All day long the doctor carries on this work, observing, weighing, comparing values of which neither he nor his patients may know the significance. . . . He is half-ashamed to have people suspect him of carrying on a clandestine, a sort of underhand piece of spying on the public at large. . . . His only fear is that the source of his interest, his daily going about among human beings of all sorts, all ages, all conditions will be terminated. That he will be found out.

William Carlos Williams, Autobiography (1951) Black bag (adj., as in black bag jobs): illegal, surreptitious, undercover operations with the purpose of securing information, such as warrantless wiretaps, break-ins, and mail-openings.

William Carlos Williams was luckier than most people. He seemed always to know what he was about. Or at least, writing at the age of sixty-eight, he knew what he had been about. "As a writer, I have been a physician, and as a physician a writer," he said simply in the "Foreword" to his Autobiography in 1951.

Although it is accurate to say that William Carlos Williams' stories are a doctor's stories, saying that does not indicate that they are to be judged less strictly or rigorously than are the stories of, say, Stephen Crane or Henry James. The point in calling them a doctor's stories is that at their best they draw essentially both from the doctor's quotidian experiences and upon his embodied conflicts between his learned professionalism and his affective impulses. His practice was his avenue to particular kinds of sociological experience that would otherwise have been unknown to him. His profession, however, placed him in a peculiarly vulnerable position as a participant-observer. His temperatment, moreover, was neatly split between that of the feeling, observing doctor and that of the practicing poet. He was a doer and a maker. He was a contemplator and an actor. He was a poet-physician. These two-parted identities stand behind his every word.

Such complementary/conflicting identities shape the substance of his "doctor" stories, four of which I shall examine here: "The Use of Force," "Jean Beicke," "A Night in June," and the superb late tale, "Comedy Entombed: 1930." Spanning Williams' entire career as a writer of fiction, these four stories, taken as a block, are representative of Williams' interests and techniques.

"The Use of Force" was first collected in Life Along the Passaic River (1938). Readings of the story frequently conclude that the doctor-narrator's encounter with his young female patient, understood psychoanalytically, evolves into an adventure in displaced sexuality. But the story can also be read in terms of affective neutrality, which sociologist Talcott Parsons defines as the encouraged capacity within a physician to set aside normal human emotions and to depend instead upon medical training and learned technique to guide professional behavior. That control, in turn, enhances the possibility that his procedures will be technically successful. Paradoxically, the practice of medicine, seen by many as an art in the service of humanity, calls for a practitioner to put aside, indeed to suppress even the possibility of his ever feeling emotion toward a patient. "The Use of Force" explores on a small scale the human consequences of the physician's having to live with this paradox.

The story starts out quietly enough. The narrator (a doctor) reports having smiled at his "new" child-patient in his "best professional manner." The smile leads to other "professional" devices. Mixing questions with suggestions, he asks the child to tell him her given name; he asks her to open her mouth; and when she does not immediately accede, he gently coaxes her. All to no avail. So far the doctor is still in control. Careful as he has been, however, he has already slipped up once. He has not taken the child's parents into account and the failure to do so begins to affect his relationship with the child. First, the well-meaning mother tells the child that the "nice man" will not "hurt" her. "At that I ground my teeth in disgust," reports the doctor. "If only they wouldn't use the word 'hurt.'" After further futile efforts at getting the child to open her mouth, during which she knocks the doctor's glasses off, the mother again takes the initiative, shaking her by one arm and chastising her for her bad behavior towards "the nice man." This time the doctor turns on the mother. "For heaven's sake," he breaks in. "Don't call me a nice man to her." There is nothing "nice" in what he is there to do, he insists. It is a matter to be handled with professionalism. "I'm here to look at her throat on the chance that she might have diphtheria and possibly die of it." Another direct appeal to the child fails. This is followed by the doctor's rather unprofessional threat to shift the burden for the child's safety to the parents. "Then the battle began. I had to do it. I had to have a throat culture for her own protection," he insists. "But first I told the parents that it was entirely up to them. I explained the danger but said that I would not insist on a throat examination so long as they would take the responsibility." (Emphasis added).

