For my dad, who taught me to love the beauty of language and the kindest soul to walk to this Earth
Siempre serás mi calma y mi casa
Introduction
Our Medical School Summer as Poets: Writing Towards Healing
How can poetry help us heal?
After finishing our first year of medical school, we attempted to answer this question by writing and reading poetry in conversation with each other. We each wrote ten poems about professional and personal experiences – Camila’s father’s sudden illness and death, and Elizabeth’s husband’s cancer diagnosis and treatment – and one joint poem. Our poems intertwine medical terms with emotion, unearthing what gets cut from clinical summaries. Our writing process demonstrated the rich human connections that poetry weaves for the writer and the reader. We want to share our process to inspire other medical students to use poetry to deepen their relationship to healing.
Elizabeth on poetry
I had written poems before starting this project. Poetry is the form of writing I crave when I need to process emotional experiences. It helped me figure out that I wanted to pursue medicine and marry the person who is now my husband. I love the freedom of poetry. It’s like snapping a photo of an experience, then playing with the zoom, contrast, color, until the scene is captured as I see it. In the process, the poem’s pixels catch the light, entering dialogue with the space around it. Observing this conversation is enchanting.
Camila on language
Before this summer, I read poetry but never attempted to write it. The daughter of two literature and language professors, my childhood was surrounded by words and books. I was taught the importance behind each word, and the power of translating thoughts and stories into an accessible form. Growing up in a bilingual home, I would say, “Be cuidado. Te forgaste. No quiero anymás.” I find beauty in this “Spanglish”
a representation of my bilingual, bicultural home and mind that views English and Spanish as one. Language is part of my identity. Why does it have to be binary?
A year ago, we started medical school.
We’d heard of the medical school information “firehose,” but were still shocked by the intensity of the water pressure.
We donned our white coats for the first time feeling like fakes, but as sweat and dirt accumulated on the cloth, our identity as “MS1” began to feel natural. We learned the language of medicine, dictionaries of disease and treatment, and how to translate these terms for patients. In our earliest clinical interactions, we also intuited the emotion and humanity that is consumed by “chief complaints” and the “history of present illness.” The firehose didn’t relent
not even when my husband and I were struggling to figure out his mysteriously high tumor markers. Ultimately, he was diagnosed with stage 1 testicular cancer, and treated quickly and competently. The good kind of cancer. We exhaled.
The firehose didn’t relent
not even when my dad, age 50, died. He was undergoing a minor surgery and had a malignant hyperthermia reaction that led him to the ICU for five days. It was a strange out-of-body experience for a firstyear medical student. My body was present in that ICU room in Wisconsin, but my mind couldn’t process that this patient was my dad.
Conceiving our project
As the weeks of first unknown diagnoses and then grieving dragged on, we alternately found ourselves at a loss for words. How were we doing? The loose aim of this project was “healing” – to ask, more than answer, the question of how we heal, and hopefully end our writing and reading period with a greater sense of ourselves as student-doctor-healers.
On
writing
Camila: Since most of my poems revolve around my dad, I kept coming back to the question of how writing was helping me heal. Writing helped me organize my chaotic and cluttered thoughts into words. Instead of answering the question “how are you?”, I illustrated my emotions in metaphor. I found that by transforming my pain into poetry, into something physical that I could go back and read, I felt lighter. I was telling my body that it was okay to let go of these
Elizabeth:
By the time I sat down to write about my husband’s illness, I didn’t feel very emotional about it. The cancer was out. He had had two clear follow-up scans. Writing wasn’t cathartic, but it did afford closure. I zoomed out and appreciated – wow, we had a year. I was surprised, though, by how emotional my husband was when I shared a few poems with him. I didn’t realize he needed to hear my reflections maybe more than I did.
In contrast, in writing about my past clinical experiences, I was surprised by the strength of the thread between myself and certain patients I’ve served. I remembered the crack of the voice of a hospice patient’s son over the phone, the canaryyellow of another’s kitchen. I wanted to hug these families, or at least understand how their lives filled around their aching loss. Poetry helped me do so.
