For this Apollo on Call x W5H Book Club episode, Dave and Luki read Other Rivers: A Chinese Education by Peter Hessler. The book focuses on the quirks and challenges in the education system the author witnessed as a visiting professor in China. At the end, Dave and Luki reflect on an entire year of reading books about China, and how they feel at the end of this journey.

Check out Dave’s Substack for more! 

Web image created by Medhum.

DAVID HSU: What are you up to these days? What are you working on?

JACK COULEHAN: In terms of creativity, I’m working on a new collection of poems that I’m editing now. I’m also the book review editor of The Pharos magazine, and that takes up an unexpectedly large amount of time.

DAVID HSU: Do you practice medicine at all anymore?

JACK COULEHAN: No, actually, I retired about 12 years ago now, but I do still teach medical students as a volunteer. It’s a class that I began back when I started at Stony Brook in 1991. It’s called Medicine in Society, and it’s a first-year seminar course that deals with human, social, and interpersonal issues in medicine. We use a lot of literature and film in that and so I’m still a group leader. We also have a master’s degree program in medical humanities, and I teach a course in that. So I still keep my hand a little bit in teaching.

DAVID HSU: Given that you’re doing all this work in the humanities, what do you think about the relationship between medicine and the humanities?

JACK COULEHAN: You know, that’s a surprisingly difficult question for me, because I’ve always had this kind of love/hate relationship with the term medical humanities, because I think it doesn’t quite capture the problem or the issues that we’re trying to address and what we do. In a lot of my work, I tend to cite a piece that Rafael Campo wrote in JAMA in 2005, entitled “The Medical Humanities, For Lack of a Better Term.”  What I’ve really always thought is that what we’re trying to do is to teach students and ourselves, really, to become more reflective and more thoughtful…[Campo] used the terms reconnection, renewal, and meaning. . I think we’re not necessarily encouraged in our profession to become aware of our own needs, to become reflective, thoughtful, to become focused on the personhood of patients and so on. And so I think, through discussion, through examples in literature, film, etc., we can really try to address these issues. I guess the term medical humanities is fine as a placeholder, but I wish there was a better term for it. But, aside from reflecting on the name itself, those are the things I think we’re trying to address in medical humanities. 

When I started in this business, pretty long ago, I was thinking about [medical humanities] mostly in terms of becoming a better doctor by improving one’s empathic skills and reflecting on the patient as a person. But as time has gone on, I’ve become more aware that I think it’s really something that makes you a better person and also more able to cope with the stresses and the challenges of modern medicine. So, I think it works both ways.

DAVID HSU: What are your criticisms of the way medicine is practiced now, since people aren’t doing all this [reconnection, renewal, and meaning]?

JACK COULEHAN:  First of all, I think medicine has to be understood in our current overall culture of increasing subspecialization and focusing on narrower and narrower fields [of practice], using more and more technological instruments, tools, and machines. Also, medicine is more and more controlled by larger interests that are not necessarily oriented towards the primary values of medicine.  There are virtually no constraints on the use of technology, the focus is entirely on disease, on narrow perspectives on disease.  

What I’m saying is that all this detracts from the ability necessary to see the patient in terms other than as an object that has a disease or a person who has a specific problem that needs to be addressed.

Just to give my personal examples, when you get to be 81 years old, as I am, you have a lot of opportunities to experience being a patient. I saw a cardiologist a couple of weeks ago who is an older cardiologist, and he was what I would call an ideal physician. He does interventional cardiology, he’s a professor, well-published, and yet his approach, I would consider to be very therapeutic–very positive, trusting and good eye contact. He wasn’t looking at the computer. He was just a genuine person, genuinely interested. I’ve also gone to a urologist who was just the reverse. Equally specialized in the same medical system, but one who was all about the particular issue, the particular organ, and the particular thing that’s happening to that organ.

It’s possible, you know, when you start talking about the kind of values and the kind of stresses that modern physicians are under, the first response you get is that, “Oh, yeah, that’s great. That’s what we should do.”  But you know, we only have 15 minutes [and] we have to deal with the EMR, etc. But that belies the fact that there are physicians out there who are very good at actual doctoring and others who aren’t, and I think that’s because, well, let’s say, look at those two things on a spectrum…I would say that there is the opportunity, even in today’s world, to help students keep their belief, which most of them have, I think, when they begin, that doctoring is really interested in persons. And I think we could increase the percentage of physicians who feel that way and practice that way.

DAVID HSU: I’m curious because you mentioned that you’re 81. You’ve been around the medical system for decades. How has the system changed from when you first started in it until now? Is it getting worse, or has it always been like this?

JACK COULEHAN: Well, that’s tough. I definitely think it’s worse, but I also think it’s romanticism, you know, to look back and say, “Oh the good old days.” 

I graduated from medical school in 1969 and graduated from my residency and fellowship in 1975. Those were the days when I was learning to take a history. Taking a history–that’s another phrase that I dislike. But we had a little black book, that had 100 or 140 questions to ask in it. There was no concept of medical interviewing, nor the  teaching of it. I had the feeling that a lot of the values of good doctoring were kind of implicit and not necessarily taught in those days.

And so we’ve gone through a whole phase of learning that the medical interview is a therapeutic tool, and now I think we pay a lot of lip service [to it], but I don’t know that we necessarily carry it from its place in the curriculum to its place in the clinic or the hospital.

But there’s no question that it’s gotten worse [although] the technological advances are just so incredible. I remember at some point, as a student, you have this idea that the CT scan will give the answer, or the lab result will give the answer. The patient’s story is secondary. And I remember some instructors saying, no, no, wait a minute, you should know 80% of the time what the answer is before you even request the test. The test is not meant to be, the be-all, end-all of everything, but, definitely, that is the case now. Even within practice, every advancement that happens in technology kind of nudges us closer to thinking of the computer as a solution for everything.

Let’s say, one patient comes in with chest pain or nausea. I think the tendency now is to focus on those symptoms, to think of what disease might cause them, and to do various tests, rather than sitting down with the patient and trying to understand what their situation is.

DAVID HSU: You mentioned this earlier, and I wanted to follow up on this little comment you made about how the practice of humanities and writing has a self-care component to it, and that as you’ve practiced it more, it’s helped you handle stress and different challenges. Can you elaborate a bit about this?

