How can Creative Expression Inspire Reflection in Medicine?
Image by Jr Korpa on Unsplash
An Interview with Fae Kayarian
Interview by Annelise Swords
Fae Kayarian’s Journals of a Visitor is a collection of poetry that reflects upon her journey as a medical volunteer and scribe, through which she continues to learn about herself, her relationships with others, and the medical field. I recently met with Fae over Zoom, and from our makeshift, living room-offices, we discussed the physical, emotional, and spiritual effects that the high pressure field of healthcare has on those who pursue it as a vocation. We talked about what we can learn about these experiences—and ourselves—by using creative outlets like poetry.
Fae Kayarian is a medical scribe, writer, and poet. Inspired by the physician poets William Carlos Williams and Rafael Campo, she began writing medical poetry to document and process her experiences at Harvard Medical School and its teaching hospitals. Hoping to attend medical school in the near future, Fae confirms that she looks forward to continuing her literary exploration of the medical field, and what it can reveal about the human condition.
Annelise: I noticed that this book is divided into three chronicles, an exploration of yourself in the field, of your relationships with others, and of your own path to self discovery. I’m curious why you decided to give each of these chronicles their own section?
Fae: I minored in ethics as an undergrad, and I took a lot of philosophy courses, so the first draft of the book was a collection of patient stories as told through the eye of a volunteer and medical scribe. It was compelling, but during my last year of college, a lot of things changed. I experienced my first real heartbreak, my relationship with academic research started to shift, I realized I wasn’t happy in research and was looking for a more clinical-based job. I was about to go into the world after graduating and was at a real crossroads, and I realized there were three parts of me that I was trying to reconcile with. I was trying to reconcile with all of these patient stories, and how to deal with that weight, and how to take meaning out of our interactions without getting too heartbroken. And there was experiencing deep, genuine love for the first time, and what deep, genuine heartbreak felt like. That was another aspect of myself that I was compelled to write about. Then there was who I am as a person outside of these patients and this heartbreak. How am I evolving as a person and where is that bringing me? So I thought to explore these three parts of myself that are all kind of the same story. It’s that I either love something or someone, either medicine, or this woman, or myself, and trying to explore what that means to me and how to grow from it. So the chapters are similar in a way, but they’re all just different facets of a very painful, but really important time in my life, and at the same time I was reading De Anima, which is written by Aristotle who is writing about the difference between the mind and the body, and what makes us whole people. I thought by looking at medicine, and love, and myself, I was assessing myself as a whole person.
Annelise: Did it help with the reflective process to separate those three, or did you find as you’d gone through that it was equally easy to get all of those words experiences on paper?
Fae: The writing process was really interesting, in that I wrote this book and never intended anyone to see it. I wrote it as a way to live through this painful, important time in my life, and I was in school, I was working, really busy but somehow at lunch I would jot down a poem, or before bed I would pump out 3 or 4 poems, and I found I didn’t write it to be chapter specific, but I found there were these 3 major themes. There was medicine, there was me mourning the loss of this person that I’d loved, and there was me trying to figure out who I was and what was important to me and why. The chapters naturally found themselves, and I was at the end of De Anima, and it hit me “I’m writing a chapter book”. I’m writing a book of poetry that has 3 distinct stories with a plot that threads between the 3 of them. There are these 3 different motifs that are just jumping out from my journal, it wasn’t intentional but they wrote themselves that way.
Annelise: One of the neatest parts of writing is getting to read back through it and discover those parts of yourself. You’ve addressed this a bit already, but how do you think that your creative writing and poetry process has impacted the way you view the medical field and your role within it?
