I have written over the years about doctors and nurses, writers and poets, as well as other groups. But I am a physician first.
I have met, worked with, observed, and read about hundreds of physicians in the 50-plus years since I entered medical school. There are many that I have respected, usually for their medical skills, intellect, or efficiency. Some I have deeply admired, often for their humanity, their view of medicine as a calling and a sacred trust, or for the personal sacrifices they made for their patients and profession. And a handful have stimulated not only respect and admiration, but also a sense of awe and wonder. I would like to tell you about one of the latter, an American physician of my grandparents' generation that I never met, but have read about extensively.
William Carlos Williams was a general practitioner and pediatrician in New Jersey. He cared for a working class, mostly poor, immigrant population early in the 1900s through the Great Depression of the 1930s when house calls were a regular part of each day, and thereafter until his death in 1963. Why he is special, and the only reason I know of him, is that he was also a poet, probably the greatest successor to Walt Whitman as a uniquely American poet. He wrote about ordinary people and everyday things in his community and his practice.
Williams was drawn to the arts at a young age and spent his life as a full-time physician while trying to be a full-time poet. So he wrote in his carriage on house calls, between patients and after office hours, "stealing" time from his practice and often complaining of overwork and the lack of time for writing. However, despite the urgings of his colleagues in the arts, he refused to give up his practice to write and refused lucrative Manhattan practices.
Listen to Williams talk, first about "The Practice" from his autobiography: "It is the humdrum, day-in, day-out everyday work that is the real satisfaction of the practice of medicine; the million and a half patients a man has seen on his daily visits over a forty-year period of weekdays and Sundays that make up his life. I have never had a money practice; it would have been impossible for me.
"But the actual calling on people, at all times and under all conditions, the coming to grips with the intimate conditions of their lives, when they were being born, when they were dying, watching them die, watching them get well when they were ill, has always absorbed me. I lost myself in the very properties of their minds: for the moment at least I actually became them, whoever they should be, so that when I detached myself from them at the end of a half-hour of intense concentration over some illness that was affecting them, it was as though I were re-awakening from a sleep. For the moment I myself did not exist, nothing of myself affected me. As a consequence, I came back to myself, as from any other sleep, rested."
And more about his patients and society: "I don't care a rap about what people are or believe. They come to me. I care for them and either they become my friends or they don't. That is their business. My business, aside from the mere physical diagnosis, is to make a different sort of diagnosis concerning them as individuals, quite apart from anything for which they seek my advice. That fascinates me.
"From the very beginning that fascinated me even more than I myself knew. For no matter where I might find myself, every sort of individual that is possible to imagine in some phase of his development, from the highest to the lowest, at some time exhibited himself to me. I am sure I have seen them all. And all have contributed to my pie. Let the successful carry of their blue ribbons; I have known the unsuccessful, far better persons than their lucky brothers."
And finally, he speaks about his poetry, for which he began to be recognized by literary critics only late in life: "...I have never felt that medicine interfered with me but rather that it was my very food and drink, the very thing which made it possible for me to write. Was I not interested in man? There the thing was, right in front of me. I could touch it, smell it. It was myself, naked just as it was, without a lie telling itself to me in its own terms."
As with medicine, poetry was not a pastime for him, which was made clear in his ever-present red notebook:
If I did not have
verse
I would have died
or been
a thief
So we hear a man deeply committed to his profession, his patients, his community, and his poetry. The four are fused, inseparable and interdependent, nourishing and revealing secrets to one another, about his patients and about himself.
Williams wrote many poems, his magnum opus being the book-length "Paterson," in which he writes about the city, the times, and especially the people in all their glory and decadence, disease and health, joy and sorrow. His style of writing is not ornate, but direct and tangible, though not necessarily simple or straightforward. In "A Sort of Song" he describes his style, using a metaphorical snake and flower; the phrase in the second stanza (my brackets) is his famous statement on poetry:
Let the snake wait under
his weed
and the writing
be of words, slow and quick, sharp
to strike, quiet to wait,
sleepless.
-through metaphor to reconcile
the people and the stones.
Compose. [No ideas
but in things] Invent!
Saxifrage is my flower that splits
the rocks.
He also wrote The Doctor Stories and poems about his practice and patients, some of which were compiled and introduced by Robert Coles, himself a famous physician and author.
As Coles says of them, "...the sheer daring of the literary effort soon enough comes to mind-the nerve he had to say what he says. These...accounts meant to register disappointment, frustration, confusion...or, of course, enchantment, excitement, pleasure...These are stories that tell of mistakes, of errors in judgment; and as well, of one modest breakthrough, then another-not in research efforts of major clinical projects, but in that most important of all situations, the would-be healer face-to-face with the sufferer who half desires, half dreads the stranger's medical help."
Needless to say, The Doctor Stories, which I have read several times over the years (and that I highly recommend), were the final steps in elevating Williams to the upper level of my pantheon of doctors. He was by no means a saint and often a curmudgeon, but he worked hard every day at his passions, medicine, and poetry. In both his practice and in his art he respected his poor, societally insignificant patients enough not only to care for them, but to listen to them, to study them, to understand them and to write about them in all their humanity.
I am awestruck by his perseverance, sensitivity, artistic talent, and his commitment to the medical profession, which for him was clearly a calling and a sacred trust, as well as the lifeblood of his art. Though he died over 50 years ago, in his stories and poems he still has much to teach us about being a doctor, and about life.