JACK COULEHAN: As a high school, college, and even a medical student, I had this inexplicable urge to write poetry, which I did. It’s pretty juvenile. But anyhow, I did it. Then of course, I gave it up because I was a doctor. I was practicing, I was doing research, etc. And in my mid-40s, I was reaching, I think, what you might call burnout. That might be a little too dramatic, but I felt that there was something missing in my life, in my career, and I happened to have a patient who was a professor of poetry at the University of Pittsburgh, where I was teaching at the time. And one thing led to another, and she encouraged me to start writing again. And I did, and I found very quickly that by writing about…my experiences in medicine, I was able to…work through them and understand my reactions better, and so I think that poetry is a reflective practice that in a sense provides occasion for you to grapple with experiences, issues that have been troubling you, or that on the other hand have been very happy. It can work both ways.

Getting back to medical humanities, I think what we’re trying to do in medical humanities is to stimulate that kind of process in young physicians or young clinicians, whether it’s through poetry, through writing journals, through just meeting in small groups…that kind of thing…and to use not only personal experiences, but literature, poetry, film, etc. as stimuli for that.

DAVID HSU: Let’s wrap up with what you would like to see medhum.org do? How would you like to see it grow in the months and years to come? What type of topics or articles do you want us to tackle? 

JACK COULEHAN: I like the concept of being provocative. I’d like to encourage people to come in through material that’s kind of leading edge. I’d like to see people have conversations, comments and so on.

DAVID HSU: Thank you, Jack for participating in “Meet the MedHum Editors.”   It’s been a pleasure to speak with you.

Written by Jack Coulehan on Medhum.org (View All)

Alphonse Daudet and Intractable Pain

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Children Who Remember Former Lives 

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The Anatomist by Frederico Andahazi

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Rethinking Medications by Jerry Avorn

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The Word Is an Instrument of Healing 

16.12.2025 877

Stuck By Heidi J. Larson 

3.11.2025 807

Jurecic’s astutely researched, nuanced answers to those questions propose a corrective to the extreme skepticism of “disembodied criticism.” Such criticism, she claims, dismisses testimonial writing from “a position of distance and privilege.”  At the same time, her answers affirm that intellectually “rigorous” responses to texts are central to the critical humanities (15). To support her position, she offers attentive readings of illness narratives by Virginia Woolf, Reynolds Price, and Jean-Dominique Bauby, as well as the theoretical writing of literary and other scholars.  For instance, Jurecic speculates that the condition of a reader’s body aligns with their responses to texts. In a chapter called “Theory’s Aging Body,” she observes that as skeptical scholarly readers aged—think of Stephen Greenblatt, Michel Foucault, Judith Butler—they turned their attention to “illness, vulnerability, and mortality” (93).  Jurecic also suggests that criticism’s function to expose cultural conditions turns illness stories into critiques of the effects of contemporary medicine on our experiences of vulnerability and mortality. The relatively new concept of living “at risk” is a case in point. Stories about living with the risk of experiencing a particular illness in the future leave potential patients with uncertainty,” prompting narratives that seek the “personal meaning of the impersonal statistics” that medical encounters now regularly deliver (18).   

Jurecic also reflects on the ways theorists have understood the possibilities of representing and responding to pain in the varied approaches of philosophical thinkers Elaine Scarry, Martha Nussbaum, and Richard Rorty, along with anthropologists Jean E. Jackson, Byron Good, and Veena Das. In an exceptionally comprehensive and nuanced reading of Susan Sontag’s theoretical, fictional, and journal writing about suffering, Jurecic uncovers Sontag’s inconsistent, yet revelatory positions on the human capacity for responding to representations of pain. The chapter on Sontag is enriched by Jurecic’s reading of Annie Lebovitz’s controversial photographs of Sontag’s final days (included in A Photographer’s Life: 1990-2005) and David Reiff’s responses to Sontag’s suffering in his memoir about his mother’s illnesses (Swimming in a Sea of Death).   

Illness as Narrative closes with examples of what Jurecic calls reparative writing and reading practices. Reparative writers, such as Jean-Dominique Bauby (The Diving Bell and the Butterfly), Jurecic claims, both create “a more coherent sense of themselves” and dislodge culturally “fixed ideas and narratives” about illness or disability (109). Her discussion of reparative reading considers the limits of two competing readings of Anne Fadiman’s The Spirit Catches You and You Fall Down. One assumes that readers will empathically and unreflectively imagine those who are culturally different from themselves. The other looks skeptically at the assumption that what medical educators call cultural competence can be acquired by reading a book. Jurecic suggests that strategies for reading and teaching informed by Janelle S. Taylor, Eve Kosofsky Sedgwick, and Rita Felski encourage more complex habits of response, such as Taylor’s concept of “’empathic curiosity’” (122).    

Illness as Narrative poses questions so central to discussions in the medical humanities that it should be read by those who teach in the health professions and disciplines. Jurecic’s book advances the groundbreaking case made by Arthur Frank that illness narratives contribute not only to medicine, but also to contemporary culture and individual lives. Since Illness as Narrative rigorously addresses questions of how to respond to and teach the literature of suffering, it has consequential implications for literary studies and the critical humanities more generally. It exemplifies how a marginalized sub-field can offer a perspective that the dominant theories in the larger discipline fail to notice. Perhaps the most urgent professional question Jurecic asks is what we lose if writers and readers attuned to the ill or suffering body are not heard in critical discussions. Fortunately, Jurecic’s clear, jargon-free prose and the texts she writes about also welcome readers in disciplines beyond literary studies and health humanities into the conversation.  

Illness as Narrative: 
https://upittpress.org/books/9780822961901/

Arlene Croce: 
https://www.newyorker.com/magazine/1994/12/26/discussing-the-undiscussable

Arthur Frank:  
The Wounded Storyteller: Body, Illness, and Ethics, 2^nd ed. Univ of Chicago Press, 2013. (Orig. 1995) 

Illness as Narrative 
By Ann Jurecic 
University of Pittsbugh Press: 2012, 192 Pages 
Web Photo by Mostafa Saeed 

I have been involved in the field of health humanities for more than seventeen years. The field initially focused on medicine but later expanded to involve other health disciplines. I started teaching medical students but have also been involved with nursing and dental students. I have also facilitated sessions for faculty members. My perspective on and comprehension of the practice of medicine have expanded because of this interaction.  

