William Carlos Williams is considered one of the greatest American poets of the 20th Century. He was also a general medical practitioner. This is how one of his poems begins.


They call me and I go.

It is a frozen road

past midnight, a dust

of snow caught

in the rigid wheeltracks.

The door opens.

I smile, enter and

shake off the cold.

Here is a great woman

on her side in the bed.

She is sick,

perhaps vomiting,

perhaps laboring

to give birth to

a tenth child. Joy! Joy!

Each reader will have different responses to a poem, and our interest might be drawn to different details. Before you read my comments, I would ask you to read this poem opening again, slowly, out loud.

The poem is written in free form, without regular line length or rhyming patterns. It is a narrative poem, telling a story in a conversational tone. It is told from the point of view of the doctor, someone who is familiar with the unfolding of a patient’s history. Written almost a century ago, the poem doesn’t fit into the tight structural conventions of the time, but Williams had a huge influence on the shape of modern poetry.

The title he chose puzzles me. My initial response was to anticipate a patient making a complaint. I have had to deal with several patient complaints recently, in my role as a Complaints Officer. We tend to see in a poem, as in life, what we already know.

Decades ago, I was involved in providing GP obstetric care, including a total of eighty home-births. Being called out in the middle of a miserable night to participate in a wondrous event is familiar, but what strikes me here is that Williams has pared the drama down to two actors, his focus being only on the distressed woman and himself. Where were the husband, the other children? Was there a midwife? But a poet has the freedom to pay selective attention to the truth. This is not a documentary, it is creative art, however deeply it may be rooted in real experience. Like parables and mythology, poetry need not be ‘realistic’ to be a potent vehicle for truth.

But perhaps this woman is not in labour. She is sick, we are told, but the next two lines begin with the word ‘perhaps’, bringing a surprising degree of uncertainty into the poem. That may have been his first consideration as Dr Williams entered the room, but for this poem he was not concerned with sharing his diagnostic thinking to resolve uncertainty, instead he abruptly concludes with the following lines –

I pick the hair from her eyes

and watch her misery

with compassion.

Compassion is an abstract term which we are very familiar with in medicine, but for me the most powerful and moving line in this poem is, ‘I pick the hair from her eyes’. The description of that simple gesture conveys in so few words far more than a general lecture on showing compassion.

Williams’ great strength as a poet was his observation of the particular details on which the grand principles of life and medicine hinge. And this is also one of the defining features of general practice – to appreciate and attend to the singularities, the specifics which are of greatest concern for each patient we are with.

This essay was originally published in NZ Doctor, 2022.

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O world of spring and autumn, birth and dying!

The endless cycle of idea and action,

Endless invention, endless experiment,

Brings knowledge of motion, but not of stillness;

Knowledge of speech, but not of silence;

In this excerpt from Choruses from the Rock, poet T.S. Eliot starts by comparing the perpetual cycles of the seasons and the life-cycles which continue throughout history, with the endless march of scientific and technological progress.

In our lifetime, the advances in pharmacology and surgical procedures have been astounding. The emergence of new therapies seems to be not only endless, but exponential in growth. I recall when Cimetidine arrived as the first of the H2-antagonists, followed about ten years later by Omeprazole as the first of the proton pump inhibitors. What huge advances these have been on the antacids and bismuth preparations we had to manage dyspepsia and peptic ulcers with previously.

Percutaneous coronary interventions, cochlea implants, laser retinal surgery – yes, these are the days of miracles and wonders, as poet/song-writer Paul Simon expressed it.

Yet we doctors still struggle on a daily basis with patients with medically unexplained symptoms, which often leave us feeling impotent to assist in spite of our incredibly smart arsenal of interventions.

As T.S. Eliot reminds us, we find we have knowledge of motion, but not of stillness, knowledge of speech but not of silence. All the clever toys and tricks at our disposal do not equip us to be still, to have the ability to sit quietly with our patients. To create or allow the space into which the patient may feel they trust us enough to spill some clues as to the true nature of their distress.

To sit still and to listen actively, is an ancient art which has not been replaced by new technologies. In fact, our heads bursting with information often get in the way of effective compassionate medical practice.

T.S. Eliot went on in that same poem to ask,

Where is the Life we have lost in living?

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

Powerful information technology can help us organise data into knowledge, but what about the link from knowledge to wisdom? We can supplement the information we gather from a detailed history with another layer of information obtained from labs and imaging, but how much does that help us to understand the patient’s experience of illness. How much does the information we gather help us to decide whether we ought to proceed with an intervention, just because we can?

Eliot’s poem, although written in 1934, suggests that we might be smarter with more inventions to use compared with previous generations, but we may have lost some wisdom in the quest for more knowledge and information.

This essay was originally published in NZ Doctor, 2022.

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Oh, Ian, so suddenly you’re gone.

These cold purple lips

delivered denial

through our twenty-five years together

kissed the smokes

sank deep the 19th hole with your mates

cheerily asked for the bad news

at every visit, while I kept saying

what doctors are expected to say

repeated quarterly

along with ritual weigh-ins

lab tests and prescriptions

and all that diabetic crap.

Bald, bearded, round

this face under the sheet.

Your iron defence, always jovial

eventually rusted

to an anxious edge

as you borrowed time nearing sixty.

Sure, Ian, you accepted late

the need for needles

and made your peace with pills

but the habits of a single bloke

life-blood and death-trap

were never really on

the negotiating table

were they?

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