Emily Silverman

You're listening to The Nocturnists: Conversations. I'm Emily Silverman. Today we speak with Laura Kolbe, a poet, physician and medical ethicist. Her poetry collection, Little Pharma, won the Agnes Lynch Starrett Prize in 2021. She's currently writing a nonfiction book that blends memoir with the history of medicine and the arts. Her writing has appeared in The Nation, The New York Review of Books, The New York Times Magazine, Poetry, The Washington Post, The Wall Street Journal, the Yale Review, and elsewhere. She practices hospital medicine at the New York Presbyterian Weill Cornell Medical Center in New York City. Before I spoke with Laura, I asked her to read a poem from Little Pharma, called “Buried Abecedary For Intensive Care.” Here's Laura.

Laura Kolbe

“‘Buried Abecedary for Intensive Care’
It's called an awakening trial when the pleasanter drugs stop. It's
called bucking
when the lungs and vent jam wing against each other. It's called
clubbing when
the fingernails thicken to spoons from lack of oxygen. It's called
drug fever when
no one knows why. It's called elevation when the eyes can see
where the feet
should be. It's called fasting when radiology foretells like a
speaking goat on the
blood-blue mountain. It's called gunk when they suction the trach.
It's called
hippa when no one tells. It's called inspiration just before the
triggered cough. It's
called jaw thrust when the head is prepared for the macintosh
blade. It's called
kin when they don't shy speechless from the gunk. And when they
do. It's called
labored when breath outmoans machines. It's called manual blood
pressure
when you hope the machine lied. It's called nitroprusside when the
body is
flushed like a cinema. It's called octreotide when the blood untucks
the napkin
of the diner. It's called a pan scan when the body won't tell. It's
called a query
when insurer and the bank won't tell. Called resuscitation but it
isn't. Called
shock when it started as resuscitation. Called trendelenburg when
the feet are
in the air. Called underventilation when the gas is more like the
future planet's.
Called the vagus nerve when touching the neck makes the rhythm
stop. Called
weaning when the fentanyl hangs salivary at the chin of the bed.
Called xeroform
when the gauze smells like gin and tonic. Called you when it's a
question of error.
Called zeroing out when they reset the machines for the next
body.”

Emily Silverman

Thank you so much, Laura, for that reading and for being here today.

Laura Kolbe

Thank you for having me.

Emily Silverman

So before I begin, I just wanted to apologize to the audience for my raspy voice. I am recovering from COVID. So forgive me.

Laura Kolbe

That's all right. We've all been there.

Emily Silverman

Unfortunately, that seems to be the truth. Yeah. I loved this book of poetry, Little Pharma. Such rich language, so many powerful images. And I'm really excited to talk to you about it today.

Laura Kolbe

Thanks.

Emily Silverman

But to start, I was doing some research on you and your work. And I learned that you got the idea to be a doctor while you were working at a Harm Reduction Center on the Lower East Side. And so I was wondering if you could tell us a little bit about that.

Laura Kolbe

Yeah, absolutely. From a very young age, I loved stories and loved poetry. I loved to read, I loved to write. I had lots of failed novels as a kindergartener, and epic poems. So it was very clear that I wanted a life that was entrenched in narrative and probably a literary life. And I wound up studying English literature as an undergraduate, and going to grad school for English literature as well. And at a certain point, it became clear the academic study of literature was probably not going to be my home. But, nevertheless, I knew that I wanted a life in stories and poetry. And so part of my process of figuring it out was spending a little bit of time doing volunteer work and thinking about which direction I wanted my life to go. And I had the opportunity to lead a creative writing workshop at a Harm Reduction Center on the Lower East Side of New York City. And it was a phenomenal experience. There were people who were bringing sections of memoir, short stories, poems. And we workshoped them in a more or less traditional way, where people shared work and received feedback from other people in the group. And together, we started to compile this really rich body of stories from people who were using the Center. And I loved that work. And I don't regret any part of that experience. But I think as someone who had previously lived a fairly sheltered and privileged life I had not been exposed to very much chronic illness, or dying, or people who had really fallen through the cracks of the healthcare system. And I was really shocked by the incredible burden of disease that I noticed among the people who I was working with in this workshop. And it really reset my notion of where disease comes from, of the interplay between the body and the many chronic diseases that can be comorbid in a particular person. And also, obviously, the psychosocial factors that can exacerbate disease and people's ability to manage their illness. On the one hand, the workshop felt like this tremendous success in fostering this sense of creative community out of the Center. But on the other hand, it really made me rethink how I want it to be helpful in the world. And I think that making art, teaching art, propagating art, are all tremendously useful and important things that we need as a society. But at the same time, I wanted to learn more about how I could be more practically useful, and could engage with people on a more physical and visceral level, and help them solve the puzzle of their bodies and their illnesses in a more direct and biomedical way. So I wound up doing a postdoc program and started on the long trail towards becoming a physician.

