Summary:

Johanna Shapiro, Director of the Medical Humanities Program at University of California Irvine School of Medicine, brings her considerable skills and experience as medical educator, writer and literary critic to this unique volume of medical student poetry. Shapiro collected over 500 poems by medical students not only from her home institution but also from other US medical schools and performed a content and hermeneutic analysis. As Shapiro carefully details in her methodology section, she treats "poetry as a form of qualitative data, and [therefore] techniques of analysis developed for other sources of qualitative data (such as interviews, focus groups, and textual narratives) can be applied to an understanding of poetry." (p. 42)

Relying on the work of Arthur W. Frank (see The Wounded Storyteller), Shapiro devises a typology of student poems: chaos, restitution (and anti-restitution), journey, witnessing, and transcendence (this last category was not Frankian in origin). These categories are developed and explicated in Chapter 2: Functions of Writing for Medical Students. As the author notes, poems traverse the boundaries between types; nonetheless, the framework of the analysis rests with this typology. Further, Shapiro explores the metaphors of topography (illness as a foreign land) and quest (student on a heroic, however tentative or confused, journey) throughout her study.

The book contains many fully reproduced medical student poems, contextualized with academic theory on medical education. Hundreds of references, particularly in the fields of narratology and medical education, are cited. After three chapters of theory and methods, eight topics are explored using the outlined analytic tools: anatomy class, becoming a physician, patient experience, doctor-patient relationship, student-patient relationship, social and cultural issues, death and dying, love and life. Prefacing each of these topics is a scholarly essay providing historical and research foundations; every chapter concludes with a summation.

Within the chapters are examples of poems, not only organized by typology, but also by content. For instance in the patient experience chapter, the topics are: "patient pleas for empathy and compassion," "patient fears and suffering," "stigmatized voices," "vulnerability/courage of child patients," and "personal experiences of illness." Within each topic/subtopic, different poems are highlighted and fully analyzed. Additionally, other poems, not reproduced, are quoted as illustrative examples. Summary arguments are provided at the conclusion of each chapter as well as in the final chapter: "Strangers in a Strange Land: What Matters to Medical Students on Their Journey and How They Tell About It."

Although Shapiro states that her purpose "is not to address the literary and aesthetic attributes and value of the poems", she also notes "when students write authentically about their own experience, the results are uniformly moving, compelling and impossible to ignore." (pp 44-5) Indeed many of the poems are rewarding to read not only for content but also for word choice, word play, imagery and narrative line. For instance, in "Ode to the Peach" Brian McMichael explores the senses Neruda or Pollitt-like: "you invite me with / your voluptuous curves / your feminine little cleft". (p 236) Another example is the humorous, self-deprecating "Piriformis" by Curtis Nordstrom relating an early clinical experience by a medical student who hopes against hope that the patient's presenting complaint will require the student to demonstrate his acumen. Unfortunately the sum total of the student's knowledge base is limited to the location of the piriformis muscle; both the student and patient are "so screwed" when, "Alas, the patient presents with / an upper respiratory infection." (p. 16)

Shapiro's sensitivity and generosity of spirit vis-à-vis the medical student experience are evident throughout the volume. She concludes that "what may be most noteworthy about the analysis of these poems is that, amidst their own difficulties and fears, time and again these students reported engaging deeply with their patients." (p 259) She hopes that medical educators will be encouraged to support "in solidarity" the "idealism and high aspirations" expressed in these student poems. (p. 260)

In a postscript, Shapiro reveals her own experiences as a poet-patient. After noting that "[m]edical students are mostly annoyingly healthy, energetic, smart, and capable young adults who like order, structure, and control", (p 261) she also acknowledges how frequently students grapple with the topic of death and dying in their poems. That her poems emerged from advising a student creative writing group demonstrates how poetry can be renewing and vital not just to the student, but to the educator as well.

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Jasper Glass and his brother Jonathan are medical students in Toronto, circa 1975. Their father is a repressed, language professor endlessly writing a never-to-be published book on French idioms.  Jasper is having an affair with a married classmate, and he lusts after his dissection partner, Valerie. But Valerie isn’t interested.