My interest in the field dates to 2007, when I enrolled in the PSGFAIMER Institute’s health professions education fellowship program (https://apply.faimer.org/prog/psg/) in Coimbatore, India. This fellowship comprised creating and carrying out a curricular innovation project (CIP) at my home institution in addition to participating in on-site sessions at the Institute. Combining my passions for teaching, literature, and the arts, I chose to create a medical humanities (MH) module for my CIP. I began by providing undergraduate medical students at Pokhara, Nepal with a voluntary program on medical humanities, which quickly became an area of emphasis for me. My colleague and I also provided a program for all first-year students at a brand-new medical school in Lalitpur, Nepal. I also led workshops on the subject at several Indian universities in 2020, right before the COVID-19 pandemic. We exchanged knowledge, and I learned about the many projects being carried out in Indian colleges. Traditional teaching and learning methods were of course then upended by COVID-19, which also gave online education a boost.  

 In developing nations there are fewer interactions between the ‘traditional’ humanities and the health humanities. Health humanities (HH) is still a developing discipline in India, where most states/provinces have specialized health universities with which colleges offering health courses are affiliated and involvement of humanities faculty in teaching the health humanities is low. In India, the former Medical Council of India developed an attitude, ethics and communication module that has now been taken up by the National Medical Commission. This module has created interest in the humanities among faculty of medical colleges, and there is now greater awareness of the discipline. A retired English teacher, Dr Radha Ramaswamy, and her team created the Centre for Community Dialogue and Change in Bengaluru, India. This organization offers Theatre of the Oppressed workshops for breaking patterns and creating change. They have facilitated workshops at several institutions in India and even in other countries. Workshops have also been offered in medical colleges. The organization offers periodic training-the-trainers’ workshops. Some medical college faculty who have been trained in these training workshops also facilitate Theatre of the Oppressed workshops. Online webinars and conferences have become more common.  

In Aruba, in the Dutch Caribbean, I began teaching medical students through films, and for the past ten years, I have been concentrating on this. We have presented seminars on this topic at various health professions education conferences in collaboration with others. I have written a few articles on the topic, and I recently worked on a module that used films to help undergraduate dental students develop empathy. 

The last two decades have seen a steady growth in health humanities in South and Southeast Asia and in other regions of the continent. Modules and sessions are being offered to undergraduate and postgraduate students. A few institutions are also offering electives in this area for medical and other healthcare students. HH has several benefits in the education of future health professionals. Health is inherently psychological, social, and related to history and culture. Modern medicine is dominated by technology, and the health system is inherently complex. Methods from the humanities and the social sciences using an interdisciplinary approach are required to promote sustainable interventions that can address the complexity of health and disease that may have origins in social, economic and other factors. HH can develop students’ capacity for critical reading and reflection, and they can then examine health and medicine in society, practice and their own lives; it may also inoculate students against the hidden curriculum (a set of norms, values and beliefs that are not explicitly taught but are learned at the institution) and loss of empathy that may occur in medicine. Doctors and other health professionals engage in a social contract to serve society. Health humanities can help to introduce the contract to students, encourage its exploration, and also introduce ethical issues and dilemmas.  

I have gained a deeper understanding of HH and its connection both to medicine and to the general humanities. A year and a half ago I became a member of an online global network for the health humanities, and the group in addition to health professions educators also has individuals from the arts and the humanities. I have realized that like medicine and the health sciences, the humanities have their own terms and descriptors, theories and concepts, and these may be difficult for health professionals to comprehend. The opposite is also true, as humanities scholars struggle with medical jargon. An open mindset and greater effort are required to address the gaps. In the developing world, the humanities and the health sciences diverge right after ten years of schooling and are mostly in physically distinct locations, yet many health care professionals still have a personal interest in the art of medicine.  

A variety of factors must be considered to treat illnesses and maintain health. The physical and genetic makeup of the individual, the socioeconomic status, social determinants of health, access to good quality healthcare, rational use of medicines, cost of healthcare and preserving the power of antibiotics are among these. Through my research and teaching in the health humanities I believe I have gained a more holistic understanding of a human being and of health and illness situated in culture, society, family and moral values. Today we have wearables and other devices that provide a constant stream of data that must be interpreted and converted to actionable insights. However, we have a responsibility to make sure that the essential humanity of our patients does not get lost in a sea of data. The humanities and the sciences can, should, and must work together to improve health and well-being.   

Web image by Giuliano Gabella on Unsplash

At bottom, these two categories of judgment largely overlap. My concern here is the role of the physician’s own emotions (or, as we like to say in medicine, in order to sanitize them, affects) in judgments of either category. Do the physician’s own emotional responses contaminate her judgment when making clinical or moral decisions in patient care? Or, rather, do her emotional states constitute essential components of medical judgment? 

Clinical Judgment 

Medicine has a long tradition that attributes a special quality to the diagnostic and therapeutic thought processes of good clinicians, an attribute independent of intelligence or medical knowledge. Traditional views of clinical judgment included personal experience, received knowledge in the profession, and evidence from empirical studies. Emphasis was put on developing the “clinical eye” or clinical intuition as a result of personal experience, perhaps guided by role model physicians. In 1967 the Yale clinician and epidemiologist Alvan Feinstein published his book, Clinical Judgment, which was the first (as far as I am aware) systematic and scholarly analysis of judgment in medicine.¹ What Feinstein added to the mix was a firm grounding in epidemiological methodology; notions like prevalence, sensitivity, specificity, predictive value. What constituted evidence became more scientific and less subject to bias. However, Feinstein acknowledged the important influence of a personal relationship with the patient in good clinical judgment. 

