Little Pharma by Laura Kolbe
Laura Kolbe is a doctor and medical ethicist at New York–Presbyterian/Weill Cornell Medical Center. She studied English and American literature at Harvard and the University of Cambridge. Her work has been anthologized in A World Out of Reach. She lives in Brooklyn with her partner Andrew and their dog Bonnie.
Of the many impossible chemicals, we need the one
whose free-state speeds the road then warms to
wet commitment on the windows.
We need the one in small jars that grows
big as remorse to float us down canals
flayed straight beyond intention.
All the foams I know stuff walls or clean,
hold heat or lay bare the face.
Bring me the other, white whip
that shames and elates the hungry
carpets of medians. Bring me the acid
that inflames Ohio's battery. Then the one
for Pittsburgh. As yet the one serum for travel
dries the mouth, locks the far hills like a bone
plate. There is nothing for
the shrift of your elbow, the hands at ten and two.
When you are drunk, you touch my face
as though it were made of cities
and you were a bobcat's toe.
There's that much fear of pulsed light
and flare, of how joy can be timed
like a wekk-run boulevard.
You'd rather screw the moon.
I know I've been waiting to be happy –
foolish when you see how cabs coast
the stop line, how they believe in green before it
blinks a fern eye on their rusted skins.
Foolish, when you catch the furred backs rising out
of the park, the half-seen night snouts sliding
across the road toward God knows
what sweet, what slip of meat brine
in appointed cans and alley boxes,
at the brink of anyone's home.
[“Little Pharma,” from Little Pharma with permission from University of Pittsburgh Press.]
CORINNE GOULD: You wrote the early poems of Little Pharma during your first year of medical school in 2012, and the bulk while completing your medical residency at Brigham and Women’s Hospital in Boston. How did the poems first take shape as a full collection?
LAURA KOLBE: I imagine this happens to many early-career poets, but the embarrassing truth is, I thought this book was finished much sooner than it was. Almost as soon as I had a book-size pile of finished poems—all unified by having been written by me!—I felt sure I had a book. I knew the poems all derived from a lifelong argument with myself, so in that sense they seemed to belong together.
It took time to see that the sense of steadily escalating predicament wasn’t necessarily there for readers yet, until I cast off some otherwise technically-just-fine poems and wrote new work into the gaps. I wanted it to feel like there was a persistent bass line vibrating beneath it.
CG: “Little Pharma” is a character who serves as “dreamlike double” or proxy for you throughout the book. What was your first inspiration for this character?
LK: The first poem I wrote called “Little Pharma” is one that’s in the middle of the book, and it’s about an imaginary pharmacopoeia—like, I wish we had a drug for X, I wish we had a chemical fix for Y. “Little Pharma” wasn’t really a distinct homunculus yet. But it got me thinking about tales, from Ovid to Lewis Carroll, in which someone ingests something and is totally transformed—and about how helpful that would be for me personally.
I was hitting a block in my work, being both desperate for candor and utterly terrified of it. Experimenting with the persona poem, and then developing the character of “Little Pharma” across multiple poems, was an enormous relief and terribly exciting, doing truth and theater at the same time. Of course there’s a deep and still-present tradition on this that I’m indebted to, which might include Umberto Saba, Zbigniew Herbert, Frank Bidart, and Monica Youn, to name just a very few.
CG: Did the writing and editorial processes provide any new insight into your experiences of medical school, residency, and patient care?
LK: On a very reductive level, I’m glad I kept writing all through medical training, because my memory of those years is shockingly poor. I think some of the memory gaps are trauma reactions and some are just because the hippocampus gets a bit sickly under low-sleep conditions.
CG: In your poems, you evoke Shakespeare, Bill Traylor, Merle Haggard, Marianne Moore, Anni Albers, and others. What strategies do you use to hone your point of view while also honoring the influence of other artists in your work?
LK: In my actual life, I’m constantly knee-deep in other texts. Our apartment is lousy with gigantic piles of battered books and records, and I’m always in the middle of a few of them. To write a narrator or speaker who isn’t constantly jumping around between half-remembered books and albums and paintings would be kind of a marvel of fictioneering, since it’s so different from how I actually nose through the world.
My poor memory can actually be helpful here as a sort of disinhibitor, since I would feel pretty pompous going through the world looking at my neighbor’s fig tree and thinking to myself, “Ah yes, ‘tis just as Lawrence said, a strange and sweet-myriad-limbed octopus!” When I’m working on a hospital ward and something mutters inside me, “the nectarine and curious peach/ into my hands themselves do reach” or “each of us / closes himself in his small San Francisco without recourse,” I don’t always know where it came from, but maybe I look it up to remind myself, and a metaphor starts growing.
CG: In your note on “After the PET Scan,” you explain how cancer cells more quickly metabolize sugars, leaving bright indications on a positron emission tomography (PET) scan. You say, “The clarity of the scan requires that a patient fast beforehand or eat only slow-burning fuel (fat, meat, and the like). The strange diet may feel like a form of propitiatory ritual, asking the machine to unveil a fortunate result and pass over whatever strange bad news hides within.” I was struck by 1) the humility with which you explain a technical medical process and 2) the humanity you ascribe to a fasting patient. Can you speak to your decision to include notes in the backmatter and who you were writing for?