Fae: It helps to reinforce that medicine is trying to understand and serve the human condition, it’s self-actualizing because I thought that I could only get that as a novelist or as a writer, but what I wanted from the beginning, I found in medicine. You can do anything in medicine. You can work strictly in the clinic, you can be a public health advocate, you can help serve underserved populations. With the versatility of the MD and DO degree, you can do anything. You could be an astronaut! It’s endless. It’s really nice to know that through writing, I have created a deeper understanding and appreciation for medicine ultimately being the exploration and service for the human condition. But it’s also nice that it is a humbling activity, and just like medicine, writing allows you to see things that are scary, to think things that are uncomfortable, to feel out of place. It allows you to face things in a way that is challenging. It’s really informed the way I see medicine. Two things that people perceive as so different but are really the same at their core. They complement each other so beautifully.
Annelise: When did you begin to write poetry, and what inspired you to start?
Fae: I was interested in writing as a kid, and I either wanted to be a novelist or a children’s book author, because I felt like writers could do everything. Though at the root of what they were doing, they were trying to understand the human condition. And I thought that was really, really empowering. And so I was really interested in writing but then as a middle/high schooler, I started getting into poetry. It felt like poets had this crazy ability to pack a punch into so few words. Because I’m a minimalist at heart, I just love things that are at their truest form, and so I thought that poetry was a great way to deliver so much in so little. In undergraduate I started writing medical poetry because I was inspired by the work of William Carlos Williams and Rafael Campo who were famous poets, but they were also doctors and would write poems between seeing patients. I was empowered by the thought of capturing so much within words that had so much depth and meaning. You don’t have to write a lot to say a lot and that’s what poetry has meant for me. It was an evolution of, “Oh this is a really cool thing that I’m observing”, and evolved into, “Well this is something that I have to do in order to find any type of meaning and root myself in something”.
Annelise: So would you say that poetry has aided in your ability to reflect on your experiences, do you feel like you remember it with more depth and clarity when you express it through poetry and then look back?
Fae: I feel like I’ll experience a moment with someone, without truly reflecting on how much weight it carries, or what it means to me, or whether it’s a positive or negative experience. Just that it’s a profound, meaningful experience. Usually the poem will come a couple days or weeks after that moment and it’s as if you put an extra filter on the experience. As these poems start to bubble up, it’s a way of remembering. I experience a moment, then take a step back, process it, and it presents itself to me in a way that communicates the overall impression of that moment. Which is helpful because sometimes in medicine, you experience such intense moments with patients, and it’s hard to immediately say, “Wow, that was really profound because this person’s dying”, or “Oh, that was my first pediatric patient who thanked me”. Sometimes it’s good to take time and let the meaning slowly trickle back to you so that you can fully reflect on its impact, and for me that’s what poems do. They allow me to establish or solidify what that moment meant to me. Sometimes in medicine there’s so much pressure to experience the “full flavor” of an interaction, sometimes you have to live it and then let all of the meaning slowly enter the spaces in between.
Annelise: That is a wonderful way to articulate a solution to a problem that a lot of pre-meds have when they look back on their experiences. They remember having them, but can’t exactly remember how those experiences affected them, or find that level of meaning by reflecting. So that brings me to the question, how important do you think reflection is to working in the medical field?
Fae: That’s one of the most important questions you can ask yourself early on. I remember talking to one of the attendings that I worked for in the first couple weeks of my scribing. I always like to ask the doctors, “Why did you get into medicine, what were your reasons for going to medical school?”. Most would say, “I really like biology”, or “I like the human genome”, but she said, “I don’t know yet, but I think I have an idea. I ask myself this every day, not ‘if I love medicine’ because I obviously do, but ‘why I love medicine’. I ask myself that every day and I’m in my forties, and you should be doing the same”. That was the first time it hit me that, “Oh! You have to do your initial reflection, but you have to reflect every single day!”. You have to take a step back and ask yourself, not only ‘If I love medicine’, which is the first step, but not the only step. It’s also ‘Why I love medicine, why do I continue to love it’, because if you don’t ask yourself those questions, you kind of lose yourself in the process, because helping people in this way is very consuming, and it’s a huge honor and privilege, but it’s really challenging, and if you’re not touching base with yourself, reminding yourself almost daily of the things that you hold near and dear to your heart, it’s really hard for medicine to also be part of that list of things you hold near and dear to your heart. I urge everyone to ask yourself, “Why do I continue to love medicine?”. It feels good to know that you’re doing what you want to do, and celebrating that journey is all that reflection is.