In this sense he was following a tradition that has been prominent among physician writers for over 250 years and was often expressed metaphorically by reference to the heart. For example, John Gregory, Professor of Medicine at the University of Edinburgh wrote in 1772: “Of the physician’s character, the chief quality is humanity, the sensibility of heart that makes us feel for the distress of our fellow-creatures, and which, in consequence, incites us… to relieve them.” Physicians “by being daily conversant with scenes of distress, acquire that firmness of mind so necessary in the practice of physic.”² Yet he warned his readers to maintain “a gentle and humane temper” because “rough and blustering manners generally accompany a weak understanding and a mean soul.”² In 1803 Gregory’s student, Thomas Percival, instructed physicians to, “Unite tenderness with steadiness in your care of patients and cultivate the tender charity that the moral practice of medicine requires.” He warned his readers that medical practice makes the practitioner vulnerable to “coldness of heart,” and he concluded: “This coldness of heart, this moral insensibility, should be sedulously counteracted before it has gained an invisible ascendancy.”³ 

Physicians reiterated this dynamic throughout the nineteenth century. Morril wrote that “the study of medicine has a peculiar tendency to harden the disposition,” which makes it incumbent on students to cultivate “an affectionate sympathizing spirit,” while Jones reflected on medicine’s “manifest tendency to harden and corrupt the heart.”⁴ And famously, in his 1889 graduation address at the University of Pennsylvania, William Osler encouraged the graduates to cultivate the virtue of “aequanimitas,” which would assist them in meeting, “the exigencies of practice with firmness and courage without, at the same time, hardening the human heart by which we live.”⁵

In the early twentieth century, Francis W. Peabody, chief of the Harvard medical service at Boston City Hospital, published an influential description of this tension between the “intensely personal” values needed in caring for patients and the “entirely impersonal” aspects of treating disease. Peabody recognized that the hospital setting creates a hostile environment for humanism, but urged students to commit “time, sympathy, and understanding” to creating a “personal bond” with their patients, which will make them more effective healers, as well as give them personal satisfaction.⁶ This tradition was most recently and eloquently summarized in A Flag in the Wind, Thomas Inui’s now famous report to the American Association of Medical Colleges (2003).⁷ Each of these writers emphasized the importance of tenderness or sensibility of heart, while warning students and practitioners against the tendency of medical practice to chill, harden, or corrupt the heart. 

A second tradition, almost diametrically opposed to the first, experienced a growth spurt in the mid-twentieth century and has become the most prominent model for medical education and practice in recent decades. In terms of diagnosis and therapy, the ascendency of randomized clinical trials, statistical techniques for the metanalysis of multiple studies, evidence-based medicine, algorithms, and clinical decision rules has progressively reduced the role of judgment in medicine because decisions are presumably to be based on complete, rather than incomplete, knowledge. Judgment is to be replaced by decision rules that can be applied without the adverse influence of spooky elements like intuition, biases, experience, emotion, or idiosyncratic beliefs. 

In tandem with this, the doctor’s proper stance toward her patient became detachment, rather than personal engagement, and the doctor’s emotions became stumbling blocks, rather than beneficial to care. This tradition holds that emotional experience decreases objectivity, which harms the patient because it compromises clear thinking and harms the physician because it makes her vulnerable to emotional stress, depression, and burnout. In summary, what was once a pernicious tendency to harden the heart is no longer considered pernicious, but rather a positive development that should be fostered by medical education.^8-11 Clinical judgment, according to this tradition, should ignore the heart and focus exclusively on the mind. 

Moral Judgment 

Medical morality originated in ancient writings from Greece, India, and China that specify the personal traits and moral duties of medical practitioners. These documents include such duties as honoring their teachers, acting in their patient’s best interests, and keeping “whatever I shall see or hear in the course of my profession” confidential. These admonitions were later incorporated into a Judeo-Christian-Islamic framework that added a theological dimension (e.g. respect for human life, compassion, fidelity, and vocation) to medical morality—for example, in the Oath of Maimonides: “May I never see in the patient anything but a fellow creature in pain.” Or, in the Islamic oath, “I swear by God to be . . . an instrument of God’s mercy.” This work was secularized in the eighteenth and nineteenth centuries by writers who adapted Aristotelian virtue theory to the profession. The basic idea, then, was that learning to be a physician involved a process of character formation in which certain defining virtues were incorporated as personal traits or qualities, thus enabling physicians to make correct moral judgments in their professional lives. 

This work was brought up-to-date in recent decades by philosophically-minded physicians, like Edmund Pellegrino¹² and Eric Cassell^{13, 14}, who argue that judgment in medicine should be an instantiation of the Aristotelian intellectual virtue called phronesis, or practical wisdom.⁹ They remind their readers of the moral goals intrinsic to the profession, and that certain physician character traits or virtues further those goals, e.g. compassion, fidelity, integrity, courage, humility, self-improvement. They argue that, in fact, that all clinical judgment is informed by moral judgment. 

Although moral judgment was thought essential in deciding what to do for patients, it was proscribed in making decisions about the intrinsic value of patients. The ethos of medicine strongly warns against judging the patient’s personal worthiness or value, even if the physician considers the patient’s beliefs or actions hateful. Thus, professional ethics dictates that you remain detached from any behavior that would compromise treatment of enemy soldiers, criminals, terrorists, or patients that you find personally hateful or disgusting. 

Beginning in the 1960s and 1970s, the professional virtue tradition was supplemented by (or challenged by, depending on your perspective) a new moral framework that generally goes by the name biomedical ethics. This development became necessary for a variety of reasons, most notably (a) technological advances in medicine that enhanced the ability to prolong life and especially to harm, as well as to help, patients; (b) new societal emphasis on individual and civil rights; (c) increasing opportunities for conflicts of interest in medical practice; (d) revelations about medical research conducted without the subjects’ knowledge or adequate consent; and (e) concerns about the lack of equity in the provision of health care services. 

The biomedical ethics movement involved a concerted response to these issues by a great number of moral philosophers, theologians, legal theorists, and physicians. In the United States the movement acquired its canonical form as a result of the publications of two bodies, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-78) and the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1978-1983). The former developed the ethical framework (i.e., Common Rule) that has since guided all research involving human subjects. The latter delineated and elaborated four basic ethical principles: respect for autonomy, beneficence, nonmalificence, and justice. 

In biomedical ethics the focus is entirely on explicit justification of individual decisions (i.e. who should make them, what principles should be invoked), rather than on the qualities or character of the decision maker. Importantly, the model is one of shared decision making between patient and clinician, with adult patients having the determining voice, unless they lack decision making capacity. 

The notable aspect, for my purposes here, is that principles, like respect for autonomy, are intellectual constructs rather than personal traits, like virtues. There is no explicit role for such traits in biomedical ethics. I take it that virtues like compassion, empathy, humility, or courage cannot be actualized without an emotional component. You cannot act compassionately without experiencing some feeling. Thus, while traditional medical morality highlights sensibility of heart, biomedical ethics (at least in theory) exclusively involves intellectual considerations. Principle-based biomedical ethics is often labeled “thin” because, theoretically at least, it leaves out particularistic features of the patient’s community, culture, beliefs, and personal story. Advocates of care, feminist, and/or narrative ethics maintain that such features have great moral relevance to health care decisions. They argue for a “thick” form of health care ethics that takes particularities into account.

