"We Can Endure"
Rafael Campo, M.D. ’92, has lived through a plague once before. An internist at Beth Israel Deaconess Medical Center, he was a young medical resident in San Francisco during the height of the AIDS epidemic—a searing experience that profoundly shaped the way he practices medicine today. In the exam room, Campo tries hard to shed clinical distance and emotional remove, to build an empathic connection with his patients.
He also brings the arts into his medical work. An award-winning poet, Campo writes evocatively about his experiences as a physician, and often shares poetry by favorite writers with his patients. He encourages other healthcare providers to engage with the arts too—as readers or writers, as artists or appreciators—and leads literary workshops with Harvard Medical School students, believing that the humanities are crucial for fostering empathy and helping clinicians become better caregivers and stave off burnout. Since 2018, Campo has served as poetry editor for the Journal of the American Medical Association.
Last year, I profiled Campo for Harvard Magazine, and I thought of him again last month when a close friend in Chicago had to be hospitalized with COVID-19. Thankfully, my friend recovered, though it was an awful experience. Recounting the ordeal afterward on the phone, he told me how anxious and lonely he’d felt, separated from loved ones who could not visit him. And he talked about the doctors and nurses who’d cared for him—how attentive and compassionate and professional they’d been, but also how the contagion had kept them at a distance, which they regretted as much as he did. They spent as little time as possible at his bedside, he said, and they would sometimes call on the phone outside his room instead of coming in to check on his condition. My friend said he could see that they struggled with this disconnect, that it pained them not to be able to give the kind of close care they were used to providing.
So, this week I asked Campo to talk a bit about this idea, and about his own experiences as a doctor and caregiver amid this pandemic, whether there were parallels for him to the AIDS crisis, and what ways he was finding to stay connected and whole during this extraordinary period of isolation and stress for clinicians, patients, and ordinary people alike. The conversation is edited and condensed below.
~ Lydialyle Gibson
First, how are you?
I'm hanging in there. It's a really difficult time, but we are doing the best we can. With all the restrictions on folks coming into the hospital, trying to protect everyone from exposure to the virus, we're limited in how we can care for people. And I find that I really miss that human connection. Phone calls and FaceTime and trying to manage care remotely is just a different experience. And it’s of course a real problem especially for folks who are facing end of life, and how do we get family members and loved ones together? It's just awful. I mean, it runs contrary to all we naturally want to do in those moments when it's so important for people to be together and be present for one another.
What are your workdays like now?
They can be pretty chaotic. Right now, I just got called to do urgent telephone care, which means speaking by phone or video with patients I’d normally see in the clinic. It's kind of unpredictable. I'll have days where I need to be in the hospital to see patients who require urgent, face-to-face medical attention. Although, even that is impeded by all the gloves and gowns and masks. It's a different way of being with a person, sort of guarded and distanced.
But we're really trying to do as much care as we can telephonically. And of course, there's a lot of understandable worry, and so a lot more calls from folks who might otherwise have said, “Oh, I just have allergies,” or, “Oh, it’s just a cold.” So far, I have only had one patient from my regular practice diagnosed with COVID, and he is doing well at home. Another patient, who's one of our young docs in training, was very, very ill and I'm sure he had it. He's doing much better now and is actually returning to work, after waiting out the full quarantine period. He really wanted to go back into the trenches.
Besides that, a lot of us are being redeployed into areas where we don't typically work. We have a dedicated respiratory care unit that's set up temporarily outside of the emergency room. Because the emergency room has been of course flooded with people coming in with more concerning symptoms. And caregivers who usually don't attend on the wards or in the ICU are being asked to do that, because we have a lot of folks who are just really—I mean, they're working around the clock. And several have tested positive.
So, it’s all kind of in flux, and my job description could change momentarily. Our ICUs are filled nearly to maximum capacity, and we're opening up new ICUs in other areas of the hospital to try to accommodate all the people who are coming in. On the bright side, it looks like we may be nearing a peak, in terms of new infections and patients requiring ICU-level care. It’s hard to say for sure, of course, but it helps so much that people have been working to flatten the curve by staying home.
You started your medical career at the epicenter of the AIDS epidemic. Does that experience echo here for you? Are there parts of it that help you navigate what we’re going through now?
