Commentary

Doctors are often encouraged to write about our personal experiences in clinical and academic settings. Sometimes, that writing evolves into something beautiful and literary, as in the career of John Stone. In this poem, “Getting to Sleep in New Jersey,” we have Stone the poet–cardiologist literally treading the footsteps of pediatrician–poet William Carlos Williams outside Rutherford, New Jersey. We have the solitary Williams scratching things down on his prescription pad when he should be grabbing a few hours of sleep. But perhaps most important, we have Stone revealing insights about the writer's craft and about following two vocations—insights all physician–writers should heed. For the last five years, I've helped to edit a literary/medical humanities magazine called ARS MEDICA and have read hundreds of submissions. We commonly see five errors that doctors make when they start to pursue creative writing. These observations begin with elements of craft and narrative competence but then move into murkier territories like hunger for publication. Stone's subtle lessons in “Getting to Sleep” can guide physician–writers away from these common pitfalls, as I'll point out below. By habit, doctors cut to the chase, so they do a lot of “telling” and not enough “showing.” Their narratives may be terse and pragmatic, and can mimic a case presentation. On the other hand, physicians' poems can become oversentimental and sometimes embrace cliché, perhaps to counter the clinical detachment so valued in medical culture. We as readers need sounds, dialogue, color, scents, and images to enter the story. Readers, like patients, want to know that we are in good hands. Consider how Stone, with very few words, gives us the wind, how it “corners the house with a long crow.” How the snow is “contagious.” We more than know—we feel—Williams is cold and alone in the night. Doctors tend to favor tidy endings, epiphanies, and accounts of patients who exhibit extraordinary courage. These have become the tropes of illness narratives, but they don't capture the chaos and suffering of medical practice or of real life. Readers want to be shaken and left with a challenge, dilemma, or new perspective. Stories and poems about our clinical “failures” are much more honest and compelling. Stone reveals that there is nothing easy about writing. He doesn't leave us settled by a triumphant Williams churning out perfect verse on a spring day. We are reminded of the loneliness of the writer—of the errors, of the compulsion to edit, of the hunger for the right word. Physician–writers sometimes forget about their audience. Processing a personal dilemma or using writing as a reflective, therapeutic tool has great value, but it doesn't make the writing comprehensible, or even interesting, to someone else. We've read a lot of submissions that were spontaneous and raw but that remained “scratches on a pad” because they were not ushered through the exigencies of craft. “Getting to Sleep” is all about craft. For the imagined Williams, writing a poem is like going into labor. Pain. Exhaustion. Waiting and trusting that good will come of the process, whether “feet or butt or head first.” Then we have Stone's own considerable craft. We could imagine Stone mimicking Williams' precise, pared-down style, to which he alludes by mentioning Williams' “red wheelbarrows.” Instead we have Stone disciplining his admiration for a beloved poet through use of form. He uses meter and rhyming couplets to propel us to read to the end. We, too, are “hungry for morning” and come to have a much better sense of the patience it takes for “the perfect word” to appear. Neophyte physician–writers often lack humility and patience. They are used to calling the shots, seeing results, and manifesting their authority. Many don't accept that they are beginners at writing and that creative talent (and the muses themselves) simply won't be rushed. Here, Stone models humility through Williams' toil. Every physician reader of this poem likely knows about William Carlos Williams. Yet Stone reminds us of the difficulty in sustaining both roles, of catching a baby, then moving to delivering a poem. We see the slow dedication and discipline that are required in this poem's poiesis. The final error we all make as we take up the pen is more serious and needs to be reviewed through the lenses of ethics and professionalism. We as doctors often think that the stories heard in our offices somehow belong to us and are ours to tell and even publish. Writing physicians, if they are honest with themselves, can usually identify the impetus for a poem or story—a singular image, a facial expression, or a patient's unique way of saying something. Part of craft is using that detail as a point of departure, then moving into something entirely new, perhaps another “perfect word,” without violating confidentiality. Stone does not write about a specific patient in “Getting to Sleep” but, rather, pays homage to a fellow traveler. He is respectful because he can mentalize Williams' experience as a poet who must steal time for his creative work. He can appreciate that waiting, observation, repetition, and reflection are the skills of both the doctor and the poet. Allan D. Peterkin, MD

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