In its wisdom, the medical faculty has decided that electives in the humanities must be taken to broaden the educational experience. Jasper and his friends opt for literature. When the graduate student assigned to the teaching task dissolves in angst over how to communicate with savage medical students, the young, Mexican poet, Roberto Moreno, becomes their instructor. The students love Roberto, and through him they learn to love poetry too. Valerie especially loves Roberto. Jasper learns to deal with it.

Over the course of the year, the friends have many adventures. Jasper rescues a young woman from assault, and she, in turn, defends him from a wrongful accusation. Jonathan loses his way and fails miserably. They meet a sinister psychiatry resident who abuses his position with patients, colleagues, and students. Only slowly do they realize the full potential of his dangerous mind. They deal with that too. 

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The story is based on an actual 1950's trip by two university friends, Ernesto 'Che' Guevara (Gael Garcia Bernal) and Alberto Granado (Rodrigo De la Serna). Guevara is studying medicine, Granado biochemistry. They plan to travel from Buenos Aires across the Andes Mountains to Chile, Peru, and, then, to Venezuela. Before too many miles their derelict 1939 motorcycle fails, and the two young men continue by whatever means is available. The journey intent is one of adventure--drinking, meeting women, seeing the world.

The young men do discover South America's impressive natural beauty but more strikingly, their eyes and sensibilities are directed to abject poverty and shocking injustices. These blatant inequities, as well as an extended period of time in a leper colony, contribute to the reframing of their original happy-go-lucky adventure and explain, in part, the impulses that eventually would shape Guevara's role in the Cuban Revolution.

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Most of the twenty works in this anthology are first-person narrative essays. They represent a wide range of women’s experiences of embodiment, spanning both the average lifespan and the particularity of individual lives, focusing on puberty and menstruation, weight-consciousness and eating disorders, facial disfigurement, multiple sclerosis, infertility and pregnancy, cosmetic treatments and surgery, breast cancer, and aging. A few essays offer a valuable cross-cultural lens on the experience of embodiment.

Hanan al-Shaykh’s Inside a Moroccan Bath (see this database) explores her dual experiences of being stigmatized in Middle Eastern culture for her thinness, and then having her stigma recast as value when she moved to a European city. Judith Ortiz Cofer’s "The Story of My Body," which begins "I was born a white girl in Puerto Rico, but became a brown girl when I came to live in the United States," (299) offers another perspective on the cultural instability of the criteria for female beauty. Linda Hogan’s "Department of the Interior" positions her experience of embodiment within the intertwined contexts of American Indian culture and the physical landscape of the West.

Some of the contributors are well-known for their texts on embodiment ( Lucy Grealy, Nancy Mairs, and Naomi Wolf, for example), whereas others are well-known creative writers (Margaret Atwood and Linda Hogan). Pam Houston’s Out of Habit, I Start Apologizing is also annotated in this database.

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In the sing-song voice of a Latin-American child, with the repetition and rhythm of a nursery rhyme, the poem tells of "my brother/who spins his eyes" and the child-narrator's awareness of the shame the parents feel about having a mentally retarded son. The poem superbly captures traits of mental retardation, and the sibling child's awareness of its impact on the family.

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Worlds Apart is a set of four documentary videos designed to stimulate thought and discussion about the effects of culture on communication and medical decision-making. Each video encapsulates the story of a real patient and his or her interactions with physicians and family.

The four videos are: (1) Kochi Story--an Afghan man, diagnosed with stomach cancer, decides about chemotherapy amidst miscommunication due to translation issues and religious convictions; (2) Chitsena Story--the mother of a four-year-old girl from Laos is caught between physicians who tell her that her daughter needs surgery to correct an atrial septal defect, and her mother who upholds the traditional Khmu beliefs that scars, including surgical scars, are injurious to a person in future lives; (3) Phillips Story--an African-American man on dialysis discusses the prejudices against black people in the health care system, particularly the decreased chances for receiving a renal transplant; (4) Mercado Story--a 60-year-old Puerto Rican woman who lives in Hell's Kitchen, New York City, explains the complex social situation which affects her ability to take care of her chronic health problems, such as diabetes and hypertension.