I know now that when we open ourselves to listen fully, patients’ stories become a part of us. I’m interested in digging down into that imprint, understanding the way in which our stories –patient and doctor, friend and friend – weave together.
emotions because I’m placing them in a safe space.
Writing, together
Our joint poem is a braiding of our reflections on our personal illness experiences. As friends, we supported each other with immediate text messages and then the richer language of in-person communication and acts of kindness, like lending study materials.
Our writing began by rereading our text messages to each other as first the cancer and then the malignant hyperthermia unfolded. We realized the scariest part was the intensity of the unknown, and the spaces that amplified it: the ICU, the pre-op room, and the waiting room. We decided to juxtapose the two waiting rooms and write towards each other: Camila on the left, Elizabeth on the right. Over FaceTime and a shared Google Doc, we started writing, bolding overlapping terms as we went, stopping to ask each other questions and flesh out ideas.
The bolded terms shaped our lens on the next part of our stories, and we realized we were writing towards this overlap, seeking more words that connected us. We were surprised by the physicality of certain connection points – hands clasping in silent meditation, the pallor of shock and hospital sterility. We appreciated the abstractness of others – the jarring speed and slowness of time, the subjectivity of ‘forever.’ We added the twice-spoken line, “A simple genitourinary surgery, in and
out…” [Figure 1] after finishing the first draft of the poem. Only then did we realize the eerie similarity between the two outpatient surgeries.
Writing towards our connection points didn’t feel reductive, it felt natural. We put our scariest moments on paper, together, and in doing so, their weight shifted. We felt understood. We worried that in writing a “braided” [1, 2] poem – giving equal space to each experience – we would be equating them. But poetry, we learned, is a creative whole greater than its parts.
The breadth and depth of healing, when we took the time to sit with it, is immense, and it is always a conversation, a human braiding. And isn’t braiding – like braiding a sister’s hair, something we both used to do growing up – always an act of love?
Poetry as healing: broader strokes
We use poetry to transform pain and fear into something akin to beauty, and to offer our oftenoverstimulated minds a creative outlet. Both medicine and poetry connect people intimately: doctors get to ask and hear the most personal stories, and poets tell them viscerally. Many poems are about one person, but they could be about anyone. Our self-consciousness lessened when we read our drafts aloud to each other and realized their resonance.
As medical students, we wrote poems that speak to where we are in our education: learning how to be present with our patients, to offer them something physically and emotionally healing as we struggle to master their diagnosis and treatment, and to maintain our humanity in the process. Poetry doesn’t turn the medical firehose off – nothing can – but it allows us to find places where the stream is not so forceful, “eddies” where we can hear ourselves feel. Poetry is not reductive, but it forces us to choose our words carefully. It is not stagnant, but it is borne of stillness. In medicine, we relay snapshots – chief complaints and “pertinent” positives and negatives. Poetry allows us to add back the “impertinent” humanity that clinicians are forced to cut for efficiency
How can we use poetry to deepen our humanity as we progress through clinical training? We found that poetry can bridge stories and expose beauty in otherwise sterile or dark moments. From our summer as poets, we learned how to see poetry in our patients. If patients were to write a poem about their medical experience, what would they say? If we – patient and doctor – were writing jointly, what words would we bold, together? In this way, our summer was an exercise in empathy.
This poetic lens helps us craft more healing experiences for our patients, and a more empathetic, resilient mindset for ourselves as doctors-in-training. Poetry can help fill the gap between the clinical and emotional realities in which we operate. We must fill this space of “what exists and isn’t named” with expression, or else risk the self- and patient- “harm” [3] of burnout, exhaustion, and dissociation. From our summer as poets, we believe poetry is a form of individual and collective healing.
As future physicians, we will continue seeking the words to describe the “wordless” [Figure 1]. In doing so, we hope to be more empathetic interpreters of our patients’ stories, integrating the patient with their personhood.
