William Carlos Williams (1883-1963), a figure deeply immersed in the dual worlds of medicine and literature, dedicated his life to bridging these seemingly disparate fields. For Williams, being a doctor and a poet were not separate identities but rather intertwined facets of a single mission: to capture the essence of everyday life through language, reflecting his observations and experiences back to the reader. His project, constantly evolving and refined throughout his career, aimed to utilize accessible, ordinary language to articulate and reimagine the world around him.
While the advancements in medicine and medical education since William Carlos Williams’s time are undeniable, modern medicine’s relentless pursuit of progress, efficiency, and technological sophistication has inadvertently led to a detachment from the human core of medical practice. Williams practiced medicine in an era where technology was nascent, emphasizing the critical importance of acute observation and empathetic listening in patient care. As Williams himself articulated in his autobiography, the poet, much like the physician, must “not talk in vague categories, but to write particularly, as a physician works upon a patient, upon the thing before him, in the particular to discover the universal.”
This exploration delves into William Carlos Williams’s poems and prose to reveal how a close engagement with his literary works can guide contemporary physicians back to the fundamental values of attentive observation and embodied understanding. By immersing ourselves in Williams’s writing, we, as readers, physicians, and medical trainees, can rediscover a more embodied approach to medicine, enhancing our observational skills, deepening our empathy for patients, and fostering a more profound reflection on our own human perspectives within the medical landscape.
Acts of Outward Attention: Lessons for Physicians from William Carlos Williams’s Patient Observations
William Carlos Williams’s practice as a physician in a rural setting provided him with unparalleled access to the intimate lives of his community. This immersion in the local environment profoundly shaped his literary work, rooting his writing in the tangible realities of American life. This commitment to the immediate and the real set him apart from many of his contemporaries in the literary world, who often gravitated towards European aesthetics and abstract themes. Williams championed a distinctly American poetry, one that shunned detached artistic abstractions in favor of the concrete, the palpable, asserting that abstract “ideas” originate from tangible “things.” His emphatic declaration in Paterson, “Say it! No ideas but in things -,” encapsulates this focus on material reality.
Alt text: William Carlos Williams, the doctor-poet, in a portrait from 1953, highlighting his thoughtful expression and the wisdom gained from his dual careers.
Literary critic Mike Weaver highlights this divergence, noting that while “[T.S.] Eliot in London was abstracting spiritual values, or an absence of them, from the air; Williams, in the physical waste-land of his own part of New Jersey, detected an irrepressible force in the soil.” Weaver’s description underscores the groundedness and rootedness in American experience that permeates William Carlos Williams’s writing.
This keen observational capacity was undoubtedly nurtured during Williams’s medical education at the University of Pennsylvania. The early 20th century marked a pivotal shift in medical education, moving away from purely didactic lectures towards practical, hands-on learning in laboratories and clinical settings. The faculty aimed to impart medicine “as an application not as an abstract science,” a sentiment that resonates deeply with Williams’s “No ideas but in things -.” The practice of medicine became a crucible for honing Williams’s observational skills and attentive listening, qualities that are palpably reflected in his poetic approach.
The Power of Observation and Listening: Training Senses Like William Carlos Williams, the Doctor
Observation stands as a cornerstone of medical practice. To restore the body to its central place in medicine, we can turn to William Carlos Williams’s work to learn how to “train” our senses. For Williams, the meticulous focus on sensory details to “discover the universal” was fundamental to both his medical practice and his writing. In medicine, overlooking the specifics can lead to missed crucial medical signs, while neglecting the universal can result in overlooking the patient’s holistic needs and the ultimate aim of healing.
William Carlos Williams crafted poems that often served as precise snapshots of his observations. Furthermore, he conceived of poems themselves as objects to be observed on the page. He meticulously considered the visual elements of his poetry – lineation, syntax, and layout – recognizing their profound effect on both the poem’s meaning and its visual impact.