The films depict the patients and families in various settings--in doctors' offices, at other health care facilities, at home or work, during religious ceremonies. Phillips Story is different in that only the patient speaks during the film--in the other three stories we hear family members, translators, and physicians. The pitfalls of translation by a family member or friend are discussed, as well as the need for the physician to elicit information from patients about the social contexts that may affect their health and decisions.

For example, Mr. Kochi's religious beliefs contravene the use of continuous infusion chemotherapy, but not other regimens--this distinction is not elucidated for many months. Hence cultural competency in health care requires that the provider not assume reasons for patients' behaviors and decisions but rather emphasizes communication to understand the particulars of the situation.

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In the Introduction the editors describe the "day of reckoning" they each experienced at one point--the sudden realization that they were "fat." Prior to this insight, they had identified fatness with negative characteristics, like being funny or undesirable; the breakthrough came when they were able to experience fatness as simply factual and not value-laden. This freed them to enjoy their lives without looking over their shoulders, so to speak, to see how other people reacted to them. Their liberating insight led to this anthology, which consists of "works of notable literary merit...that illustrate the range of ’fat’ experience." (p. xiii)

A number of the stories and poems in Who Are You Looking At? have individual entries elsewhere in this database. These include: Andre Dubus, The Fat Girl; Stephen Dunn, Power; Jack Coulehan, The Six Hundred Pound Man; J. L. Haddaway, When Fat Girls Dream; Patricia Goedicke, Weight Bearing; Rawdon Toimlinson, Fat People at the Amusement Park; Monica Wood, Disappearing; and Raymond Carver, Fat (annotated by Carol Donley and also by Felice Aull and Irene Chen).

One of the outstanding pieces in the anthology is a long story by Junot Diaz entitled "The Brief Wondrous Life of Oscar Wao" (42 pages). Oscar is a Dominican boy who is both fat and a nerd. He is obsessed with girls, but none will have anything to do with him, until he meets Ana who becomes his (platonic) "best friend" until her boyfriend Manny returns from the Army.

As narrated by Oscar’s sister’s boyfriend, things go from bad to worse until Oscar spends a summer in Santo Domingo and meets Yvon, an older woman whose former boyfriend, the Captain, is a cop. When Oscar pursues Yvon, he first gets beat up and later the Captain kills him, but before the end he actually makes love to Yvon. In his last letter to his sister, Oscar writes, "So this is what everybody’s always talking about! Diablo! If only I’d known. The beauty! The beauty!"

Editor's note (4/14/09): The Brief Wondrous Life of Oscar Wao was published as a full-length book in 2007 and won the Pulitzer Prize.

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In the title poem, Jimmy Santiago Baca says: "To write the story of my soul / I trace the silence and stone / of Black Mesa." This collection of poems carries the reader into the mountains and valleys of northern New Mexico, and to the barrio where the poet and his family live. They are poems full of incident and experience, of the "twenty-eight shotgun pellets" that remain in "my thighs, belly, and groin" from an incident with Felipe in 1988 ("From Violence to Peace"), and the slaughter of a sheep to the tattoo of wild drums ("Matanza to Welcome Spring"), and the tragic story of "El Sapo," the Frog King.

Baca’s characters live close to the land, close to the mountains, and sometimes outside the law ("Tomas Lucero"). These poems witness to the violence and despair of barrio life, but also to its energy and joy. Baca’s hope continues "to evolve with the universe / side by side with its creative catastrophe."

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The poems in physician Rafael Campo's latest collection examine familiar themes: lost homelands, the agonies of patients and providers, local and global abuses, love and betrayal, of both the heart and the body.  In this book, Campo expands these themes, writing of child abuse, war, and the certainties and uncertainties of maturing love.  As in his earlier collections, Campo investigates these themes in poems that are expertly crafted and often in form, as if form might contain this poet's empathic and deeply felt connection to the world.  While Campo has always been a reliable witness, especially to the world of healthcare, in this volume his vision becomes even more incantatory, paradoxical and mature.  The narrator's personal losses and responsibilities expand into the universal, into a world that cries out to us to care, to act, to heal, to notice, to tell, to "realize the human" (92).