References
1. Williams TT. Braided Essay: Workshop [unpublished lecture notes]. ENVS 80: Writing our Way Home, Dartmouth College; lecture given 2016 Apr 28.
2. Williams TT. Refuge: An unnatural history of family and place. New York (NY): Vintage Books; 1992.
3. Olivares, J. Promises of Gold. Ruano González D, translator. New York (NY): Henry Holt and Company; 2023.
Acknowledgements
We wish to thank Dr. Nuria Mendoza-Olivares, our fearless leader in this writing fellowship and a doctor-writer we both admire. We are indebted to Dr. Abigail Ford-Winkel, for her thoughtful guidance in the conception and editing of this essay; to Dr. and Dean Victoria Dinsell, for her steadfast support of us as students and humans; and to Jordan Reif, for her co-construction of our fellowship and her tireless furthering of the humanities at NYU Grossman School of Medicine.
My mother is sitting in a chair, laughing at a text message.
Words for the wordless
As I waited with my husband
I couldn’t help but laugh at his ears sticking out of his surgical cap. A simple genitourinary surgery, in and out. General anesthesia.
A simple genitourinary surgery, in and out. General anesthesia.
I wish I was with her when those three surgeons stepped into the waiting room, with faces as pale as their white coats.
I might buy an $8 latte to study here, in this white room–endless outlets, pillowy chairs, so many chairs but in them only one person, per patient, is allowed to sit
on a firm pillowless couch by the window, we strap into our seats for the next five days a rollercoaster of emotions, struggling to unbuckle and not ready to release
I hear a husband updating his children by phone: “Hi honey, mom just went into surgery.” His voice is clear and steadied.
Entering the ICU is like falling into a nightmare
The air is heavier, the space tighter
The sterile walls alive with machines. Tubes like slithering snakes, wrapping around my neck My footsteps unsteady
As he glances at the neat notes beside him, I startle at his eyes – ablaze with emotion –sorrow-singed fear only strangers like me can see.
faces, faces, so many faces racing in, racing out
I step inside his kind eyes and see his grandchildren racing to greet him at the door, asking him to read one of us “sleeping” in the ICU the others in the waiting room
the monitors like a bedtime story
But when I felt my body drifting into sleep I awoke, panicked: still breathing? Still beating?
a bedtime story, please, grandpa, just one more!
My textbooks lay beside me, unopened. when will I hear my phone ring when will I hear the voice of the doctor in my ear saying: it went OK.
I can still hear the steady beeps, the rhythmic ventilation craving: he is OK
Buenas noches Papa, I would say
I can’t bear to let my eyes seek this stranger’s gaze. he will see my fear and waste his steadiness on me. I study his steadiness – the still of his hands –and will myself to imitate.
time to let go a circle of hands grasping each other, a circle of love we hug him goodbye
If imitation is the sincerest form of flattery, then flattery is lying, lying to myself with my husband laying flat on an OR table.
I can’t believe this is happening.
I lay my eyes on him for the last time, electric candles laying by the door the nurses gift us a beautiful vial of his last heartbeat, to hold with us forever
I can’t believe this is happening.
