Summary:

The Heavenly Ladder is physician-poet Jack Coulehan's most recent chapbook, bringing together 48 poems, many of which have been published individually in various medical journals and literary magazines. The collection is divided into four sections.

Poems in the first section, "Medicine Stone," are written in the voice of patients or in the voice of the physician who treats them. The second section, "So Many Remedies," consists of five poems inspired by physician-author Chekhov. The poems of "The Illuminated Text" section reflect a wide-ranging interest in people who lived in distant times or in distant places. The final section, "Don't Be Afraid, Gringo," stays, for the most part, closer to home and includes a number of poems addressed to, or about, family members.

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To relieve her insomnia, Claire Vornoff seeks help from Dr. Declan Farrell, a well-known holistic physician, who begins to see her professionally at his country home. Farrell's methods focus on massage and bodywork, along with some acupuncture. Claire finds him an attractive paradox--sensitive and "tuned in" to her, yet also blunt and emotionally unsettling.

The client-therapist relationship becomes deeper and more complex. After Claire has a brief sexual escapade with a married man, she admits to herself that she actually loves Declan and confesses her love to him. Indirectly, he reveals that he also has strong feelings for her, but is desperately resisting those feelings and attempting to maintain his professionalism.

Claire finally breaks off their relationship and attempts to go on with her life. Over the next couple of years, Declan closes his practice, moves elsewhere, divorces his wife, and ultimately commits suicide. Claire learns of these events gradually, at second hand, as she, too, moves on, but in much a different direction. Eventually she begins a new life in Toronto.

Although the relationship between Claire and Declan occupies center stage, Claire's quest for improved health leads her to consider, and sometimes consult with, other alternative medicine practitioners as well. (I say "improved health" rather than "relief of insomnia" because, although never stated, it seems clear that Claire seeks a sense of completeness and meaning in life that goes far beyond solving her sleep problem.)

One of these healers, for example, is Mr. Spaulding, who reviews Claire's blood work and concludes, "You're in rough shape, girl." (p. 231) He explains that her "body salts are so high I can't measure them" and that her "body is throwing off one hundred times more dead cells than it should . . . "

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In this collection Richard Selzer brings together 25 stories from his previous books, along with two new stories, Avalanche (see this database) and "Angel, Tuning a Lute." The unifying theme is the world of medicine and healing, which Selzer explores with a keen eye and compassionate heart. These stories are firmly grounded in the foibles, suffering, and exultation of the human body.

In the Introduction Selzer sketches the path by which he became a surgeon-writer and he indicates the origin of some of the stories. Particularly interesting are the stories that do homage to literary and historical figures; for example, "Poe's Light-house," which grew out of a fragment Edgar Allan Poe wrote in his last delirium, and "The Black Swan," a re-writing of a Thomas Mann novella (Mann's The Black Swan is annotated in this database).

Likewise, the story of how "Avalanche" was written is an interesting tale in itself. Selzer's description of pruning the story from his journal reminds me of Michelangelo's comment that the sculpture already exists in the block of marble. The sculptor merely removes the unnecessary stone. The Doctor Stories contains many of Selzer's tales that have become part of the Literature and Medicine canon; these include, for example, "Tube Feeding," "Sarcophagus," Imelda, Mercy, Brute, and Four Appointments with the Discus Thrower. (See this database for annotations of the latter four.)

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The story begins with the doctor-narrator unobtrusively observing an older man lying in a hospital bed. The patient is blind and has amputations of both legs. (We are given no medical details that cannot be observed in the room.) The narrator tends to the man's amputation wounds and answers a few simple questions. The man requests a pair of shoes.

Back in the corridor, a nurse tells the doctor that the patient refuses his food, throwing his china plate against the wall of his room. The narrator hears the man and a nurse argue briefly about food and then, by himself, watches as the patient carefully and powerfully throws another dish against the wall. The next day the doctor discovers that the patient has died.

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Under the aegis of the Association of American Medical Colleges and its journal, Academic Medicine, the editor of the Medicine and the Arts column has collected 100 selections for publication in this volume. Each selection is made up of a piece of literature or art relevant to the medical humanities, followed by a commentary that elucidates or elaborates upon the contribution of the primary piece to the practice of medicine.

Given the wide-ranging nature of the art and literature in this collection, essentially every keyword listed in this database could come into play; those denoted above identify broad categories under which fall the works discussed. The artists represented vary from poets of the classical period, to ancient and modern painters, to writers who study the human condition in their fiction or essays. The scope is enormous; the adventure daunting.

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A young boy dreams of "Mangan’s sister," who lives nearby: "Her dress swung as she moved her body and the soft rope of her hair tossed from side to side." Her image pursues him, even at night when he is trying to say his prayers. One day, he actually encounters Mangan’s sister, and she asks whether he plans to go to the bazaar (Araby) on Saturday night. She herself "would love to go," but cannot, because she must attend a retreat at the convent. This is the boy’s big chance! He promises to bring her a gift from the bazaar. On Saturday evening he waits for his uncle to come home and give him some money, but the uncle doesn’t arrive until nine o’clock.