Emily Silverman

Tell us a little bit about your practice these days as a hospital medicine physician. What kind of patient population are you working with and what kind of work are you doing in the hospital?

Laura Kolbe

I am a hospitalist at a large academic medical center at Weill Cornell, which is on the Upper East Side of Manhattan. And I also do about half of my practice at Lower Manhattan Hospital. It's right beside the Brooklyn Bridge, right alongside the traditional Chinatown neighborhood of Manhattan. And I work with PAs at times, but also I love working with residents and medical students and teaching at the bedside. So those are some of the hats I wear. And then I'm also a clinical ethics consultant at both hospitals.

Emily Silverman

I've always been so interested by the idea of an ethics consult. And I have some exposure to ethics consultants through my work as a hospitalist at San Francisco General Hospital. But I'm just curious how that works where you practice. Do medical teams run up against difficult scenarios and then is there like an ethics pager that they can page? And then when they do that you give them a call and they explain the ethical dilemma and then you and your team come in? And how do you approach tackling those ethical problems?

Laura Kolbe

Yeah, that's a great question. We have a consult order in our EMR that people put in, and then that sets up an alert system. And so my phone rings, and then I find out what the team would characterize as the ethical dilemma, which is not always what I think the ethical dilemma is. But we start from there. And we build a framework. And we have many, many conversations. I think when I started out in my clinical ethics training, and I think for many of my colleagues, there's this perception that the clinical ethicist is sort of a King Solomon, or maybe Judge Judy figure who's going to, like, hear all the facts and then hand down a verdict. And that's really rarely the case. The vast majority of the time there is a true dilemma in the sense of there being multiple answers, none of which are fully satisfactory, and none of which really do justice to people's sense of moral responsibilities, of their duties, of the rights of various stakeholders involved. There's just no way to satisfy all of them in the space of clinical reality. And so we help people to manage sitting with that, and a lot of the work winds up being about conflict resolution. It can be about mediating between people who have developed antagonisms, or ill will, over the course of very long and messy and complex hospitalizations. So there's a lot of interpersonal dynamics. It's a lot of managing the emotional labor of clinical work. It's a lot of helping establish continuity, when a patient's course has gone so awry, through foreseeable or unforeseeable complexities or complications, that it's really, really hard to keep a narrative thread going.

Emily Silverman

When I was in medical school, we had some teaching on medical ethics. And I remember they taught the four pillars that were, like, beneficence and nonmalfeasance and justice and autonomy, I think they were. So is that the framework that your clinical ethics team uses to approach these cases? Or is there, like, an ethics 2.0 that I don't know about? Or are there different schools of thought? What is the landscape of Biomedical Ethics these days?

Laura Kolbe

Yeah, I think pretty much everyone in medical school probably learns the four principles outlined by Beauchamp and Childress in their famous framework for medical ethics. And I think it's still useful in a kind of checklist fashion to make sure that you haven't missed anything crucial. But I think there is a much more dynamic and contested, in the best way, in an interesting way, interplay happening in medical ethics right now between different schools of thought about whether it makes more sense to adhere to a more principalist framework, which focuses on the duties that healthcare workers have towards patients, or whether you want to come at it with more of a virtue ethics framework where you think more about what kinds of character traits or attributes you want to cultivate within clinicians, or whether you take a more pragmatist stance, which is the dominant stance where I happen to practice, which is really about rich context, and making room for uncertainty or ambiguity, and letting the specific facts of the case guide you in an iterative way, so that you don't try to force a rubric onto the case–you rather let the case develop in almost a novelistic or theatrical way. I think it is related to the practice of narrative medicine, and that it's deeply rooted in the specifics of what happens, and allows for some kind of surprise, and allows for many people to, in some sense, coauthor the case and feel like we're all taking part in the creative act, that is, the pursuit of both a moral resolution for the case, and, of course, a clinical resolution as well.