Finally, the call from the surgeon it went perfectly, he is in recovery a 42-minute forever, finished
The chapel says it fits 100 300 came for his Celebration of Life how many people he touched from all corners of the world–it was surreal but their stories were real
The pathology report says stage 1 seminoma active surveillance recommended: not radiation, not chemo, just scans, scans, scans
I feel disbelief, I feel disbelief, and loved, and relief, relief, relief
He was so loved, loved
There are no words but here’s a few words, between us, from us
There are no words
By Camila Hernández Blanco & Elizabeth MarkowitzMalignant Hyperthermia
Oh, human, In you, two DNA strands forty-six chromosomes twenty thousand genes three billion two hundred million base pairs from A to T, C to G the code that makes you, you
Oh, human, In you, a silent assassin a gene led astray autosomal dominant, from generations to generations hidden in the strands waiting waiting and waiting …
Oh, RYR1 gene on chromosome 19, In you, a point mutation a single base substitution an A to G a subtle change, a switch of fate the smallest shift, a crumbled world
Oh, RYR1 gene on chromosome 19, In you, the protein RYR1 the role of muscle contraction regulation the release of calcium the contraction of muscle allowing movement, alas
Oh, mutated RYRI gene on chromosome 19
In you, the abnormal protein RYR1 a cowardly assassin in the serenity of anesthesia’s sleep succinylcholine, your sly sidekick In you, chaos unbound an uncontrolled cascade a calcium storm prolonged state of muscle contraction temperature soars, heartbeat quickens limbs once nimble, stiffen rhab do my o l y si s dis semin
Organs shutting down every second counts but in this story, dantrolene the hero fails to save the day
Oh, human, In you, a ticking bomb exploding exploding and exploding…
In me, mutated RYR1 gene on chromosome 19 an unseen scar now an open wound
Oh, father, But don’t you see?
In you, nineteen thousand nine hundred ninety-nine beautiful genes three billion one hundred ninety-nine million correct base pairs from A to T, C to G the code that makes you, you the color of your eyes the shyness of your smile the sneakiness of your wit
your intelligence
your gentleness
your love the genes that gave me you beautiful you, from A to T, C to G
written in your code was the creation of me
A body, a machine
What is a human body, but a machine? Where broken parts replaced anew
How can a body live longer than its soul? But what is a body without the soul?
Though absent be the sparkle in your eyes to light they grow wide in size
Cranial nerves 2 and 3 in check
Your smile devoid of its dimples and allures yet your skin feels warm and pure
Metabolic processes still producing heat
Silence befalls as your words are held captive but in my ears your breath sounds whisper, no shout, quite active
Ventilation giving off O2, diffusing into alveoli
Your fingers rest, in the stillness they reside My hand in yours, forever my guide
Epidermis remains intact
Eternally waiting, my "I love you" remains Lub Dub Lub Dub your heart exclaims Valves opening, valves closing
Is it really you?
Or has a machine taken control over your body?
What is a body with no soul but a machine.
A hole in the heart
Doctor, I have a hole in my heart
Differential diagnosis:
Atrial Septal Defect
Patent Foramen Ovale
Ventricular Septal Defect
Coarctation of Aorta
Let me take a listen
Lub Dub Lub Dub Lub Dub
External chest is normal in appearance without lifts, heaves, or thrills
PMI is visible and palpated in 5th intercostal space at midclavicular line
Regular rate and rhythm
S1 and S2 heard and of normal intensity No murmurs, rubs, or gallops
What other symptoms do you have?
My heart hurts
Can you describe the pain?
Aching Constant
Can you tell me more?
Like a person pierced my heart with a sword and left it there
Differential diagnosis:
Angina
Aortic Dissection
Myocardial Infarction
Pericarditis
GERD
Doctor, I'm in pain
I'll run some tests
Doctor, I lost someone
Who?
Someone I love
Chicken Noodle Soup
I miss the sound of your heart beating
Don't stop the epinephrine
Like chicken noodle soup for the soul
Epinephrine for the heart
Doctor, will you give me soup to save the soul?
Patient in Room 8
Patient in Room 8
Who is he?
Patient is a 50-year-old male who had undergone a robotic excision of a bladder diverticulum. During the procedure, the patient had an arrest. He was resuscitated and received dantrolene for concern for malignant hyperthermia. Patient is now in CVICU for continued treatment of malignant hyperthermia.
Patient in Room 8
WHO IS HE?