I have been thinking a lot about that time. I am seeing what's happening now through that lens, and it's in some ways kind of re-traumatizing to be back in that moment. The current situation does evoke similar feelings of how distant we often are in the care we provide our patients. Sometimes, like now, that’s imposed by the circumstances. At the same time, there are obvious differences in what we're going through now. With HIV, there was much more of a stigma around the disease that informed some of the ways docs and other care providers responded. There was antipathy toward specific at-risk populations. Now, there’s more of a sense of a shared purpose, that we’re all in this together.
Another similarity in this moment: a sense of, “well, what can we do?” We don't have a cure. We don't really have treatment yet. We're hoping those treatments and cures are coming—and, ironically, some HIV therapies are being looked at for coronavirus—but there’s definitely that sense of powerlessness at the moment. And a feeling of burnout, a sense that this is unending. Right now, it just keeps coming. People keep coming to the emergency room, people keep suffering. There is not yet an end in sight. That part feels familiar.
So much of your work, in both poetry and medicine, is about human connection and sustenance through art. How are you thinking about those things now, given the limits imposed by this contagion?
You know, during the HIV crisis, people came together to tell their stories, and to make their voices heard. It was a different dynamic, because of the stigma and prejudice against groups who were most affected by that illness. But the activism was also hopeful and inspiring.
It’s critically important for us to find ways to stay connected through this crisis. As awful as it was during the HIV crisis, we could still come together. This new virus really prevents that. We can’t gather in community. It’s very painful. And so, I think it's all the more important that we go to those books that we love, and go in virtual settings to paintings and music and other works of art that provide a larger human context to help us make sense of what's happening.
I have certainly been turning to some of the poetry and other literary work from the AIDS crisis. It provides a kind of guidepost, a reassurance that we've been through this before, and that we can make it through again. We can endure. That message from the arts and the humanities is so necessary now, especially again, when we feel cut off from our usual sources of empathetic mirroring. If we can't be with loved ones, we can still be with other people through words, through music, through digital access to artwork.
What writers do you find yourself turning to?
Thom Gunn’s poetry, and Mark Doty’s. Marilyn Hacker has also written very eloquently about HIV and AIDS, and about her own experiences of illness. And I’ve been reading William Carlos Williams, who of course was a physician as well as a poet. His writing is so deeply empathetic, even when he's not writing about the hospital or about caring for patients. And also, of course, Walt Whitman, who worked as a nurse during the Civil War. His poems also are so physically embodied and just sort of electric in a really uplifting way. And we need that right now—to feel like our bodies are alive and are dependable, even when we fear they might betray us. I mean, it's just so affirming to read those poems, to be in the physical body in Whitman’s celebratory and incantatory way.
I've actually been putting together some poems by living American poets in particular, to share them through my role at JAMA with a wider audience of doctors and other care providers. Folks who really need some sustenance right now.
You are writing your own poems, too, about the coronavirus pandemic. What’s it like to be writing poetry about this crisis at the same time that you are living through it as a doctor?
I think it feels necessary to be a kind of a channel for some of the experiences that I’m having and that we’re having. Some patients living with this disease are literally silenced. When that tube goes in someone’s throat to support their breathing, it physically takes away the voice.
And so, bearing witness feels not only sustaining for me, as something that keeps me alive to what's happening and renews my sense of purpose, but it also, I think—I hope—can shed light on what people are actually experiencing who have this illness and who are dying from it and who don't have that voice, which is so necessary for us to hear. Writing poetry, and reading poetry, is a kind of antidote to the loneliness that both docs and patients experience, a way of surmounting those barriers to connection. That kind of keeps me going. Even when we feel our most dispirited, and are at our most beleaguered, poetry and the arts offer a way of recharging. I think that's why so many artists feel called to respond to these kinds of crises.
In our history, as we move from crisis to crisis, the artistic responses from each one help us live through the next one better than we would otherwise. What we create now will help others in a similar moment.
The art from this pandemic will help us through the next one.
Yes. It really will.
Anything else you would like to say?
Just one other thing: I imagine that most people are feeling really overwhelmed by all of this, but I want to offer a word of encouragement to create, to make something from this experience. That really helps us all to connect, whether it's poetry, or a journal, or photography—whatever it is that draws on that sustaining creative impulse, which we all have. I think that could be really helpful to folks who are feeling trapped, a kind of opening out into the world with a creative gesture. And it doesn't have to necessarily be published. It doesn't have to be something you're going to show people. But I think that might be helpful to folks who are struggling with the four walls of their quarantine. It’s a way to transcend that enclosure. We all need that.