“Thickness” in decision making applies to physicians in decisions about the best (or most virtuous) way to allocate their time and effort. Part of this thickness relates to the physician’s feelings, emotions, or “tenderness,” to use Thomas Percival’s term. Consider the following case example. 

Case Example 

The case is an excerpt taken from “Narrative Medicine and Negative Capability,” an essay by the cardiologist Terrence Holt.¹⁰  Holt illustrates his discussion of the complexities of moral judgment in medicine by describing a situation he once experienced when he was a resident in the cardiac ICU: 

“It is about eleven in the morning, and I have been up since six in the morning the day before. The patient has been under my care eleven days… About fifteen minutes earlier, in response to her request and after several days of discussion, I had asked the nurse to turn off the pump that had been keeping her alive. The family members are around the bedside. The patient is awake… She will probably be dead within the hour. 

Tears are coursing down my face. I am being very quiet about it, but in a very quiet way I am sobbing as freely as I know how. I’m determined to stay with the patient during this ordeal. But meanwhile I am thinking: This is crazy. I’ve got several unstable patients who need attention. And there’s that arterial line in twenty-four that needs changing… At the same time I am utterly sad, haunted by memories of my father’s… death ten years ago. 

But somewhere a voice is also thinking: I’ll never get to lunch at this rate. I’m so backed up I’ll never get out of here on time.”¹⁵

Reflections 

I want to reflect on several aspects of Dr. Holt’s judgment in light of the clinical and moral traditions that I have outlined. First, the writer appears to combine deep emotional experience with a sense of detachment. He experiences (a) feelings of sadness and compassion, (b) awareness that at least in part those feelings arise from grief over his father’s death, and (c) detached reflection about his own needs and the work he has to do that afternoon. This combination appears consistent with older admonitions that physicians should maintain “sensibility of heart,” but to be at variance with the contemporary belief that emotional connection with patients is incompatible with good judgment—assuming, of course, that his current choices constitute good judgment. Do they? 

Second, from the perspective of contemporary biomedical ethics, Dr. Holt had already fulfilled his ethical duty when he respected the patient’s right to refuse treatment, and consequently withdrew mechanical ventilation. In addition, he may have consciously employed the principle of nonmalificence if he believed that the respirator was only prolonging the patient’s suffering. He has no moral duty to maintain a compassionate vigil. In contemporary terms, his actions would be considered supererogatory—commendable, but not a moral duty. 

Third, but how commendable is his behavior? It is clear that Dr. Holt’s course of action could have arisen, at least in part, from unresolved emotions related to his father’s death ten years earlier. He admits to strong feelings of sadness, loss, and grief, even to the extent of crying. Is this a case of countertransference, a psychological defense mechanism, rather than a true expression of moral virtue? We need to consider the extent to which the emotions about his father’s death are nurturing appropriate compassionate behavior, or, alternatively, contributing to a form of hyper-compassion that is preventing him from attending to other duties. 

Fourth, this brings us to the question of harm. Given the level of criticality among his ICU patients, Dr. Holt’s compassionate vigil has a reasonably high risk of negatively impacting the others’ care. He does, after all, have an established duty to provide the best medical care he can to each of his other patients in the ICU. They all have identified and pressing needs. To what extent, if any, does his behavior represent an abrogation of his duty to others? In bioethical terms, he may well be discounting the ethical principles of beneficence and justice in his desire to demonstrate compassion. 

To demonstrate this, we can take the narrative a step further. Suppose the man whose arterial line needed to be changed (e.g. nurses have noticed local redness and swelling) develops septic shock shortly after the first patient dies. Dr. Holt has spent more than an hour in the room with the dying patient and his family. Did his delay in removing the infected arterial line precipitate the septic shock? Perhaps it could have been averted had he changed the line earlier that morning? Has his compassion for one patient and his family caused a life-threatening complication in another? 

This leads to a fifth consideration. Let’s return to the concept of clinical judgment as being informed by phronesis, a type of wisdom relevant to practical things, requiring an ability to discern the right or virtuous action in a given situation. Thomas Aquinas considered phronesis to be equivalent to prudence, and medical writers like Pellegrino tend to use the terms interchangeably. Pellegrino and Thomasma, in The Virtues of Medical Practice, describe prudence as the virtue that fosters the ability to choose the right way of acting.11 From this perspective, was Dr. Holt’s decision a prudent decision? Would it have been more prudent to excuse himself and go tend to his other duties? 

Sixth, let’s look briefly at Dr. Holt’s situation through the lens of narrative ethics, which is a relatively new perspective that highlights medicine’s traditional focus on particular cases or stories as providing the context for individual judgments.12 In this framework, Dr. Holt’s actions make for an engaging story. There is little doubt that his response to what is going on with the patient and his family suggests a more affirmative and inspirational narrative than had he chosen to continue with his ordinary duties. This version is more comforting for the patient and his family, it is more personally fulfilling for the doctor himself, and more compelling for the reader than the more prudent alternative. For better or worse, heroic or passionate behavior is generally far more interesting than prudent behavior. Does that make it right? 

Conclusion 

Judgment in medical practice is complex and omnipresent, involving decisions that range from diagnosis and treatment of illness to the assessment of relevant patient characteristics and choice of appropriate words. A great deal of this judgment has an important moral dimension. In this paper, I have argued that medical judgment also frequently integrates emotional content into the decision-making process; and the role of emotion can be important and beneficial, rather than damaging. In fact, traditional medical virtues – e.g., compassion, fidelity, courage, humility – are habits of the heart that are intrinsically associated with emotion, as well as rational cognition. 

The case I have presented illustrates this complexity. It also illustrates the role of incomplete knowledge in medical judgment. For example, if we knew more about the benefits and risks of Dr. Holt’s actions, we might come to a more definitive judgment about whether, under the given circumstances, his clinical/moral judgment was right or wrong, correct or incorrect. Surely, respecting the patient’s decision to discontinue the ventilator was morally right, but what about his subsequent decision to spend considerable time with the patient and his family, while postponing other duties? Well, that is a question of judgment.