A Colorado boy son of Mexicans and farmers proud of his roots of tostadas, burritos, y pan mexicano
A true poet in our midst an English major but his heart remains loyal to another language
Semester in Argentina full of fútbol, "Che, boludo", mates, y asados Buenos Aires now his second home
Back in Colorado, teaching high school Spanish where he met a fellow teacher an Argentine woman teaching English his soon to be soulmate and wife
He is a Professor with passion for language, culture, and travel admired by his students bilingual, bicultural intelligent beyond his years always working hard never expecting applause
He is an athlete the matching scars on his knees never stop him from playing soccer with his students tennis like Federer and the perfect golf swing
He is a husband who never stops professing his love and his luck
buying mother’s day cards months in advance a true romantic the example that real love never ends
He is the father of two daughters always putting them first, no exceptions the first to say Te amo siempre making them lunches every day until they left the nest, missing them terribly the first to text them Te amo siempre
He is the father the husband the son the brother the friend the person we dream of A shy, kind soul in this loud, brutal world
Yes, he is the Patient in Room 8 but he is so much more.
Patient Rooms
15 minutes per patient
Have I gone over?
Another needle stick, missed the vein
Will my resident be mad?
What was the mechanism of action of that drug?
I need to do more Anki
Maybe I can squeeze in 30 minutes of Uworld after my shift
What did the patient in room 7 need?
What was that mnemonic for?
It's easy and expected to get lost in the overwhelming sea of medical knowledge like large waves crashing against a tiny boat afloat yet drowning at the same time
Illness scripts and memorizing drugs first, we place their humanity second but each patient is a person a person with stories a person with loved ones a person A Person A PERSON A PERSON!
stripped of their clothes, wedding rings, and jewelry replaced with hospital gowns stripped of their names replaced with MRNS, patient rooms, and diagnoses connected to tubes, machines, and gauze it's easy to de identify and HIPAA calls for de identification
but when it comes down to it what I remember the most during those sleepless nights in the ICU was the way the nurses still talked to my father even though he was in a coma it was the way the physicians sat with us held our hands, hoped with us it was the way the staff cried with us asking us stories of my father
so I implore you
don't forget who they are don't forget who you are humans taking care of humans
Before and After
There is a before and an after
I never gave much thought to death before just those conversations with friends at sleepovers late night talks
drinking wine laughing
I never gave much thought to death before just those ethics classes in medical school where brain death was assigned reading and happened to your patients We practiced how to break bad news what to say, how to act respect wishes
That was when death was untouchable just a concept, really a philosophical conversation
But there is a before and an after
Now death haunts me or is it that I haunt death? Imploring her for answers not found in my textbooks Begging for a glimpse
Take me for a carriage ride or do you have wings? Do you kiss your victims too?
Take me, but don't keep me Just for a minute I promise I just need to know then I will let you go, Death until we meet again
losing a parent losing a parent to me feels like turning off the music, permanently quiet my home stripped of its innocence and laughter stripped of its safety
I’m neither swimming nor drowning simply being, teetering amidst the sometimes undulating sometimes tumultuous waves I’ve never felt so much like an adult and a child at the same time, simultaneously
Mi casa en pedazos
entre las paredes escucho tu voz dulce como de leche llamándome, amándome cuidandome
entre las paredes exitís vos el primero que me sostuvo donde crecimos, donde vivimos en cada rincón tu sonrisa en cada crujido de madera tu risa
el humo del asado ya no sube pero el olor de chorizos en el verano permanece
el sonido de moler cafe mi despertador siempre aunque solo en mis sueños
entre las paredes mi casa, sos vos
entre tus paredes órganos colapsando coagulación intravascular diseminada sangrando como el lavarropas que pierde agua coágulos paseando por tu cuerpo y llegando a tu corazón como los atascos por las tuberías con destino al lavaplatos