LK: I hoped that different readers might hear different overtones in the notes, while all hearing the same fundamental pitch. Composing the notes reminded me of my experience as a student of foreign languages. Say you want to get better at your Italian, so you buy Natalia Ginzburg’s Le Piccole Virtù and start ploughing ahead. You understand about 30% of the first essay, which is actually plenty to love it quite a bit. After some time and some further study you read the second essay and by that time you understand half of what’s on the page. Pure delight. Then after still more time and study, you read the next one at about 75% comprehension. I’d love to write something that can warmly greet people with all different levels of comprehension.
CG: University of Pittsburgh Press is known for the Pitt Poetry Series and the Agnes Lynch Starrett Poetry Prize, which you are a recipient of. They also cultivate a scholarly focus on the history and philosophy of science, technology, and medicine—a cross-section of specializations I imagine were uniquely suited to support your work. What was it like publishing with University of Pittsburgh Press?
LK: The team at Pitt has been absolutely fantastic. I’m honored by the trust and the joy that they have in the work, and the level of intellectual seriousness across their catalogue. Publishing with a great university press also underscores that poetry belongs, as a way of knowing or a way of inquiring, right alongside other kinds of “seeking” disciplines—history, philosophy, and so on. It’s not decoration.
CG: In addition to poetry, you also write essays and reviews, fiction, and nonfiction. How does your use of characterization change as you shift between forms and genres?
LK: Even in the first-person essay, there’s still some theater and some distance, shining a little more light here, leaving some spots dusky, talking a little louder or softer than my natural speaking voice, adopting a bit of swagger or not, all those kinds of decisions. That’s true across every kind of writing that I do. Maybe less so in writing reviews, though even there I guess I’m acting out a kind of self-effacement and handiness—oh sorry, let me get out of the way so you can check out this thing!—that isn’t quite my core self (whatever that is).
CG: Your interests include health equity, social medicine, and transitions of care for vulnerable patient populations. How did those focuses inform your co-creation of the Weill Cornell Medical Center COVID Palliative Care and Hospice Unit, and the COVID Recovery Unit?
LK: Transitions of care—moments when the patient, now finishing a hospitalization, is “handed off” to another doctor, or another facility, or just to their home community—are always vulnerable thresholds for any patient. You know the game “whisper down the alley” or “telephone,” when children pass a message down the line until it’s babble (sometimes deliberately mishearing or misrepeating, or at least that’s what I always did…)? The same thing can happen to a patient, where I might say that I’m concerned about a patient’s high risk for stroke, but also about their recent internal bleeding, and therefore am giving them a hiatus from their blood thinner, but by the time I’ve stopped being that patient’s doctor and someone has picked up the baton a few weeks later, some insane misunderstanding has arisen. Or when someone’s offhand comment about a patient’s frame of mind becomes mistakenly understood as a formal psychiatric diagnosis. Sometimes doctors call it “chart lore,” things that are wrong but somehow stick to someone’s clinical narrative forever. There are all kinds of checklists and automated processes that try to reduce this, but they all take effort and attentiveness, which is not always incentivized for patients who are already treated as outsiders, as “difficult cases,” in the healthcare system.
Initially healthcare had no idea what to do with patients with COVID who were either (a) too sick to leave the hospital but didn’t want aggressive treatment with a fictive or chimeric “curative intent,” or (b) were overall getting much better but were going to need weeks of intensive multimodal rehabilitative therapies, while still having access to hospital-level acute care. The COVID palliative care and hospice unit and the COVID recovery unit were two spaces where we fought back against the entropy of transitions of care, particularly for patients who had the hardest time advocating for themselves.
CG: Congratulations on being awarded a MacDowell Fellowship. You’ve shared that you plan to work on a next nonfiction book. Can you tell us more about that project?
LK: Thanks! History and Physical is a memoir of both my medical training and my parallel growth as a writer and poet. It’s told slant, not just through my own story, but via investigations into the history of medicine and medical ethics, and the books and works of art that saved my life along the way. Sometimes narratives by doctors can be a little pious and tidy, a little too safe. But where the archetypal doctor-memoir tends to sanitize the mess and romance of actual life, I want the whole of it to flood in.
Some of its route overlaps with places traveled in Little Pharma. But it’s more than liner notes, I promise.
CG: At the close of your acknowledgments, you write, “And thanks to all of my patients, for whom I labor to get it right the first time, but who have also tolerated repetition and revision when it’s needed.” I love the comparison you are teasing there. Can you expand on the connections between your medical practice and writing process?
LK: The possible endlessness of revision in poetry is such a relief given the very different temporal structure of my other work, the limitations on how much you can change, the unidirectional nature of time as we know it, the tempo of illness.
I don’t want to instrumentalize or therapeutically-deputize poetry itself, but perhaps one way the physical habit of working on poetry has made me a better doctor is in giving me a habitual comfort and familiarity with the contours of my own obstinacy. I know that I have a certain doggedness about retuning a particular line a million times. I recognize this in myself when I have this nagging feeling of some big diagnostic miss, some clue I haven’t picked up yet and worked into the whole. I’ll just have to chase it, until the story or the line fits in my own mind. Patients who’ve gotten to know me are familiar with the heel-spin as I’m about to leave the room—“sorry, just one more question!” I live on the tip of my tongue and on the esprit of the escalier.