To Awaken Soulfulness in the Human Voice

Poetic Medicine

THE INSTITUTE FOR

My Machine

If I had a machine to use

in a case like yours, I'd use it

on the nucleus that makes

my feelings, to deepen them.

 

I'd take a long time, like a monk

at morning prayer, before I spoke

and turned each word into a sign

of passion. When I told you,

 

Yes, the damage is more

than anyone knew, I'd hold you

in my arms, desperately close

like death. I'd throw off the shame

 

of working in a reasoned way

to find the answers to your pain.

Instead, I'd use an archaic

neural poem and feel the pull

 

of healing, skin to skin, instead of

acting neither man nor woman

and doing the decent thing. The ache

would be a price worth paying

 

--Jack Coulehan

Changing the World : Arts and Medicine

an Interview with Jack Coulehan, Poet/Physician

by John Bowman

 

Jack Coulehan, MD, is director emeritus of the Institute for Medicine in Contemporary Society and professor of Medicine and Preventive Medicine at the State University of New York at Stony Brook. He also is author of four collections of poetry, The Knitted Glove, First Photographs of Heaven, Medicine Stone and Bursting with Danger and Music. He and Angela Belli, an English professor at St. John’s University in New York, edited Blood & Bone, and Primary Care, anthologies of poems by physicians. Jack’s poem Complications and commentary appears in Finding What You Didn’t Lose. He and John Fox have been friends for twenty-two years. In this interview with John Bowman, friend and writer for the Institute for Poetic Medicine, Dr. Coulehan explores the value of poetry in medicine, for both physicians and their patients—a favorite topic in talks he gives at conferences around the country.

INTERVIEW:

  • Bowman: You and Angela Belli are working on a new book?

Coulehan: Yes. The working title is Second Opinion and it’ll be with the University of Iowa Press again. I think it’ll be out in the spring. (update: Blood and Bone: Poems by Physicians)

  • Bowman: Is this more poems by physicians? The same ones as in Blood & Bone?

Coulehan: Another anthology, yes, and some repeat poets but lots of new ones including some international— Australian, British, Canadian. It should be even better because of that and because we’re emphasizing more poets. That is, last time it was more poems by just a few physicians; this time it’ll be more poets. So, a variety in different voices and moods.

  • Bowman: How do you use poetry in your professional life?

Coulehan: I use it some in my practice and in teaching certainly. In my practice, which is mostly with chronically ill patients, in some cases I encourage patients to write -- journaling and poetry. I don’t have my own patients in many cases, but work more with hospice and in these cases I sometimes use poetry especially with family members.

  • Bowman: Reading poetry aloud?

Coulehan: Yes, sometimes that is comforting. I work with the Good Shepherd Hospice in Suffolk County New York—Port Jefferson. Only a small percentage are people who can really benefit from services because they still have time—months sometimes—to set goals—around spirituality for example. Long Island is a highly technological society and the cultural norm is to try to avoid hospice until the last minute. Sometimes I have been able to get patients to respond to poetry and literature but that’s not the norm. The large majority of my experience is with hospice personnel.

  • Bowman: How do your medical students respond when you introduce the concept of poetry in medicine?

Coulehan: Usually, at first, they are turned off. In the Medicine in Society Program I run at Stony Brook, we try to introduce a variety of disciplines—arts, etc.—in trying to reach goals of getting students to be more empathic, to listen better, to be more reflective and to increase self-awareness.

  • Bowman: How do you do that?

Coulehan: In one reading assignment, I offered a bunch of poems and asked them to choose two poems, to reflect on them and then have a discussion. We also encourage students to lead the groups. In one case a student group leader began by saying, ’We have these poems but we should discuss some issues raised in other readings, from lecture material’ and it was a pretty dead session. So then, about 20 minutes into it, the student leader said, ’Okay, let’s look at these poems,’ and for the next hour the students were alive and engaged. When we get them into the poems they respond well but getting them into it is difficult.

