The Struggle of Physician Writers
July 2, 2010 3 Comments
If I did not have
I would have died
William Carlos Williams
In The Practice, an essay which appeared as a chapter in William Carlos Williams’ autobiography, he recounts his life as a physician writer. Although his true passion was for poetry, he viewed the medical profession and his patient encounters as a window into the life of every day man for whom he wrote. Williams writes, “as a writer I have never felt that medicine interfered with me but rather that it was my very food and drink, the very thing that 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. Oh, I knew it wasn’t for the most part giving me anything very profound, but it was giving me terms, basic terms with which I could spell out matters as profound as I cared to think of.”
Williams’ son writes in the afterword of The Doctor Stories that his father was “a man making his living at medicine who has given up medicine for poetry.” Williams often flirted with the idea of giving up medicine for poetry but was never able to make the full transition. As an often misunderstood poet in his early years, he achieved major recognition for his work posthumously as winner of the Pulitzer Prize for Pictures from Brueghel.
Like Williams, I am first a writer, secondly a physician. I derive energy from medicine and appreciate the human interaction and “basic terms” which it provides. Many physician and patient write simply to recount their stories – and this has inherent value. Abigail Zuger discussed this in a recent New York Times article, Compelling Stories, if Not Literature. But the rare act of expressing medicine through art is much more difficult to master. This is mainly because the modes of thought and expression that are required for the medical profession and artistic endeavors are quite different.
As a physician, we are constantly required to maintain our calm. As Williams writes, “And though I might be attracted or repelled, the professional attitude which every physician must call on would steady me, dictate the terms on which I was to proceed.” We must distance ourselves enough from the human condition in order to diagnose and treat objectively, and this often requires a certain degree of reticence or repression. On the other hand, the primary goal of an artist is to express – passion, imagination, memory. Artists by nature are not often attracted to the scientific world of medicine. Likewise, physicians are not often attracted to the world of art.
Being a physician writer requires that one live in two opposing worlds, while recognizing that it is impossible to belong fully to either one. As a physician, I constantly struggle to hold back my sensitivities and artistic impressions while I am caring for patients – for, as Williams says,”The relationship between physician and patient, if it were literally followed, would give us a world of extraordinary fertility of the imagination which we can hardly afford. There’s no use trying to multiply cases, it is there, it is magnificent, it fills my thoughts, it reaches to the farthest limits of our lives.” Physician-patient relationships would be too intense and unproductive if they were carried out fully on an artistic level.
Simultaneously, as a writer, I am constantly aware of my training as a physician. Over the years of medical training, I have slowly pulled away from my writing. The tone of the writing itself has changed – it has become more crisp and direct but also more distant. I often feel that I am an observer in my own life . The skills of listening and of observation have been so engrained in me through my medical training that I cannot help but apply them to myself.
My emotions are no longer raw, unregulated fires which ripple outwards without bounds or direction. Instead, they are tempered by my clinical background and by the quiet calm which comes with being a physician – the calm, or resignation perhaps, which comes after you have cared for numerous critically ill, dying patients day in, day out. Ironically, the pure intensity of medicine is something that one grows accustomed to over time. Being present, over and over again, for the reality of human devastation dampens the spirit and the world of imagination. You reach a point where it becomes bearable, if only because you have without realizing it developed a certain indifference towards life.
Some writers adjust to this dichotomy – the world of human devastation and the world of artistic creativity and emotion – as Kurt Vonnegut did. His experience as a soldier and prisoner of war had a strong effect on his writing, which articulated his cynical, futile view of life. Other writers adjust to it by creating a world of quiet melancholy. As Henry David Thoreau wrote,”The mass of men lead quiet lives of desperation.” Some writers simply indulge themselves in this world and aim to create beautifully tragic works.
So, as physician writers, how are we to deal with this dichotomy? The world of medicine is one of tragedy and miracles. Physicians witness death, but we also witness survival, birth, and moments of deep joy and gratitude. We witness the successes of spinal surgery, knee and hip replacements, cardiac catheterization, and liver transplants. These stories may give us enough optimism to cultivate a sense of hope and faith in humanity.
Williams finishes his essay with these words, “The poem springs from the half-spoken words of such patients as the physician sees from day to day. He observes it in the peculiar, actual conformations in which its life is hid. Humbly he presents himself before it and by long practice he strives as best he can to interpret the manner of its speech. In that the secret lies. This, in the end, comes perhaps to be the occupation of the physician after a lifetime of careful listening.” And thus we return to our patients – our energy source – who inspire out poetry. This is one of the aims of the artist: to capture sparks in the ocean of humanity, to create from them a flame, and to give this flame back to the vast waters from whence they came in a new and preserved form, so that we can better understand and appreciate our collective existence.