One of William Carlos Williams’s most celebrated poems, “The Red Wheelbarrow,” exemplifies this emphasis on observation and poetic form, demonstrating how these considerations shaped the visual arrangement of his poetry. In this concise poem, Williams masterfully employs enjambment, breaking lines and even words to “magnify the discrete parts of which the whole is composed.” By enjambing words like “wheel/barrow” and “rain/water,” Williams compels the reader to momentarily perceive these words as separate components, mirroring the perception of their physical reality as constituent parts. For many readers, the image of a wheelbarrow is now inextricably linked to the fragmented “wheel” and “barrow” as distinct entities, a testament to the poem’s lasting impact.
Medical trainees are taught to condense a patient’s case into a succinct summary, distilling the history and physical examination into its most essential elements. The brevity and precision of poems like “The Red Wheelbarrow,” a mere sixteen words, mirrors this crucial skill of formulating a patient summary. Despite its economical use of language, “The Red Wheelbarrow” vividly presents a rain-glazed wheelbarrow, creating a crisp image for the reader. Similarly, in the clinical setting, the goal is to observe and summarize a patient’s case with such clarity that colleagues can visualize the “image” of the patient as if they had personally conducted the interview.
Alt text: “The Red Wheelbarrow” poem by William Carlos Williams, visually arranged to emphasize its concise form and the fragmented words, reflecting his innovative poetic style and focus on observation.
Williams intended his poetry not just to be read but to be actively observed. Poems like “11/2 [Dahlias]” undulate across the page, mimicking the contours of a flower, while “An Early Martyr” appears boxed in, visually representing the confinement associated with the institutionalization of the ‘insane.’ The shape of the poem on the page is significant, contributing to both its visual impact and the distribution of lines and words, as evident in “The Red Wheelbarrow.” This visual dimension of William Carlos Williams’s poetry became even more pronounced in the latter part of his career. In “The Yellow Flower,” the poetic voice questions:
What shall I say, because talk I must?
That I have found a cure
for the sick?
I have found no cure
for the sick .
but this crooked flower
…………………………
[This]
is that sacred
flower!
This poem prompts the reader to consider the deliberate line breaks, the use of questions and exclamations, and the unconventional spacing within lines. What effects do these choices create? It is not coincidental that Williams follows with:
I have eyes
that are made to see
…………………………
[and]
through the eyes
and through the lips
and tongue the power
to free myself
and speak of it,
While the poem explores profound themes of the tension between the elevated and the ordinary, power and powerlessness, isolation and unity, Williams’s deliberate poetic design demands observation, not just reading. His techniques serve to disrupt the conventional act of reading, encouraging readers to pause and observe poetry with a heightened awareness. William Carlos Williams’s poetry intentionally creates spaces, both visually and metaphorically, inviting readers to reflect on the meaning behind his formal choices and their influence on the overall interpretation of his work.
Florence Nightingale famously stated, “Observation tells us the fact, reflection the meaning of the fact.” William Carlos Williams, however, encourages a simultaneous process of observation and reflection, akin to Charles Peirce’s concept of “abductive reasoning.” Alan Bleakley, in Educating Doctors’ Senses Through The Medical Humanities, discusses how abductive reasoning, or “reasoning in the senses,” can be a valuable framework in medicine. Through his work, Williams demonstrates that observation is a dynamic, active process that requires self-awareness. His poetry, in particular, cultivates a reflective, engaged mode of observation. Close reading of poems like “The Red Wheelbarrow” and “The Yellow Flower” can profoundly benefit medical students, prompting them to critically examine how they observe and perceive the world around them, particularly in the context of patient care.
William Carlos Williams’s commitment extended beyond observing his surroundings; he was equally dedicated to employing everyday language in his poetry. William Osler’s dictum, “Listen to the patient. He is telling you the diagnosis,” resonates deeply with Williams’s approach. Attending to William Carlos Williams’s linguistic choices and the rhythms of his language can train medical professionals to become more attuned to the nuances of patient narratives. The contemporary disembodiment of medicine not only prioritizes objective data and clinical signs but also risks marginalizing the patient’s voice. William Carlos Williams, in the mid-20th century, sought to reintegrate the poetic voice with the poetic subject, grounding both in the realities of American life. For medical trainees, engaging with Williams’s work can refocus attention on harmonizing the objective observations of the physical patient with the patient’s subjective “voice”—their “lyric voice.” Just as lyric poetry captures and conveys a particular emotion or state of mind, fostering understanding, attentive listening to the patient’s voice can empower physicians to connect with the crucial affective dimensions of their patients’ experiences.