Emily Silverman

I love this metaphor of the case, as a longitudinal narrative, or story, that can be picked up and put down. And one thing I've experienced as a hospitalist is the teams switch over so often that the context leaks out of the pipeline, sometimes, the further you get along in the case. And so as you said, the importance of keeping up that narrative thread, keeping that context all bundled in, it's not easy to do, but I feel like it's really important for making good decisions as a clinician.

Laura Kolbe

I think that's absolutely true. And it's not that these signposts of what makes a good doctor are without value, I think it's always helpful to check in on whether we are attending to justice and whether we're being nonmaleficent, and whether we are acting beneficently–all those things are incredibly important–and whether we've completely forgotten about the patient's autonomy or whether that looms large in our mind, that those are crucial. But it's not the be all and end all to say, “Okay, I checked those four boxes, and now I'm done. I'm a good enough doctor.”

Emily Silverman

Thinking back to the poem that you just read, one of the things I love about it is how it's focused on words and naming and language and meaning. And you talked about how growing up you always had a love for reading and writing, and language. So I'm wondering if you could bring us into that. What do you love about language? What do you love about words? And how does that bleed into your life as a clinician and as a poet?

Laura Kolbe

I love how gorgeously redundant language is, particularly in English because it's such a syncretic language that borrows from so many different language families from different points in its history. I mean, look at the thesaurus. There's probably 100 words for beautiful and 200 words for pleasant and 100 words for noxious. And, of course, they're not true synonyms. They all convey different shades of meaning and have different connotations. But nevertheless, we just have so much to choose from this rich array. And I think, for me as a child, that sense of plenitude and of hyper-abundance was just incredibly exciting. It was like being let into the ball pit at the discovery zone, the play place. There's just so much and you get to roll around in it. It's how my dog acts when snow falls. She can't get enough of just how much of it there is. And so she's just kind of somersaulting around in the drifts. And that's how I felt as a kid getting exposed to language and literature. I think when I put my clinical hat on it's a bit different, because I'm much more aware of how the register that I choose is a choice about power. And so I see myself sometimes retreating into a more rarefied medical jargon, for example, when I feel nervous, and my coping mechanism for my own anxiety is to try to establish a certain distance between myself and the patient. Or to make the emotional temperature of the room a little bit chillier, when perhaps it was getting a little too hot for my comfort. And so the choices that I make, consciously or unconsciously, are choices that shift distance, shift authority, shift who is implicitly permitted to speak or welcome to speak. And so it's just a much more barbed and complicated thing when I think about the language that I use. And so in this poem, I was interested in trying to scratch at some of the euphemisms that I heard in medical training, and really kind of pry them open, and expose them or turn them over in my mind, really turn them over in my mouth, see how they sound when I speak them. And think about what's happening there. Am I perpetuating a certain kind of harm by creating this veil of obscurity between what clinicians do and what patients are permitted to know? Or is there perhaps some redeeming feature there? Is there a certain gentleness? Does euphemism have its purposes in that it can protect people or create a certain helpful time lag so that processing can happen, so that people have time to come to terms with something perhaps brutal or violent or awful that has happened to their body or to their loved one. So I think about these different modes and the synonyms or choices that we have when we choose one phraseology over another. And that was one of the motivations in writing that way.

Emily Silverman

When I first read this poem, I kind of felt like I had been, like, slapped, like, in a good way, like some of these sentences, “It's called manual blood pressure when you hope the machine lied, or called resuscitation, but it isn't.” It just felt so true to me. And I remember I was on Twitter one day, and someone posted like a screenshot of this poem. And I think all they put above the screenshot was like, “Holy shit!” And I understood what she meant, because in a way, it kind of felt like the real meaning being exposed, you were just laying out this is what we really mean, when we say this.

