Doctor Coulehan’s Journeys

By John Shea

The poem, simply titled “Journey,” begins quietly: “Sixteen blocks to the hospital from home / at 47th and Pine.” As someone who has lived and worked in West Philadelphia – and who even had an apartment at 47th and Pine streets for a couple of years – I was immediately hooked. But no doubt there are other cities that have such numbered and named streets. A few lines later, however, another tip appeared: “44th and Spruce.” This was going to prove a journey within a city, then. When the narrator arrives at 34th Street, however, it is clear that Jack Coulehan, M.D., G.M.E. ’70, M.P.H., is writing about Philadelphia and his daily walk to HUP. And what a journey it is, full of surprising and sometimes amusing juxta­positions. In the poet’s imagination, yaks clang in the Himalayan mountains of Bhutan, while he dismisses from his mind a “Chevy Impala on concrete blocks.” The reader also encoun­ters the rivers of exotic Sarawak, a Malaysian state thousands of miles away, as the walker does his best to ignore dog turds on the city street. Finally, he arrives at the “lair” of the “wolves of compassion,” apparently the HUP physicians. The narrator is not yet a full-fledged member of this pack but is, instead, “an adopted son.”

More than a touch of ambivalence and uncertainty on this early morning walk: “my mind blocks the reality of row houses, muffler shops, / and work.” At the same time, his imagination seems boundless.

“Journey” was published in the December 1, 2015, issue of JAMA. Coming upon it, I recognized the poet’s name at once. In fact, I had covered a visit Coulehan made to the Penn cam­pus many years after his time here as an intern (Penn Medicine, Summer 2006). He was part of a group of distinguished guests who spoke to medical students and faculty on the vital topic of professionalism. Back then, Coulehan was a professor of preventive medicine at the State University of New York at Stony Brook, where he served as director of the Institute for Medicine in Contemporary Society. At Stony Brook, he also directed the medical school’s required four-year curriculum in ethics and social issues in medicine. A co-author of The Medical Interview: Mastering Skills for Clinical Practice (5th edition, 2006), he had also received the Humanities Award of the American Academy of Hospice and Palliative Medicine. 

At the Penn symposium, Coulehan noted that many stu­dents enter medical school determined to be activists and “complete physicians.” In the course of their four years of study, however, some become cynical as they recognize a dis­parity between the school’s explicit curriculum and what he called “the informal curriculum” and what others have called “the hidden curriculum,” the influences exerted by an organi­zational culture. Some students continue to believe that “the patient comes first,” but they remain somewhat detached from the patient. One of the ways to foster professionalism, Coulehan suggested, was for medical schools to include more role mod­els in their clinical departments who would “demonstrate the qualities we want to inculcate.” 

At that time, I did not realize that Coulehan was also a poet who often used his experiences as a physician in his writing. Looking back, I find another of his suggestions for fostering professionalism especially relevant: to teach students to make use of “narrative,” not in the patients’ charts but “in our minds, in our relationships.” It seems a small step to a differ­ent kind of creative writing that can also be a way of making deeper personal connections – poetry.

In a lecture Coulehan gave at a plenary session of the American College of Physicians meeting in 2012, he summa­rized his beliefs about the connections between medicine and poetry. One of his patients many years earlier at a community health center in Pittsburgh was a “chronically dissatisfied” woman who made it clear that “I was too young to know what the hell I was doing.” But one day she – “Celia” – appeared at the office wearing a white lace dress and presented Coulehan with a potted plant, which she called “an act of Christian love.” Coulehan was stunned – and moved. Later, he wrote a poem called “The Act of Love,” using the language of poetry “as a lens through which to glimpse the deeper meaning of my work as a doctor and my relationship with Celia.” Somehow he felt himself become more connected to her.

As he put it, “So when I speak of the poetry of medicine, I’m not suggesting that all doctors should sit down and write poetry, or even read it; rather, I’m talking about paying close attention to those ‘aha!’ moments that are available to us and can sustain us, as well as making us better able to heal our patients, if we respond appropriately to them.”

It was this spring, when I got in touch with Coulehan, that I discovered he had trained in internal medicine at HUP. In addition, he has written several poems based on his time at Penn. Six appeared in his most recent collection, Bursting with Danger and Music (Plain View Press, 2012). “Journey” and another poem inspired by his Penn internship, “The Secret of the Care,” will be included in his new book, The Wound Dresser (J. B. Stillwater), appearing this year. The “internship” poems are situated in a world of conflicting value systems, conflicting duties, and long, exhausting hours. In “The Secret of the Care,” he describes himself as wearing “vestments to clinic – / pressed white pants, crisp shirt, and jacket, symbols of purity.” At the same time, however, he is “disguising the depth of my doubt” as he hoped to “grow in wisdom.”