References

1. Feinstein A. Clinical Judgment. Baltimore, Williams & Wilkins, 1967.
2. Gregory J. Lectures on the duties and qualifications of a physician. London, W. Strahan and T. Cadell, 1772. [Reprinted in McCullough LB (Ed.) John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Kluwer Academic, 1998.]
3. Percival, Thomas. Percival’s Medical Ethics. Ed. C. D. Leake. Huntington, NY: Robert E. Krieger, 1975.
4. Warner JH, Rizzolo LJ. Anatomical instruction and training for professionalism from the 19^th to the 21^st centuries. Clinical Anatomy. 2006; 19: 403-414.
5. Osler W. “Aequanimitas,” in Hinohara S, Niki H (Eds). Osler’s ‘A Way of Life” & Other Addresses With Commentary & Annotations. Durham, Duke University Press, 2001., pp. 21-29.
6. Peabody FW.  The care of the patient. JAMA. 1927; 88: 877-882.
7. Inui TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: Association of American Medical Colleges, 2003.
8. Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994; 69: 861-871.
9. Coulehan J, Williams PC. Vanquishing virtue: The impact of medical education. Acad Med. 2001; 76: 598-605
10. Coulehan J. Williams PC. Conflicting professional values in medical education. Cambridge Quarterly of Healthcare Ethics, 2003; 12: 7-20.
11. Coulehan J. Today’s Professionalism: Engaging the Mind, but Not the Heart. Acad Med. 2005; 80: 892-898.
12. Pellegrino ED, Thomasma DC. The Virtues in Medical Practice, Oxford University Press, 1993.
13. Cassell EJ. The Nature of Suffering and the Goals of Medicine, 2^nd edition, Oxford University Press, 2004.
14. Cassell EJ. Doctoring. The Nature of Primary Care Medicine. Oxford University Press, 1997.
15. Holt TW. Narrative medicine and negative capability. Lit. Med. 2004; 23(2): 318-333.
16. Jones AH. Narrative in medical ethics. Brit Med J. 1999; 318: 253-256/
17. Lothe J, Hawthorne J. Narrative Ethics, Value Inquiry Book Series, Rodopi, 2013

EDITOR’S NOTE:  This essay is taken from a paper presented in 2020 by the author at the Joske Colloquium, a gathering of physicians, philosophers, historians, lawyers, social scientists, and creative writers that met biannually at the University of Tasmania from 2002 to 2020 to discuss broad topics of human experience and flourishing.  We feel that it nicely supports and illustrates some of the philosophical underpinnings, multidisciplinary nature, and real-life applications of the field of medical humanities.  

Photos from Wikimedia. CC BY-SA 3.0.

Dr Ravi: Good afternoon and thank you for agreeing to be interviewed.  To begin, can you tell us something about yourself?

Dr Unni: I was Pulikkal Subran and Vilasini’s second son born in 1969. At that time Chettichal, the remote village in Thrissur district, Kerala, India where I was born, was a ‘pure’ village in the real sense, with all the features and richness of a remote countryside untouched by modernization.

Maybe I was destined to be alone while growing up. I grew up as an introvert. Spoke little; brooded always. Plants and flowers, bees and butterflies, birds and branches of sandalwood, dreams, and I – all grew up together. The silence was our language. Intimacy was our grammar. 

In 1986 I enrolled in the Government Medical College, Thrissur. Seven years after this (in 1993) was the most important phase of my evolution. I learned the simple truth that while friends are the greatest teachers of life and love, they are also, by the very nature of close friendship, able to “invade” your emotional and psychological space, to manipulate your thoughts, actions, and even perceptions of the world, sometimes even negatively.   At this time my tastes in the arts began to change; light music gave way to classical compositions and watercolors to oils and acrylics. Themes evolved from landscapes to surrealism, to abstraction and postmodernism.

Dr Ravi: What got you interested in the arts?

Dr Unni: Frankly, it was a natural activity for me, just like eating and playing, right from the earliest days I remember. I used to draw and paint from childhood days, continued it always. With more ‘education’, always informal, from my artist-teachers, the style changed, subject matter changed, and the materials changed. The most important change was the medium. My primary medium changed to photography from the late 1990s. I do paint even now, and make sculptures from found objects and granite, and create on-site installations. What keeps me attached to photography is its innate quality of making memories permanent, and its quality of refining my vision of the world.

Dr Ravi: You were a keen painter during your undergraduate medical days. Do you still pursue painting?

Dr Unni: Yes, I do. But I seldom exhibit. It remains mostly a private engagement. After opting for photography as my primary medium, I have been combining photographic printmaking with painterly practices like over-painting and over-drawing on photographs creating works of art that stay at liminal spaces, smoothening the distinction between painting and photography.

Dr Ravi: When and how did you get interested in photography?

Dr Unni: I got interested in photography around 1995, and I bought my first SLR camera a few years later; photography has occupied the major share of my expressive activities since then. At that time, it was my connection with nature and its beauty that attracted me to photography. I was always amazed by the transience of natural phenomena like light, the moon, and the monsoon. What attracted me was the fleeting moments in the natural world that had no permanence. I hoped to preserve those moments through photography. Later I understood that the transient moments must be transient to possess their innate elegance. This understanding took me to more of conceptual art photography wherein I had to tax heavily my imagination, execution, and labor-intensive processes in both analog and digital photography. Through this practice, I was trying to make my thoughts and memories into palpable objects that can last and stimulate me (and others) to make more meaningful art.

Dr Ravi: What were some key moments in your journey as a photographer?

Dr Unni: For a true photographic artist, every moment is a key moment, the only question being how sensitive he or she is in recognizing the true significance of the moment. As for my evolution as an artist, one significant point in time was my meeting with Mr. Vijayakumar Menon, an art historian and teacher, a relationship that lasted for decades until his passing a year ago. Some other people who influenced me as an artist were Mr. T.N.A. Perumal, a nature photographer and naturalist, and Mr. Theo Berends of the Netherlands, a fine art photographer. The single most important influence in my evolution was, and continues to be, my association and friendship with platinum photographer and photo-historian Mr. Herbert Ascherman Jr, of Cleveland, Ohio, USA. He mentored me in the nuances of black & white photography and analog photographic processes in his Cleveland studio. 

If you mean to ask about my achievements, I have had solo exhibitions in the Cleveland Museum of Natural History in the USA, the Film and Industry Museum in Germany, and a few group shows in Australia, the Middle East, and the UK, in addition to several venues in India. I received the title ‘Associate of the Royal Photographic Society’ from London in 2007 and a Senior Fellowship from the Ministry of Culture, Government of India, in 2013. Along with some of my friends, I founded PhotoMuse – the Museum of Photography in Kerala, southern India, in 2014, the first of its kind in the country. What I consider the greatest achievement is my contribution to mentoring a new generation of photographers in Kerala and beyond, imparting to them the same edge of a new vision that I owed to my mentors, through various academic activities of PhotoMuse over a decade.   