Annelise: Many physicians have found that expressing oneself through creative outlets can help combat burnout. Do you believe that writing poetry or journaling about one’s thoughts about the medical field could help them to explore their passion for medicine?
Fae: Especially now since there’s so much burnout, and so many people who have experienced primary and secondary trauma through Covid, I think writing for a lot of people is going to be really helpful. Of course, it doesn't work for everyone. I won’t say that this is the singular package to help everyone to alleviate trauma or fatigue, but for the people it helps, it works so well because it allows you to take a step inward. In healthcare, we run headfirst towards the suffering of others, but when it comes to our own suffering, we tend to run away from that because we’ve never been trained in a rigorous way to help ourselves, to heal ourselves. But any type of journaling or creative writing gives us a space to step into, so instead of helping a patient, you’re helping yourself in that same way. Healthcare providers deserve time and space to heal themselves, and reflection and solitude in your words and in your thoughts is something that is really powerful. It’s important to give ourselves that therapeutic space and a lot of my colleagues tend to agree that it’s a way to reconnect with ourselves, because we give so much of ourselves to other people, and we want to do that, but it’s great to also feed yourself, because it allows you to continue to give to others.
Annelise: Absolutely. It’s a positive feedback loop, where if you nurture and care for yourself, then you can continue to do what you love to do so much, which is nurturing others. And with that in mind, what advice would you give to a pre-medical undergraduate who’s feeling completely overwhelmed by their vocation?
Fae: I always think back to the same exact story. I was heading onto a shift, and there was an attending from the overnight that was about to pass off to my attending, and I remember a resident came up to the attendant, and was clearly anxious. She said, “Can I talk to you for just a second?”. They stepped to the side, close to where I was standing. The resident was so upset, saying, “I just don’t know how to do this, I don’t think I know this system well enough. I’m trying to admit this patient and the medical senior is giving me so much pushback, and I really think that this patient needs to be admitted, they’re really sick and they’re going to decompensate in the ED, I’m just not smart enough to figure it out.” And he replied, “I can teach you how to do everything you need to know, it doesn’t matter how smart you are. The one thing I can’t teach you is the most important thing in medicine, and you either have it or you don’t have it: your ability to care. If you don’t genuinely care, then you’re not going to be a good doctor and there’s nothing I can do for you. Don’t beat yourself up for not being able to communicate with a medical senior properly, I’ll take care of it. You have the thing that we all want, and that is enough.” So what I would say to a medical student if you’re really starting to feel burnt out, and you’re starting to feel devastated by the toll that medicine is taking, then it’s not because you’re not good enough or smart enough to handle it, it’s probably because of the thing that not a lot of people have, and it’s the ability to care. That feeling of burnout is because you have it, and that’s a really special thing. If you were a mindless robot or could never really connect with patients, you’d probably be tired and frustrated but you wouldn’t feel that deep rooted feeling of burnout. And so if you’re starting to feel that way, you 1), have the central tenet of what makes an excellent doctor excellent, and 2), there are so many resources for you, and there are so many things you can do when you are starting to feel burnout. Medicine is such a social space, and everyone wants to support each other. If you reach out, you will get support, resources, and the help that you need. Just know that if you are feeling burnt out, it’s not because you’re weak, it’s because you have that thing that everyone is pining for.
After a monotonous day of remote work, it was cathartic to describe the joys and difficulties of medicine, especially during this time, and with others who are in the same creaky, leaky boat of uncertainty between undergrad and medical school. While no two healthcare workers share the same experiences, it has never been more apparent that we all hold similar values, goals, and the desire to understand others that accompanies this vocation. As Fae put it, “It’s great to hear yourself in other people’s stories”.