The boy rushes onto a deserted train, trying desperately to reach Araby before it closes, but when he arrives "the greater part of the hall was in darkness." A few stalls are still open. A few people are still hanging around. The boy looks at some porcelain figurines, but suddenly realizes that his quest is doomed to failure: "Gazing up into the darkness I saw myself as a creature driven and derided by vanity, and my eyes burned with anguish and anger."

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The poem begins, "I'm mighty glad to see you, Mrs. Curtis." The speaker is a woman who is dying of leukemia and Mrs. Curtis is the lady who comes around periodically with the book-cart, offering patients something to read. While the other patients are celebrating the holiday with family or friends, the speaker, who has no visitors, feels conspicuous and lonely. Thus, she is grateful for Mrs. Curtis' regular visit, especially since the book-cart lady appears willing to sit down and listen.

The patient's father is afraid to visit, since he knows "that I will predecease him / which is hard enough." Chemotherapy hasn't helped. The leukemia makes her so fatigued that she doesn't even feel like reading. So instead, she sits by the window and looks at the trees. Since the leaves have fallen, the trees look like "magnificent enlargements / Of the vascular system of the human brain."

The patient has given names to these "discarnate minds." For example, "there, near the path, / Is the great brain of Beethoven, and Kepler / Haunts the wide spaces of that mountain ash." These trees remind her of "The Transparent Man," a toy one of her friends had when they were girls. "It was made of plastic, with different colored organs, / And the circulatory system all mapped out / In rivers of red and blue." At the time she and her friend giggled, but now she remembers the intricacy with amazement, and stares at the riddle of the trees.

The dying patient decides not to take one of the books, but thanks Mrs. Curtis again for coming. [120 lines]

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This poem consists of six "letters" in verse from an aged, chronically ill father to his daughter. In the first he presents in excruciating detail the sorry state of his body, and also Mother, "who falls and forgets her salve / and her tranquilizers, her ankles swell so and her bowels / are so bad . . . " Things are so bad that he has "made my peace because am just plain done for . . . " At the end he mentions the fact that, though the daughter enjoys her bird feeder, he doesn't see the point; "I'd buy / poison and get rid of their diseases and turds."

In the second letter, written after the daughter visited and gave them a bird feeder, he says that Mother likes to sit and watch the birds. In the next one, he talks about how much the birds eat and fight. As the letters progress, they include less and less about the parents' pain and disability, and more and more convey curiosity and, eventually, enthusiasm for bird watching.

By letter #5 the father ticks off the names of numerous species he has observed, and at the end casually mentions, "I pulled my own tooth, it didn't bleed at all." Finally, "It's sure a surprise how well mother is doing, / she forgets her laxative but bowels move fine." He ends by describing his plans for buying birdseed for the next winter. [112 lines]

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This poem employs language in ways that are characteristic of the involuntary outbursts seen in patients with Gilles de la Tourette's syndrome. The devices include frequent obscenities, word repetition, and a jerky, spasmodic forward motion. The male Tourette patient is thwacking "the roof of the car, knuckles / calloused and winking . . . " He is driving with his wife beside him, patting her thigh, "her thighs are warm as kettles, your palms moist / as hiss . . . " Whatever it is that happens in the last stanza, he becomes excited, "god damn, god fucking / damn, and god bless." [30 lines]

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Dr. Constance Petersen (Ingrid Bergman) is a beautiful, unattached psychiatrist whose business-like facade fails to conceal a natural empathy that draws men. For her, however, love is a mere epi-phenomenon, easy to explain and resist, until she meets Dr. Edwardes (Gregory Peck). The famous expert on the guilt complex has arrived to replace the retiring chief (Leo Carroll). Constance is smitten, and so, it seems, is he.

But soon, she realizes that Edwardes is "not well," that he is terrified of dark lines on white: fork marks on a tablecloth; threads in her robe. Worse, she discovers that Edwardes is not, in fact, Edwardes, but an amnesic physician of initials "J. B." who is convinced that he has murdered his analyst. Constance does the right thing by having him removed from work, but she refuses to believe he is a murderer. Wanting to protect her, he leaves. But she, intent on curing her lover, follows him on a journey to retrace his last movements. The task is to recover both a memory and a missing person.

They go skiing (dark lines on white) at a resort where the real Dr. Edwardes had sojourned with his patient-colleague. On a dangerous slope, J. B. suddenly remembers that Edwardes went over the cliff. The body is found, but it has a bullet in the back.

Now hiding from the police, the couple pose as newlyweds and flee to her old mentor in Rochester. Complete with accent and beard, Dr. Brulov (Michael Chekhov) is a delightful double of the recently deceased Sigmund Freud (1858-1939). It emerges that John Ballantine (Peck) never lost his childhood feelings of guilt over the accidental death of his little brother.

In a gruesome ten-second flashback, the tyke is abruptly impaled on a iron-spike fence. This ancient guilt was reactivated by his doctor’s demise and it was sublimated by the defense mechanism of an assumed identity to keep the dead man alive. An idle slip of the tongue reveals the murderer to be the jealous retiree. The killer threatens Constance and then makes a quick end by dispatching himself instead.

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