Written by Dr. Eve Makoff

Amidst the “great resignation,” COVID has had health systems scrambling to retain employees. Beyond the burnout that already existed in medicine due to an overemphasis on efficiency and technology, turning doctors into “providers,” and making a calling feel more like a menial job, it’s the moral injury, the traumatic effect of the repetitive witnessing of suffering and death without the power to stop it, compounded by the very hard truth that there are people who refuse to accept the tools science has brought to fight the pandemic, because of politics, that dealt the final blow.

Soothing stress, focusing on spiritual wellness, commiserating with colleagues after devastating clinical encounters, and time away with sand between your toes while nursing fancy pink drinks are crucial to supporting “wellness” – or at least to providing a break from the crush. But do they bring lasting change? Or do we just return, after moments of relief, and slip back into the white coat or the blue scrubs, and start all over again at exactly the same unbearable place? Are we accepting a reprieve when what we really need is a whole new path? After decades of practicing medicine, I had a kind of transformational moment that made me believe one exists.

And it happened through poetry.

In the 1980s, before medical school, I studied English in college, so it’s no surprise I was drawn to the field of Narrative Medicine. But even with my major, I’d been wary of poetry, questioning my own ability to understand what a poet was trying to convey. I sat silently in those classes, avoiding the professor’s gaze. But in the midst of the pandemic, when I enrolled in the Narrative Medicine program at Columbia, I was forced to confront my fear of verse and granted the opportunity to find its deeper meaning: discomfort with ambiguity.

As physicians, we are trained to be certain, confident, and absolute. We speak in statistics, in data. As a student, when I’d ask a question like: “The patient reports nausea. She believes it’s from her new medication. Do you think that’s possible?” Time and again, I was told by a supervising physician: “Not a chance. That pill never has that side effect.” If a connection wasn’t proven, inexplicable symptoms were dismissed. This kind of disavowal of a patient’s own experience if it strays from the script runs rampant in medicine.

In my first Narrative Medicine class, “Close Reading and Creative Writing,” we read “1994” by Lucille Clifton. Right away, I wondered what was crucial to the poet about that year, which happened to be my last year of medical school. But the teacher encouraged us not to dissect the poem, engage in literary analysis, or even question the intention of the writer. We were to submerge ourselves in the text itself and discuss what it evoked for us personally. We were asked to circle lines and phrases that “worked on us,” that made us feel, that connected us in some way to the transcendent undercurrents of our human existence. As I did so, I allowed the lines “you have your own story, you know about the fears, the tears, the scar of disbelief ” to hit me straight in the gut as I thought about my struggle to hold my family steady in the face of the public health crisis.

Within class discussions, the poem’s meaning blossomed, expanding beyond my own emotions and reflections to include the various other perspectives in the virtual room. We all came from different backgrounds and places. In this iterative process, we learned there was no one meaning in those words, and that every text is incomplete without our input, its receivers. Our thoughts, our feelings, were all valid regardless of what the poet intended. And in the process of sharing our perspectives, we got to know each other and ourselves better.

In the fall of 2021, as the pandemic roared on, I was asked to find a team-building exercise to address the theme of “engagement” at my job, where I was a medical director. The need was to stop the bleeding – to repair the detachment, the sense of depersonalization, that was now a national problem in medicine.

So I looked for a poem.
It couldn’t be too metaphoric, or too long, or overly lavish with imagery. I searched for a simple, provocative set of stanzas intended to retrieve the connections between us that were lost in the stress of the pandemic. I chose a short, simple poem about love.

That day, hundreds of healthcare workers read the poem together. And as prescribed by the Narrative Medicine exercise, groups of staff co-created their own poems, all starting with the line “Most importantly, love.” Each individual would add whatever sentence or phrase came into their mind after hearing the words of the person who spoke before them. By the end of the day, dozens of new poems were formed and shared with excitement by people who never thought they were creative. Many of whom, like me, had been similarly put off by the obscurity of poetry.

Coming together that way, spinning words into images and stories, common themes emerged while disparate styles were displayed. We learned how much we had in common despite our differing contexts.

Through this exercise we were also able to see the power and the beauty
we generate when we work together.

Since that day, the pandemic still lurks in the shadows, threatening to grow larger again. But something started to shift in what many of us view as our priorities, at work and beyond. In that moment, through the words of the poem and the community we created, we renewed our sense that our connection as humans is our most important day-to-day task. And while the structures making medicine feel less personal still exist, we continue to refocus our attention on what matters most – the people in our care, including ourselves. We now recognize that depersonalization and “compassion fatigue,” the hallmarks of burnout, are unable to survive in a milieu that centralizes humanity – and creates poetry together. ☤