I can observe from the medical perspective how marginalized communities, such as LGBT people and Latinos, suffer from health disparities, disproportionately affected by AIDS or cancer or heart disease; I also have firsthand knowledge of them, having cared for friends and family members afflicted with these conditions not as a privileged doctor but as the nameless, faceless “other” who sits at the bedside waiting for information or even just an expression of compassion that never comes. Earlier I spoke about writing poems on the back of prescription pads while caring for my own patients; when I myself felt silenced, especially when I was a resident in San Francisco, watching friends, men my own age, die of AIDS under the care of physicians who sometimes regarded them with loathing and contempt—such moments have been equally compelling calls to writing. To see identity translated into poorer health is profoundly troubling, and demands the empathetic response of the poem.
Wheeler: A lot of the factionalization in contemporary poetry seems to be to come down to grammar, attitudes towards the sentence and how one sentence flows into another. How would you respond if I said there’s a commitment to clarity and legibility in your work? “Accessibility” is a complicated idea but it can be a dirty word in some contexts.
Campo: I think those are great words. Perhaps because of the difficulty so many of my patients experience in making themselves visible, getting their narratives heard, I want to elevate those narratives so they can be heard by the larger culture. I sometimes get frustrated with experimental writing. I get the intellectual aspect: to play, to take pleasure in wordplay, to test language’s ability to convey meaning, or even subvert it to new purposes of simply sound-making—that feels sometimes like a luxury to me after a long day in the hospital. Of course, there’s a way writing accessibly can be critiqued as playing to the powers that be. But I also think: we are all so privileged if we have that concern at all. There are patients of mine with no voice, for whom a metaphor is a fundamental act of survival. I do find myself drawn to clarity. I want my poems to be heard and understood, although I hope they’re never facile. I want them to challenge as wide an audience as possible while still being attentive to form, the gestures of language, the relationship between language and the body, and all the many complexities of any writing that has to do with illness. That’s not to say I’m not open to all kinds of writing. I’ve experimented myself, written away from formal constraints, and I read very widely.
I might say one other thing related to formal poetry: sometimes people may think that to write formal verse is a capitulation to convention, for Latino or queer writers especially. Sleeping with the enemy, selling out. I can’t say I’ve experienced it in those ways. In my experience, writing in meter and rhyme has been about trying to invoke those rhythms of the body I hear so loudly and irresistibly as a doctor trained in the use of the stethoscope. I also want to see if English can sound like Spanish: can I remake English into this music I’m so in love with? Early on, maybe there was an unconscious impulse of the immigrant to master forms. But that was a long time ago. I don’t feel my project is about that at all now.
Wheeler: I have more questions than we have time, so I’ll just run through them and you can pick one or two that interest you. First, I noticed a motif that seems like the opposite of accessibility in Alternative Medicine: the book makes many references to secrets and invisibility. I wonder if that rings true to you. I’ve also been thinking about the trajectory of your poetry and how this book feels emotionally darker to me, particularly because it ends on “The Destruction of the Temples of Machu Picchu”: that last line, “they swear such a place never did exist,” hints at political pessimism, a closing down of utopian possibilities. I was going to ask you about teaching, in part because of the beautiful villanelle for your undergraduate teacher Eve Sedgwick—what did you learn from her, and how did her teaching change you? There are also the obvious closing questions of any interview: what’s next for you, what your ambitions are, whether there are subjects and modes you haven’t tackled yet that you aspire to try.
Campo: What’s next: I am working on a new collection of essays that will explore the relevance of the humanities to medical education. It’s less autobiographical than my previous work, more of a meditation on the necessity of the humanities to the work of healing. Going back to the essay is a challenge stemming from what you were alluding to in the new book of poems, something dark and problematical: what kind of medicine do we ultimately want in this culture? Are we even capable of imagining a culture that abets healing in the largest sense? Some of the changes upon us in the medical profession, which of course reflect the preoccupations and priorities of larger American society, are really chilling and dangerous to empathy and healing. We’ve made so many tremendous technological advances and there are so many new therapies to extend life and improve quality of life, and yet we’re becoming ever more distant from our patients, ever more specialized and fragmented in the care we provide, such that we’re experts on one tiny little aspect of the working of the body and can’t talk to a patient about his depression and how to have a more fulfilling life. It’s also increasingly difficult for doctors, who are still largely white and largely male, to speak across these diverse identities we’ve discussed, to be present empathetically for patients who come to us from so many different walks of life, cultural identities, languages, races, sexualities. We need to be able to engage culture through our work as doctors. Not to mention the change people are most worried about, the reimbursement of care in a way that exerts intolerable time constraints on our work with patients. I hope this new book will help us think together about what kind of medicine we actually want and need.
Wheeler: This strikes me as strongly parallel to the conversations we’re having as teachers about MOOCs, or massive open online courses. There’s a value to them—online courses can provide a certain kind of education very cheaply—but it’s difficult for me to see them as even the same kind of animal as the courses I teach, which are all about attention and listening.
Campo: Exactly. I hear over and over, what’s the use of the humanities anyway? I’m on the board of trustees at Amherst College, my alma mater, a liberal arts college, and we hear sometimes from parents: what is my kid going to do with a degree in Philosophy? I’m spending sixty thousand dollars a year, and what kind of a job can she get as an Art History major?
I am here to say as a physician that I can’t imagine the work of healing without the arts, the humanities, the context that helps me make sense of what I see every day, to place the decisions I help patients to reach about treatment options in an ethical context, to recognize that health and disease are not simply a function of physiology but are also impacted and defined by social and cultural forces. It’s unthinkable to me, but humanities budgets are being cut. Fewer students major in the humanities now. Writing programs are seeing declines in enrollment—it’s a concern in every aspect of the arts. But we need the humanities. As a primary care physician, I use what I learned in my English classes at Amherst much more than I use the knowledge I acquired in my biochemistry classes at Harvard Medical School. We need to make a clearer argument for the relevance of study in the humanities and why it will always be critically important to us, not matter what profession we enter or type of work we do.
Really, the scientific model is limited. Human beings are not equations that can be solved, nor are we hypotheses to be tested. We are not experiments. I hope we never arrive at a world where we’ve explicated everything about the human condition through the sciences. That’s a cold, soulless world. I don’t want a supercomputer like IBM’s Watson telling me I have lymphoma because I entered in my twelve symptoms and that’s what the algorithm spits out. I don’t want a doctor who’s a robot. I want a doctor to be present with me as she tells me, “You have cancer and this is what we’re going to do next.” Of course I want the latest treatment, but if there isn’t one, I want that doctor, again, to be present with me, to maybe share a poem with me, to warm my hand in the ICU, to laugh or to cry with me.
We still seek that when we are ill, not only to be cured, but to be healed. The signal works of the human imagination teach us how to be present with each other in just this way.