  • Bowman: I assume that once they do get into the poetry it helps relieve some of the stress of their med school experience?
  • (In his poem My Machine,  (see sidebar) Dr. Jack Coulehan speaks to the tension between detachment and connection for the physician dealing with a patient with a serious or life-threatening condition. “And the frustration or desire to be able to overcome that and then to really be close enough to understand and heal,” he says. “The idea of the machine comes from our constant emphasis on machines and so the fantasy is creating some kind of machine that would allow you to do that (get close and heal).” He added that, “It starts with the idea of having some kind of machine that would allow me to sort of free up my detachment and my distance and get closer. Then it obviously goes into this fantasy of becoming intimate … the sense of intimacy here is more of immersion. Anyhow, the idea of if only I could reach that sense of being able to be completely connected and completely in tune…)

Coulehan: Yes, it helps. A large percentage of medical students reflect our general culture, which is oriented toward externalities and does not promote acceptance of feelings and limitations. So, there’s a tendency to avoid feelings. There’s a term ’detached concern’ that came out of the ’50s when sociologists were studying what happened to the altruism that physicians started out with in medical school, about what happened and why that disappeared later in their practice. Why did they lose this altruism when they began to connect with people’s suffering … what happened is that they learned to be detached. Some people said this was okay, that this was desirable. I think that is an impoverished way to look at human abilities. You don’t have to be detached. It’s quite possible to perform objectively and still connect with patients.

  • Bowman: How does that work?

Coulehan: To do that you have to know yourself, to develop introspection. But that’s very uncommon in our culture. So, it’s tough for many students to break through and see that being sensitive and reflective is important in being a good doctor and poetry used in this context can be very helpful.

  • Bowman: The ’detached concern’ thing sounds like a way to cope. I mean, physicians see such pain and suffering, what do they do with the emotions that come out of that?

Coulehan: We have developed a culture in which emotions are bad. You avoid emotions and you do not like to see emotions in patients.

  • Bowman: So you stuff emotions.

Coulehan: You stuff them and then you develop an emotional numbness. You don’t consciously experience your emotions so you become numb. And that spreads into the rest of your life. You become numb with your family, numb with your friends.

  • Bowman: What can a person do at that point?

Coulehan: The alternative is emotional resilience. Here you fully experience your emotions, not stuff them and you learn this is part of who you are. If you are reflective, and here poetry can help, you learn to function as a full person with emotions.

  • Bowman: Okay, so this is great if you catch the medical students early and they begin to learn this. But what about the doctor who is 10, 15 years into a practice and is becoming numb? Where can he or she go to re-learn how to fully experience their emotions?

Coulehan: We have CME— Continuing Medical Education—programs on this. I was a speaker last year at Duke and it was a full CME weekend and we had writing, poetry, literature. This is unusual, but it’s happening.

  • Bowman: So, poetry is having a powerful influence, a significant place in medicine.

Coulehan: Not widespread yet—oh, maybe in California, but not everywhere. Not widespread but significant.

  • Bowman: Anything else you want to say about this?

Coulehan: Poetry as a word is powerful as you enlarge it to think of ceremony, metaphor, imagery. The power and symbol of the word in context is really great. A physician can use these words, symbols, metaphors in a healing way. It’s really analogous to the way the religious have healed people in the past.

  • Bowman: So how does this tie in with physicians and how they communicate with patients?

Coulehan: Without this understanding the doctors just say whatever falls out of their mouths. The power of words can also harm. A big reason that charismatics succeed is that they understand the power of words.

  • Bowman: One last question. A friend of mine, while traveling in Ireland, saw a sign in the front yard of a cottage office that said, ’Patrick Kelly, Poet-Physician.’ Can you imagine someone hanging out a shingle like that in the U.S.?

Coulehan (with a laugh): If I were to hang up that sign in Manhattan, people would be beating down my door. The New York Times would come. (Pause). In fact, maybe I should do that…

John Bowman is a Friend of the Institute for Poetic Medicine.  He has been a professional writer and editor of many publications and now serves as Director of Marketing & Communications at Holy Names University in Oakland, CA

 

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