Williams’s “day job” as a physician served as an anchor for his literary pursuits. The voices and narratives of his patients offered him profound insights into the collective, primarily rural, American psyche. He strived to integrate the rhythms and cadences of American speech into his literary work. Williams was acutely attuned to the voices of the people around him, embracing the “American voice” as another tangible element to ground his poetry. His writing captures “the rhythmic envelope of American utterance, Variable Feet and all,” with this variable foot serving as “a manifestation of the American Idiom.” Throughout his writing career, William Carlos Williams experimented with the interplay between the sonic qualities of his poems and their visual presentation on the page. In the second stanza of “To A Poor Old Woman,” he masterfully manipulates lineation to affect the meaning of words and phrases. His poetic voice reflects on the plums:
They taste good to her
They taste good
to her. They taste
good to her
Williams explores various line breaks, seeking the one that best serves his poetic intentions and, more importantly, most accurately conveys the meaning in relation to the old woman he observes. This shifting lineation contributes to a palpable sense of voice within the poem. While “They taste good to her” possesses the natural cadence of everyday speech, Williams poeticizes the sentence, prompting the reader to contemplate words, their meaning, and their sound with the same depth of consideration as the poet himself. There is an intimate sharing of poetic voice between the speaker and the old woman in this poem. This dynamic mirrors the collaborative process between doctor and patient, working together to understand an experience, encompassing both the physician’s professional perspective and the patient’s personal narrative. Through techniques exemplified in “To a Poor Old Woman,” William Carlos Williams encourages not only close reading of his work but also models the art of listening to a poem, demonstrating how this act of listening can illuminate the old woman’s experience of the plums or, analogously, a patient’s experience of illness.
Imagination in Medical Practice: Bridging Observation and Clinical Sense with William Carlos Williams
Engaging with literature can be viewed as a powerful way to affirm our sensory realities, invigorated by the power of imagination. William Carlos Williams’s dual careers were mutually enriching; his cultivation of imagination as a poet profoundly influenced his capacity for empathy and effective patient care as a doctor. In Spring and All, Williams delves into the significance of imagination in his literary endeavors, presenting imagination and reality as intertwined, asserting that “it is the imagination on which reality rides.” He further elaborates, “As birds’ wings beat the solid air without which none could fly so words freed by the imagination affirm reality by their flight.”
Medical trainees are often guided by experienced physicians to “see” beyond the overtly visible and “hear” beyond the explicitly spoken. This is a crucial yet often elusive skill for those new to the field. William Carlos Williams suggests that imagination serves as the bridge connecting keen sensory observation and the nuanced “clinical senses” essential in medicine. Just as a bird’s flight confirms the existence of air, a patient’s illness, often with an elusive cause, affirms the presence of an underlying condition. In Williams’s use of words, imagination becomes the catalyst for engaging our senses more fully with reality and embracing the unseen, contributing to the broader goal of re-embodying modern medicine. In a discipline that highly values evidence and efficacy, nurturing poetic imagination in medical students is often overlooked. However, as Fernand Hallyn writes, “a poetic imagination [refers] to the possible rather than the evident.” Embracing the realm of possibility is crucial for comprehensive patient assessment and enhancing patient safety, helping to avoid premature diagnoses and other pitfalls. This imaginative openness is an indispensable skill for medical trainees.
Empathy and Sensibility: Cultivating Human Connection Inspired by William Carlos Williams’s Poetry
Teaching and sustaining empathy pose ongoing challenges in contemporary medical education. While physician empathy is demonstrably linked to improved patient satisfaction, treatment adherence, and clinical outcomes, studies have also shown a decline in empathy among medical students during their training. Alan Bleakley emphasizes the importance of ‘sensibility’ and ‘sensitivity’ in medicine. Sensibility, in this context, refers to “sensitivity to sensory stimuli,” aligning with William Carlos Williams’s emphasis on re-embodying medicine through keen observation and active listening. However, sensibility also encompasses “sensitivity to quality in relationship and emotional or affective response.” Imagination, as William Carlos Williams portrays it, plays a vital role in everyday patient interactions. Neither the seasoned attending physician nor the novice medical student can fully inhabit each patient’s lived experience. Therefore, it is imagination that enables us to maintain ‘sensibility’ towards patients, fostering deeper empathy for their unique situations.