Laura Kolbe

I recognize that it is an aggressive poem. And I think that one of the great things about writing poetry or reading it for that matter, is that it's an opportunity to inhabit all of these various stances that are all aspects of me or shades on my emotional spectrum. And it doesn't have to be the totality of all the feelings I'm capable of having, or all the different ways of being a doctor or all the different ways of being a truth teller, that this one is kind of in flat mode, and then others are a little more curious and burrowing and inquisitive or spoken almost in a whisper, or almost offhand, almost as an aside. I think of poetry as capturing many, many different facets of a self, as well as the ability to perform personae or roles that you don't actually get to play in real life. What if I was a much more aggressive person than I actually am? What if I was a much bolder or saucier person than I actually am? Poetry is really related to theater. Obviously, the first plays were in verse and a lot of poetry is closely related to the idea of the dramatic monologue. So I think these genres are caught up in each other. And so it's truth telling, but there is also this ability to play, to try on stances that maybe in real life or on the wards or in the context of something like an op ed, you know, wouldn't quite be the framework or the psychological mode that I would necessarily inhabit.

Emily Silverman

And Little Pharma is the title of the poetry collection. But Little Pharma is also a character or a persona, as you say. So who is Little Pharma? Is it actually a character that you've created and invented, and somebody that you can see in your mind's eye the same way you can see, say, Sherlock Holmes? Or is it more the shimmering facet of yourself and all of the different shades of your personality? How do you think about this narrator?

Laura Kolbe

I love “the shimmering facet”. That's so good. I wish I had come up with that. But I think that that's right. The first time I hit upon the phrase “little pharma” was in the context of a poem that's in the middle of the book, now, that's about wishful thinking, and about wishing wouldn't it be great if we just had a chemical fix for x, or a pharmacological fix for y? And particularly in the realm of relationships and emotions, what if there was just a pill for this and a substance for that? Wouldn't that be nice? And so I called the poem, “Little Pharma” because, in contrast to Big Pharma, it's not about curing cancer or putting people on the moon or whatever. It's about the kind of mundane wishes that we have for the tiny emotional cures that we feel that we need at various points in a life course. But then I liked that phrase, and I liked that potential for wistfulness and a kind of conditional mood where this isn't like a biographical depiction of myself. It's not in the documentary mode, necessarily, all of the time. It's a way in which I can explore feelings I have had or experiences that I have had, but also play around with them and revise them and think, “What if I had done this instead? What if I had said that instead? What if I had been more attentive? What if I’d lingered here? What if I had raised my voice? What if I’d lowered my voice?” So it is related to me, but it also gives me this very helpful asterisk where I don't have to be documentarily accurate. It's a place where I can be a little more sly and playful, too.

Emily Silverman

Can we hear “Little Pharma on her Youth"

Laura Kolbe

Sure!
“‘Little Pharma on Her Youth”
The dead woman woke up after
I killed her. She said, my name
is Amy, no, May, no, Yam. Let's go
with May-Yam, double
down on darling buds. Or projects
dumped on children to relieve a late year—
punch a root in cup and water, watch it
grow or die.I hadn't imaged
her brain fast enough so she’d lain
in the CT hole like a poster on the long drive
to college, about to unfurl what
dire and obvious I didn't know betrayed
my inferior mind. Brain bled in secret,
red inside its lines like the badge
of a blind mouth commanded remotely
by the Rolling Stones. White in the starved
parts like the font without serifs
on the man's shirt that says COLLEGE.She couldn't think
after that, even her ghost troubled
the words, poking my breast and saying
your face, crumpling my white coat
lapel to meagerest flower. You,
terribly young, Inter. err
y—
you terrible. Ugh.

Emily Silverman

Thank you. What I loved about this poem was it felt like such a transparent description of what it means to be early in your training and to be making mistakes. And the disgust that the patient shows at the end in the words, “you terrible” and even that very last word, just “Ugh.” It just was so refreshing to me because you just don't see that a lot in physician writing these days. And so I was wondering if you could tell us a bit about this poem.