Divided into four sections, the first section begins with a poem, "Dialogue with Sun and Poet," dedicated to June Jordan, a deceased activist and poet whose poems once made Campo uncomfortable but now mobilize him to "arise."  Following poems tell of local abuses--an abused woman ("Addressed to Her"), the displacement of memory ("Elsa, Varadero, 1934" and "Night Has Fallen"), the crushing of the spirit ("Personal Mythology") and the reality of evil, evil that calls poets to "refuse nostalgia's reassurance that the way was clear" ("Brief Treatise on the New Millennial Poetics").  This section ends with a translation from Neruda's "Book of Questions," a poem that asks if we are in control and if we are indeed capable of change (22).

In the second section, Campo takes us, in sonnets, through "Eighteen Days in France," another country and yet one in which he is still haunted by melancholy, by both sadness and joy--when one sees clearly one cannot leave behind suffering or the potential for suffering.  These sonnets speak of loss, fear, doubt and death grounded in moments of pure happiness.  

The book's third section, "Toward a Theory of Memory," opens with another masterful Neruda translation, one that speaks of love's convolutions, "just as life is of two minds" (47).  Following are exceptionally beautiful poems that speak of the misuse of love and power ("Granymede, to Zeus") and of the deep joy and deep complications of long-married love (see especially "The Story of Us").

Section Four, "Dawn, New Age," is a collection of laments for human selfishness, for war, for the inevitable passage of time, for the emotional depressions we might lose ourselves in, for the patients we cannot cure.  In "Tuesday Morning," the poet says, "No poet cares / for such deceptions anymore, and words / don't cure" (93).  Perhaps words alone cannot cure, but these poems, intelligent and very often incredibly beautiful, can sustain us and remind us that only human connection, human love might help us survive.

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In this collection, twenty-two medical students and young physicians across the United States eloquently recount the process of medical education for those who do not believe they fit standard measures of student demographics. The editors, Takakuwa, an emergency medicine resident physician; Rubashkin, a medical student; and Herzig, who holds a doctorate in health psychology, group the essays into three sections: Life and Family Histories, Shifting Identities, and Confronted.

Each section is prefaced by an essay explicating the essay selection process, the history of medical school admissions policies and requirements, the basic progression of medical education and the reasons for this collection, such as "putting a human face" (p. xx) on the changing characteristics of admitted medical students: "With their diversity and through their self-reflections, we hope that these students will bring new gifts and insights to the practice of medicine and that they might one day play an important role in transforming American medical education into a fairer and more responsive system." (p. 141)

Additionally, a foreword by former Surgeon General Joycelyn Elders outlines her experience as a black woman entering medical school in 1956, including eating in the segregated cafeteria. The book concludes with recommendations for further reading and improvements to the medical education process as well as with brief biographies of the contributors and editors.

The range of essays is impressive: diversity itself is given a new meaning by the variety of narrative voices in this volume. Contributors include people from impoverished backgrounds, both immigrant (Vietnamese, Mexican) and not. One student, marginalized by his academic difficulties, began a homeless existence during his first clinical year. Others were made to feel different because of being African or Native American.

In two essays, mothers defy labels placed on them (pregnant black teen; lesbian) and describe the trials and triumphs of their situations. Students write of being subjected to ridicule, ignorance and prejudice due to their gender, interest in complementary medicine, political and advocacy views, or religious beliefs. Due to pressures to conform, even students from what might be considered more mainstream in American culture (e.g., growing up in a small town, or being Christian) can experience the effects of being "different" when in medical school.

A number of essays communicate the difficulties of illness, disability and bodily differences. Issues include recovered alcoholism (rather tellingly, this is the only essay that is anonymous), obsessive compulsive disorder, sickle cell anemia, Tourette Disorder, attention deficit hyperactivity disorder, chronic pain, and obesity. The authors balance their narratives of hardship with insights into how their struggles improve their opportunities for empathy, perspective and fulfillment as physicians.

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