In William Carlos Williams’s poem, “The Young Housewife,” the speaker imagines the poem’s subject moving “about in negligee behind/the wooden walls of her husband’s house.” The speaker then imaginatively “compare[s] her/ to a fallen leaf” before noting the “crackling sound” as he drives “over/dried leaves.” Through these subtle acts of attention, Williams observes his surroundings and employs imagination to imbue his observations with meaning and context. The speaker remains separate from the housewife, observing her from his car, yet, through imaginative engagement, he offers fleeting contextual insights into her solitude and potential neglect.
Acts of Inward Attention: Self-Reflection for Physicians Through William Carlos Williams’s Doctor Stories
Introspection and the Human Doctor: Learning from William Carlos Williams’s Doc Rivers
While the previous sections focused on re-embodying medicine for the patient, William Carlos Williams’s writing also advocates for a re-embodiment of medicine for the physician themselves. Introspection, in many respects, represents the ultimate reunification of the self. In the preface to Paterson, Williams states, “we know nothing pure and simple beyond our own complexities.” While his poetry often directs an outward gaze towards his surroundings, his prose encourages inward reflection upon the self.
Atul Gawande, in the foreword to The Doctor Stories, notes that these stories prompt us to reflect on our own humanity, encompassing both our capacities for good and bad. In each short story, William Carlos Williams creates a doctor-narrator who is profoundly human—a doctor grappling with prejudice, a doctor resorting to violence to restrain a child, a doctor whose substance abuse permeates his practice—interwoven with the more conventionally expected traits of physicianly empathy and healing. Williams’s character ‘Doc Rivers’, for instance, embodies contradiction. The narrator reflects, “I tell you there was a howl about the town: another decent citizen done to death by that dope fiend Rivers…And yet the man could be – often was – kindly, alert, courteous…He could be cruel and crude. And like all who are so, he could be sentimentally tender also, and painstaking without measure.”
Through Old Doc Rivers, William Carlos Williams compels us to confront challenging questions: How far are we willing to excuse someone’s flaws? How do we reconcile Rivers’s brilliance as a physician with his addiction? How would we react as bystanders to his actions, or if we faced similar struggles? As the introduction to The Doctor Stories suggests, Williams utilizes the specifics of these narratives to guide readers toward discovering the universal within themselves. These murkier facets of being a doctor, while perhaps dramatized in these stories, are not absent from contemporary practice. Medical students are not explicitly trained to navigate the complex human dimensions of being a physician, to manage moments of malice, prejudice, or personal weaknesses. William Carlos Williams’s prose provides an opportunity to ground ourselves in our own embodied experiences, to acknowledge our biases, and to approach medicine with greater ethical awareness and embodied understanding. Reading Williams’s doctor-narrators encourages us to become more conscious of these aspects in ourselves and others, fostering more open dialogues about how to manage them throughout a medical career.
Ultimately, medicine is fundamentally about human interaction. Doctors, patients, families, and allied healthcare professionals engage with the shared objectives of healing and alleviating suffering. Despite the remarkable technological advancements in medicine since William Carlos Williams’s era, the core interaction between doctor and patient remains the essence of medical practice. 21st-century medical education, shifts in healthcare systems, and technological innovations have contributed to a pervasive disembodiment of what is inherently a bodily experience. William Carlos Williams’s literary work champions an embodied awareness of both the patient’s body and the physician’s own self. While literature cannot directly cure or relieve suffering, it can cultivate more attentive, reflective physicians who are deeply rooted in this embodied experience. Close reading of William Carlos Williams’s poetry and prose can equip physicians to be grounded in their surroundings, to observe the particular and recognize the universal, to listen attentively to patient narratives, to cultivate imaginative empathy for patient struggles, and to reflect deeply on their own human perspectives within the profound and complex field of medicine.
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