embolización, embolizando esparcimiento por tu cerebro como el vidrio de tu plato cayendo y rompiéndose en pedazos y el brillo de tus ojos apagándose como el corte de luz en la cocina
entre las paredes, pedazos, pedazos mi casa en pedazos
entre las paredes de mi corazón exitís vos
we read a body like we read a poem dissecting into pieces listening for rhythm looking for patterns examining each segment analyzing, interpreting and searching for meaning we dissect into pieces to realize we need to take a step back lose a word, the poem changes meaning read it as a whole, left to right up and down backwards too but lose the context, the symptoms become meaningless immerse yourself as the author, changing your perspective empathetically read a body like a poem
Ashes to Carbon Dioxide
We are burning in a forest, verdant and lush a symphony of tiny notes a bird’s fluttering tune, delicate and serene a lady bug’s gentle crawl the rhythmic croaking of a frog a deer’s graceful dance and dash a sanctuary for all sunlight’s rays seep through the trees illuminating the leave’s maze of veins and casting a golden glow of warm orange and yellow, sunlight’s mesmerizing kiss it is the scent of childhood and summers gone by nature untouched
But we are burning in a forest, gray and dead the humming of birds now an eerie silence a deer’s dance becomes a frightful frenzy no place to hide, no home to find the trees weep carbon dioxide, releasing its wrath into the sky leaves dissolve into smoky shroud a nightmare sky, orange and red a nearby city ensnared by a hazy veil the stench scars my nostrils and burns into my eyes tears dripping but not enough water to extinguish more water more water greenhouse gasses, once invisible now on display shouting for recognition
We are inflamed lungs, the tree of life sturdy and strong,
trachea accepting air and oxygen trunk accepting water and nutrients transportation through winding paths of vessels and of roots then branching into bronchioles with breaths, alveoli expand and shrink with wind, leaves rustle back and forth inhale exhale lungs trees in harmony with one another in a mutualistic symbiosis through exchange of gasses, photosynthesis: 6CO2 + 6H2O + sunlight produces glucose + 6O2 trees, the life of lungs
But we are inflamed
our lungs house COVID-19 respiratory tract receptor cells accepting the spike protein gaining entry with host cell’s invitation taking advantage of their new home, hijacking, replicating, spreading like flames airways and alveoli catching fire areas of hazy veil, ground-glass opacities or even consolidation inflammation. cytokine storm. fluid accumulation. reduced gas exchange. not enough oxygen, too much carbon dioxide too much carbon dioxide
Acute Respiratory Distress Syndrome
First, masks inside stay six feet apart deep breaths outside the air, so fresh no virus to inhale Now, masks outside seal the windows tight deep breaths inside the air, so filtered no pollution to inhale
Our society is inflamed
Can’t you hear them scream
Our bodies aren't ours
It's 9:13 AM on a Friday
I find myself cleaning patient rooms
My mind drifting to weekend plans full of family and friends
It's 9:17 AM on a Friday
I meet my first patient of the day a 17-year-old girl
I type out her chief complaint: A late period
It's 9:27 AM on a Friday
When she asks me her options for if she were pregnant
Abortion being one
It's 9:40 AM on a Friday When I run her pregnancy test hoping for the one line she so desires
It's 9:43 AM on a Friday
Abortion is legal and two lines emerge
It's 9:46 AM on a Friday when the news arrives
The Supreme Court rules
Abortion is illegal
Our bodies are theirs
It's 9:50 AM on a Friday
In the Planned Parenthood abortion clinic
The doctors trudge into the waiting room
Tears like monsoon rain streaming down their faces
The weight of the news is crushing, as we gasp for oxygen
Earth crumbling ahead bringing us to our knees
A dire threat detected, sympathetic nervous system violently awoken, amygdala to hypothalamus to adrenal glands
Epinephrine unleashed,
coursing like a raging torrent through our bodies
Blood rerouting and vessels constricting airways dilating, heart rate increasing Our cells screaming: fight don’t flight!!!
Each patient has their story Now shaped by the Supreme Court
Our bodies aren't ours Our bodies aren't ours
Acknowledgments
Thank you to my classmate and friend, Elizabeth, for her constant support and providing a safe and creative space for our writing project. Thank you to my mom, my sister, grandma, and all my other family members for guiding me to become the person I am today Most of all, thank you to my dad for supporting me in everything that I do and teaching me the meaning of unconditional love.