Laura Kolbe

Yeah, absolutely. In the setup of the poem, this apparition of the patient at the end is sort of a ghost because it's kind of understood that this medical error went so badly that this patient died and the speaker of the poem says, "I killed her," which may or may not be true in a legalistic sense, but clearly I think that's how we've all felt at various times, particularly early in training, that whatever goes wrong, surely it was my fault—”What did I miss? Where did I go wrong?” And I wanted to think back to that experience of being a young trainee and feeling like I killed her every time something went wrong or a patient passed on the wards. And I remember how infantilizing it always felt at the same time. It's feeling like I was being initiated into this very dark and dramatic, terribly adult world in which literal life and death decisions were happening all the time. But at the same time, my inability to make the right choice or to be smart enough, or to handle my emotions on my own, just made me feel like such a tiny child again, and certainly not ready to be a physician. And so I tried to capture that a little bit in the language of the poem. And some of the imagery is, if not infantilizing, then sort of juvenilizing, if I can make that a word, in making you feel like your first day off at college, or something, where you've packed your little poster, or you're wearing a particular kind of cliched shirt. So that's one thing that the language is doing. But then you have the patient's language break down at the end. And it's a little bit hard to convey on audio, but I have the patient's words in italics. And I'm imagining her kind of literally falling apart before my eyes and being unable to quite get the words out, which is why they're the grammatical lapses and the language is breaking down, which is, I think, how we feel as clinicians in the face of the chaos of a dire medical error or an emergency that's going poorly, but also is how patients feel, as though they are being unmade, as though they're sort of disintegrating because of the forces of illness that are out of their control.

Emily Silverman

One thing that I love about your poetry in particular, but I guess also poetry in general, is this room to play, the room to bring the patient back as a ghost, for example. And it made me think a lot about the traditional physician stories and physician writing that we see a lot. And I think you mentioned this in another interview and I've seen this too. It's like the epiphany structure where it opens with the patient anecdote and then there's the learning moment or the moral of the story or the epiphany and then you come away a better doctor. Even some of the content of physician writing comes back again and again, like anatomy lab, or my first patient death, or my worst mistake. One of the reasons why I loved reading your work is that it just felt really different and fresh. How important is it that we innovate and spin those stories in new directions? I guess another reason why I'm asking this is a friend of mine, she sent me an essay and asked me to read it. And I did. And I thought it was a great essay. And then she texted me a few days later, and was in a state of despair, because she had just found the very same essay. It was written 10 years before by another physician. What would you say to somebody who maybe isn't a poet and wants to write about their experience in the hospital? And how do you deal with the fact that a lot of these stories just repeat themselves?

Laura Kolbe

I think there are good reasons to be suspicious of certain tired narrative arcs. And so the clinicians epiphany arc, I think, has some inherently problematic features. So one, as you alluded to, is that the patient becomes a mere learning tool and tends to be flattened or rendered magical, but in a bland and generic way. Where, you know, it's the kindly old lady who helps you realize that life is precious, or who re-humanizes medicine for you just when you become numb and desensitized. There's the patient who tragically dies, and that teaches you something. There's the error that you commit, and thereby the patient teaches you something else. And so each one is presented almost in this, like, video game format, where, like, now you're ready to move up a level because you encounter a character, the patient, and mistakes were made, wisdom was dispensed, and now you get to move along. And it implies that the most important story is your own personal progress, that you are the main character in this bustling novel that is the hospital or the clinic or the healthcare system at large. And it also just reduces the patient to this instrument, who is going to get you to the next step on your heroic journey. So lots of problems with that. Although I've been guilty of writing those narratives, I will probably write them again, they feel inescapable, because of course, to each of us, we are the protagonist in the novel of our lives. So it's understandable that our writing would come out that way, because it's very, very hard to shake that view of the world. But nevertheless, I think that that view tends to be stale, and tends to not help in our journey towards exploration and discovery of our own blind spots and our own uncertainties. Nevertheless, I think that a lot of great literature is in a spirit of repetition and tradition, when we think about certain poetic forms, like the sonnet, or the Villanelle, or even just poetic styles like a dramatic monologue, or that confessional poem; that whenever you're writing in that format, you are, in a sense, taking part in this polyphonic conversation of centuries of work, and you're talking back to it and you're being spoken to by the ghost of poets past. And in novels, this is true too, that there's characteristic novels of falling in love or of deciding whom to marry, or have illness or death and dying. And whenever people make new novels that are in that framework, they are joining in that great and ancient conversation. And that's not a bad thing. And I think within the realm of medical writing, yes, there are these certain near sacred experiences that tend to be pillars or milestones along the way, like the first patient death that you encounter, or the first time that you work with a cadaver, or the first time that you have to disclose a medical error or share a terrible diagnosis. These are all experiences that we've all had that are rich with potential because they do change us. And writing about how we've been changed is probably the hardest thing to do, and probably enlists the acuity of our faculties more than almost anything else. So I don't think that it's a bad thing that we return to these themes again and again. I think the challenge is to figure out how to be true to your experience of that event, rather than falling back on sort of genre conventions and feeling like you have to say the polite thing, or the expected thing, that slots into our preconceived notions of what happens at those germinal moments in the development of a clinician and of a self.