Websites by Dr. Unni Krishnan Pulikkal

www.unnipulikkal.art 

www.photomuse.in

Dr Ravi: How did the idea of the photography museum (PhotoMuse) come to you?

Dr Unni: My interest in the arts and its history has taken me to many museums around the world. Most of my journeys, especially those I did in the company of my mentor Herbert Ascherman Jr., always focus on art and photography museums. This allowed me to understand how important museums are to preserve our cultural legacy, to spread awareness about the cultural and humanistic significance of art, and to appreciate how significant it is to instill goodness in the human mind through art, music, literature and other cultural practices. This becomes especially important in a world filled with falsehood, negativism, antagonism, and violence. It was this realization that fuelled thoughts of setting up a museum of photography – the PhotoMuse – that can over time become a repository of photographic legacy and become a universally accessible tool to impart cultural education and spread awareness about the environment.

Dr Ravi: Can you share some interesting facts about the museum and its inauguration?

Dr Unni: The ‘museum’ was, interestingly, begun in a 50 square foot space (yes, you read it right – fifty square feet!) under the stairs of the Sneha hospital, with one staff, one computer and a small rack, in 2014. Soon, we shifted to a rented building and later moved to two other rented places over 10 years. In 2023 we purchased land, redesigned the existing building into a contemporary museum, and shifted to this new place in early 2024. The museum now holds more than 15000 objects of photographic history and is growing! It now has a board of trustees, and around 500 active subscribed members. Mr. Herbert Ascherman Jr. who underwrote the museum and is an advisor to the museum flew in on very short notice from the USA to India to inaugurate the museum on 10th March 2024. 

Dr Ravi: You have blended the modern and the ancient in your house. Can you share something on how you constructed the house? And how you maintain it?

Dr Unni: My house is basically built in a traditional South Indian design. It was made with locally available natural materials like laterite and wood, mostly reused wood sourced from other ancient houses. The only space that you could probably call modern is my studio where I have photographic equipment, and the paraphernalia for printmaking. It also doubles up as an acoustically designed space for music and movies. 

Dr Ravi: How do you balance your medical practice with your photography and artistic interests?

Dr Unni: Even though my formal training was in modern allopathic medicine, not art, I am living now as a part-time medical practitioner. I practice medicine half of the day, and art during the other half. It goes in a highly synchronous way because the basic undercurrent in both streams is humanism. Medicine heals mostly physical illnesses; art promotes mental wellness. The feel-good moments of art practice help me balance the stressful hours of medical practice. The goodness of art nourishes my mind, and cultivates a more humanistic culture within, helping me recognize patients as ‘human beings with a problem’ rather than ‘cases with beautiful findings’. 

Dr Ravi: You have an open-air art gallery at the entrance to your hospital. Can you mention more about this gallery?

Dr Unni: Yes, the Open Art Gallery in a hospital is something rare in India, I think. It is a project by PhotoMuse Museum and sponsored by the hospital.  It was established in memory of Vijayakumar Menon, an advisor of the museum right from its inception. The gallery holds photographic and art exhibitions around the year, accessible 24 hours a day to the patients, bystanders, and the public at large. In addition to this, the hospital exhibits various works of visual art on its walls. Together, these works of art create a soothing ambiance that calms and eases ailing minds.

Dr Ravi: What are your future plans for the museum?

Dr Unni: We are trying our best to broaden its activities, enlarge its already good collection, widen its reach to different strata of society, and, if possible, rebuild the museum with more space and amenities.

Dr Ravi: How do you think arts should be incorporated into the medical curriculum in Kerala?

Dr Unni: Fascinating and relevant question! Medical professionals need to be exposed to more cultural spaces of the country to broaden their humanitarian outlook and increase their understanding of how people engage with that cultural space. This exposure to the humanities will strengthen medical professionals’ ability to make sensible diagnoses based on peoples’ socio-cultural backgrounds and deliver treatment with humanism at heart and hand.

Dr Ravi: Any other points from your side?

Dr Unni: As part of broadening my cultural activities, I have stepped into another new art project. In addition to the PhotoMuse Museum which holds my photographic collections, I am curating another art museum at Kodakara in Kerala. The Art Museum of Love, which opened for public viewing on June 10th, 2024, holds and exhibits most of my art collection. It is based on the theme of LOVE, and consists of pieces which I have collected over the last 25 years, including paintings, sculptures, photographs, fabrics, and more. I hope this museum will help more people understand the value of the emotion we call love with a vast spectrum of intertwined emotional threads, including friendship, parental love, romantic love, and sexuality.

Happiness to you!
Unni

Dr. P. Ravi Shankar was a classmate of Dr Unnikrishnan at the Government Medical College, Thrissur, Kerala and lived in the same residence hall with him. He has long been fascinated by Dr Unni’s work and visited him at his home in December 2023. 

Webphoto: Jodhpur Royal family, c.1910, Albumen Print, 300×260 mm, Unknown Photographer, PhotoMuse Collection

A Tale of Two Museums  

Ravi Shankar Mar 4, 2025

Unni, a talented artist and photographer, founded two unique museums in Kodakara, Kerala, celebrating love and photography.

Kline opens with the shocking practice of team doctor Larry Nassar (1963-), pedophile and serial abuser of the gymnasts under his care who successfully took him down in 2017. He is serving decades in prison, where he was stabbed multiple times in 2023. She continues with the story of the Johns Hopkins University gynecologist Nikita Levy (1959-2013) who secretly photographed (or filmed) his patients’ genitalia with cameras concealed in pens that he wore on a lanyard around his neck. Abruptly fired when the story came to light, Levy died by suicide in 2013. Two years later 9000 victims were awarded a class-action settlement of $190M.

 It is not surprising, albeit horrifying, that such abuse could emerge in a medical specialty that centers on the most intimate aspects of women’s healthcare.  In a sequence of readable chapters, each of which could stand alone, Kline examines medical achievements in women’s health that could be (and have been) told in triumphalist tones: the speculum, gynecological surgery, the Pap smear, and oral contraceptives. All were invented by men. She also includes marriage counseling and patients as lay instructors in pelvic exams, both initiatives also promoted by men.