Emily Silverman

I love what you're saying about rejecting the instinct to fall into the polite answer, or the polite story or the polite lesson. Because we all know that in medicine there's this cultural myth of the physician hero. And I think it's really important that we shatter that myth and admit to each other and to ourselves that we're just human beings like our patients. But then how do you actually go about the difficult work of finding that authenticity, steering yourself away from the stale narratives? Particularly when in order to do so you may have to delve into weirder parts of yourself, the part of yourself, for example, that might conjure a ghost in the hospital room. And, especially if the work ends up published and out there and potentially accessible to colleagues and patients, also simultaneously wanting to retain that professional stance and that professional responsibility. How do you walk that line between expressing the weird, creative, artistic side, but then also having sort of like the solemn white coat professional side of yourself that patients theoretically want?

Laura Kolbe

I think in part, we should probably give patients a little more credit for recognizing that, of course, we contain multitudes, which is just a basic fact of human existence. I think they understand perfectly well, that the facet of themselves that they display towards a romantic partner is different than the facet of themselves that they display when they're grappling with a three year old having a tantrum, which is different than the facet of themselves that they display when they are delivering a PowerPoint to a roomful of people, that we're all kind of, you know, donning and doffing these costumes all day and shifting registers and code-switching depending on context. And that's true whether or not you've ever stepped into clinical work. And so, you know, if patients ask me, I explain that and I explain that–I don't say that I contain multitudes, that would sound a little presumptuous–but, yeah, that the poems are trying to inhabit sometimes fleeting emotions or thoughts that I've had, and are not necessarily representative of how I feel most of the time or all of the time. Yeats liked to say that poetry is the argument that you are having with yourself. And so you're going to play both sides of that argument. And you might lean further towards a particular stance or emotion in order to contradict it in your very next poem or work of art of whatever kind. So I think it's okay to be internally contradictory and messy, because that is the human condition. And certainly, it's the artistic condition. But I don't know. I'm sure things will probably get awkward for me at some point in my professional life, and I’ll try to embrace that with equanimity and curiosity.

Emily Silverman

Yes, contradiction, ambiguity being part of the human condition, part of the artistic condition. And it makes sense that doctors might struggle with that, since we are so conditioned to enjoy certainty and answers. In the other interview I listened to, you talked about wanting to go get your medical degree and then come right back, like getting something from the supermarket, and like wanting to go out and get this practical skill set that you could use to help people and then come back to whatever literary mind you have. You say that you're bilingual. You can speak in both languages, the poetic language, the medical language, so there's almost this feeling of having dual citizenship and going into this other world, like, how do you find the country of medicine? The people of doctors? What have you noticed about them? I mean, obviously, we don't want to over generalize, because there's so much diversity within the medical field. But as a poet and as an observer, I’m curious if you've noticed anything about, like, the physician phenotype, that's been interesting.

Laura Kolbe

I think, the longer I stick around, the more I realize that these silos or walls or what have you are illusory, and that I was probably wrong to think of myself as being this dual citizen with separate lives that weren't going to touch each other, and I was just going to shuttle back and forth and sometimes be “doctor me” and other times be “poet me.” That's certainly not how my life has worked out. Sometimes it works out that way, on a calendar level, you know, either I'm seeing patients one day or I'm not, and then I might have a day that's full of writing. But I'm the same self in both spaces. And I also think that increasingly, other physicians, whether or not they are involved in creative writing or the arts, have much more appetite for uncertainty and ambiguity and mystery than I initially gave people credit for. I think I wrote it on my high horse with my literary degrees, and had this idea that I alone would have a real gusto for getting into the mess and sort of dwelling in chaos and letting the wilderness of the human spirit come at me. And then I realized, much to my joy, although sort of chagrin at the same time, that, of course, this has been happening all along, and more and more so that I certainly find among doctors of my generation in particular, that they are here with me to kind of dwell in the muck and the mire of the human condition, and think about the dizzying interplay of different social and political and economic forces and cultural forces that all constitute together their patients’ lives and well being, that they're very interested in thinking about their speech and being conscious of the ways in which we communicate or fail to. So I think I had this rather rigid idea of the physician phenotype. And then I've been slowly disabused of that notion, which is a good thing.

Emily Silverman

What advice do you have for healthcare workers who want to expose themselves to poetry but don't really know where to start?

Laura Kolbe

Poetry is huge. It's a huge field. There are many, many, many voices within it. It can be challenging, definitely, to wade into that space and try to figure out what is poetry. it's kind of like asking what is music. You know, if someone dropped onto planet earth, and said, “Okay, I'm interested in figuring out what music is. How do I go about that?” We’ll be like, “Are you into jazz? Are you into the blues? Do you like rock and roll? Do you like rap music? Do you like classical music?” And it can be hard to know, and, but it's also extremely liberating and fun to try to figure out what your taste is. I think it's really helpful to let yourself kind of romp around in the heterogeneity that is poetry, and start to gravitate towards things. And then when I find a poet I like I often look up who they're reading. Sometimes in interviews or in essays they've written I can get a sense of what they consider to be their tradition that exposes me to further things within that niche of taste or tradition or mutual influence. And gradually you kind of build for yourself this family of poets, this little ecosystem of kinds of poetry that might appeal to you. I think things like Twitter are incredibly helpful for that, and various websites, particularly now that April is National Poetry Month. There's many, many blogs and sites and Twitter feeds, and what have you, that are just putting out a lovely, voracious and wide-ranging sprinkling of all the different kinds of poetry that are out there, that are exciting various readers and writers and editors right now. So I think it can be fun to follow those breadcrumbs and let one poem or poet that you like, lead you to the next.

Emily Silverman

Can we end with a poem?

Laura Kolbe

I'd love that.

Emily Silverman

Let's finish with "Little Pharma's Research."

Laura Kolbe

“‘Little Pharma's Research’
Sometimes when I leave the lab what's outside
seems some detail of anatomy still, as if always
the metal gurney underlay the day. A man's jeans
forming two blue veins coursing
beside my bed. The lamp’s sharp punctum where
light spools under the fixture. Street noise
leaking as through a weak wall in the heart.
The anatomist’s awe of layers, above all:
five skins between work shirt and rectus abdominis
hardly different from my skipping flat rocks minding
the many ways they waft out then fall in
or my skyping an old lover two skins,
two apartments back. Of course, the reverse
is just as true, like all the brightest
lies: in the lab I meet the rest of life, all the world
packed in one corpse: the body, a kind of government,
a flame-red senate, wrapped in fur. Its provinces
all fens and rivers, two-bit hucksters stamping
wet-booted outside the commissary store.
Out along the farthest limbs, nerves open dovecotes
for the wheeling flocks, homing, homing, home.
When I first met my hands, their small largesse,
they and I—we three—were amazed.
In the lab’s locker room, they peeled off
my scrubs, glowed blue with a cold I couldn't
yet feel but knew as mine. Little match girls.
Little lights. What is there to love
about this world without proportion? Impossible
to tell if one body is two, or five; to tell
whether, when I lie under my roof, it's about
to slough right off, wizened epithelium,
raw life lying beneath it tasting
the night as new syrup serum sky.”

Emily Silverman

I have been speaking with Laura Kolbe about her amazing poetry collection, Little Pharma. Pick up a copy. It is absolutely beautiful. And Laura, thank you so much for chatting with me today. You just bowled me over with your brilliance and your talent and medicine is incredibly lucky to have you. So thank you.

Laura Kolbe

Thank you so much, likewise.