Without denying the potential value of these innovations, Kline brings every chapter into the present with the voices and actions of women who object because of painful incursions upon their bodies, denial of their humanity, and distortions of power. Her sources include archives, journals, histories (many written by women scholars), interviews, patient stories, and artistic creations—objects, music, films, poetry. Issues of gender, race, and class pervade the analysis.

The nineteenth-century inventions of the much-maligned J. Marion Sims (1813-1883) end with the 2018 dismantling of his Manhattan statue and the 2022 unveiling, in Montgomery, Alabama, of Michelle Bowder’s Mothers of Gynecology in honor of the three slaves who had been his research subjects. The chapter on Robert Battey (1828-1895) cites the critical secondary literature on how his procedure to remove ovaries by the vaginal route became vastly overused for all female complaints, even mental illness; however, it also draws upon his papers, kept in Atlanta, allowing the reader to comprehend how his initial motivation was to end the menstrual cycle for patients.

Similarly, Kline explores the previously unexamined papers including numerous drawings and photographs of R.L. Dickenson who strove to comprehend female sexual response while purporting to avoid prurience. As much as we are put off by the excruciating details of his oeuvre, letters from grateful patients demand reconsideration of his efforts to understand female sexuality.

The Pap test, which detects early cervical cancer, and the birth-control pill both advanced women’s healthcare. Yet they each prompted reactions from lay women: the failures and inaccessibility of Pap testing and consequent delays in diagnosis, resulted in cervical-cancer survivors‘ organizations; the impersonal implementation and insistence upon regular pelvic examinations spurred the vaginal self-examination movement. Kline lays out the medical achievements and plunges into the social reactions through interviews with the founders and leaders of these activist groups, tracking them down internationally. They express the militant goal to avoid the gynecologist (as if they are all brutal), and the unalloyed joy of seeing one’s own cervix (without the benefit of cytology). Some activists called for men to be banned from the specialty. One wonders if the strident anger and hostility directed at male professionals, many of whom try to practice with compassion and care, may well have incited previously unfelt, reactionary attitudes in the practitioners.

The use of surrogate patients for teaching history-taking and physical examination was proposed and advocated by Harold Barrows in the mid-1960s. A decade later, once academic and professional gynecology accepted the complaints of activists, it followed the trend and began to engage lay women as teaching assistants on how to perform pelvic examinations. Kline outlines Robert Kretschmar’s extension of the trend to pelvic examination at the University of Iowa. She also describes the Pelvic Teaching Program of Harvard and its involvement of the Women’s Community Health Center (WCHC). Even there, we read of pushback and disillusionment as relationships soured. What kind of a woman would do that? – and why? The originally enthusiastic female participants were underpaid and treated as passive objects rather than instructors. Prostitutes had been engaged, as well as gender activists who “started feeling like [they] were in the same positions as are prostitutes….and then started saying ‘Yeah, we are. We are.’” (p. 206) The professors eventually learned to quietly observe, but the students themselves tainted the experience with sexual inuendo and disrespect. Kline provides statistics on how widely lay instructors are used today.

Also using statistics, she exposes today’s teaching of the pelvic examination on anesthetized women who have not given consent. Although the American Association of Medical Colleges deemed the practice unethical in 2003, it is still widely used, most often on racialized, “public” patients.

Kline also highlights the medical, social and financial obstacles to care for transgender people.  Citing surveys from 2015, she reminds readers that most medical students receive no training on care of trans people and that trans men should receive Pap tests but most do not, because of their own discomfort and the ignorance of health care professionals.

Under Kline’s gaze, the benefits of each medical achievement tend to unravel in clinical practice. She rarely outright condemns or criticizes the physician actors; however, she uses irony, targets hypocrisy, and never fails to highlight the opportunities for self-promotion within the benefits that they provided to their patients. Just as she observes gynecologists second-guessing or failing to believe their patients, she views their own stated motives and goals with skepticism. Instead, she allows the male physicians to skewer themselves in their own words with choice quotes. Believing his patients’ pains were psychological, James C. Wood described how he cleared a clogged ward: “’I wanted their beds above all things for real surgical cases, and I knew not one of them wanted to be cut’ So he started scheduling them for various surgeries and, within a week, all ten beds were ‘well emptied for legitimate hospital use’” (p. 102).

Issues of power, trust and consent underpin the fallout of these stories and explain why many women avoid pelvic examination despite its undeniable advantages. In a counterpoint to the miserable tales of criminals at her opening, Kline closes with a patient’s tribute to a sensitive gynecologist on Martha’s Vineyard. The patient has long suffered from an iatrogenic injury owing to the diethylstilbestrol (DES) treatment given to her mother during pregnancy. Her doctor, Dan Pesch, listens well, comprehends her justified fear, grants her control over decisions, and yet manages to wield all the advances of last two centuries to catch her cancer early. Compassion, Kline observes, “can literally save lives.”

Now—will she next expose the hidden history of the prostate exam?

Exposed: The Hidden History of the Pelvic Exam
Wendy Kline
Cambridge and Hoboken: Polity Press, 2024.

We feature James Dickey’s poem, Diabetes, with our guest, the renowned physician-poet Dr. Jack Coulehan. We discuss insights the poem offers about the trajectory of type 2 diabetes from the time of symptom onset until the time a balance is achieved between maximum compliance with disease management requirements and the compromises an acceptable lifestyle can necessitate for many individuals. In addition to providing his perspectives on how the poem expands on the biomedical components of diabetes in recognizing effects such as fear, anxiety, frustration, and oppression, Dr. Coulehan recounts how he has used this poem and others in teaching medical students and residents. He also tells stories of particular instances in which he used poetry as part of the care he provided certain patients, and as a way to connect with them. 

Links:
Dr. Jack Coulehan’s bio and posts on Medhum.org

The poem, Diabetes, and the comparative biomedical text discussed can be seen here in Russell Teagarden’s blog, According to the Arts. 

Dr. Coulehan’s poem, I’m Gonna Slap Those Doctors, which was central to one of the stories he told, can be accessed here. And, his poem, The Man with Stars Inside Him, which was central to another story he told, can be accessed here.

In this episode, we make a distinction between illness as the subjective perceptions of a health problem and disease as the pathological basis of a health problem. This distinction is explained in much greater depth here in According to the Arts. 

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Álvaro Serrano