Again the mother admonishes the child. "If you don't do what the doctor says you'll have to go to the hospital." By this time, much too emotionally involved in the conflicts, the doctor admits that while "the parents were contemptible" to him, he had already "fallen in love with the savage brat." In the ensuing, accelerating struggle, the doctor loses more and more of his professional neutrality. With a start he realizes that he has "grown furious" and, worse, that his fury is directed at the child. Fury at a child, in an adult, is ugly enough. Fury at a child who is also a patient, in a doctor, is, of course, professionally inexcusable. Worse still, although he recognizes his behavior for what it is, he can do little about it. "I tried to hold myself down but I couldn't," he admits. His continued efforts to force her mouth open with a wooden spatula have cut her tongue and caused her mouth to bleed. At that moment he realizes that perhaps he should have desisted and come back in an hour or so, that is to say, when, perhaps, both the doctor-adult and his patient-child had cooled off. But he rationalized his need to gain his clear-cut immediate victory over the child by observing that he has already "seen at least two children lying dead in bed of neglect in such cases." The rub, however, is that he "too had got beyond reason." Indeed, he "could have torn the child apart" in his "own fury and enjoyed it. It was a pleasure to attack her." His rationalizing continues. "The damned little brat must be protected against her own idiocy," he begins righteously, adding, in a moment of great self-knowledge, or so "one says to one's self at such times." To this he adds a saving professional rationalization: "Others must be protected against her. It is social necessity. And all these things are true," he insists. But it is neither professional duty nor objectivity that is now operative. "But a blind fury, a feeling of adult shame, bred of a longing for muscular release are the operatives." All ideals and duties aside, "One goes on to the end." The child is then over-powered in a "final unreasoning assault." And sure enough, the doctor has his victory and his discovery of the child's "secret." The tonsils are "covered with membrane," the child does have a sore throat, and the diagnosis is diphtheria.

"The Use of Force" tests the doctor's ability to function as a professional. There is a "best professional manner," as Dr. Williams well knew, and it goes beyond the possibilities inherent in a friendly smile. But in "The Use of Force" he presents us with a self-contained segment in which a medical practitioner willfully permits first the erosion and then the collapse of his own affective neutrality. Faced with a situation that calls only for a rather simple diagnosis, the doctor all too quickly succumbs to his own feelings. In his emotional reactions to the parents who, it is immediately obvious, remain ineffective before the child's obstinacy and his anxious willingness to redefine his physician's role into that of antagonist to his patient, the narrator allows his own emotions precedence over professionalism. Williams' account of the doctor's impetuous and dogged struggle with his young patient renders brilliantly the fragility of that professional's affective neutrality by which the physician would do his life's work.

In "Jean Beicke," a second story from his collection Life Along the Passaic River, the relationship between the physician and his patient is all on the side of the physician. Perhaps the best place to begin discussing "Jean Beicke" is the end of the story: the account of the autopsy. The child with the too long legs, with an omniverous appetite that compelled her to eat everything given her, has succumbed at last, having first won the emotional support of her nurses and doctors. So much so, in fact, that her nurse, despite the doctor's attempts, has not gone down to the postmortem. "I may be a sap, she said, but I can't do it, that's all. I can't. Not when I've taken care of them. I feel as if they're my own." It is important that we hear this, for the nurse's behavior, with her attendant explanation, serves as a necessary prelude to the doctor's account of the autopsy.

I was amazed to see how completely the lungs had cleared up. They were almost normal except for a very small patch of residual pneumonia here and there which really amounted to nothing. Chest and abdomen were in excellent shape, otherwise, throughout—not a thing aside from the negligible pneumonia. Then he opened the head. It seemed to me the poor kid's convolutions were unusually well developed. I kept thinking it's incredible that that complicated mechanism of the brain has come into being just for this. I never can quite get used to an autopsy.

The first evidence of the real trouble—for there had been no gross evidence of meningitis—was when the pathologist took the brain in his hand and made the long steady cut which opened up the left lateral ventricle. There was just a faint color of pus on the bulb of the choroid plexus there. Then the diagnosis all cleared up quickly. The left lateral sinus was completely thrombosed and on going into the left temporal bone from the inside the mastoid process was all broken down.

As one would expect, the doctor, who had been so solicitous, always looking for signs of progress and dreading the possibility of deterioration, even to the point of rooting like a fan for the scrappy kid, is now coolly clinical. Look at what he notices, and remember that the child is dead. "The lungs had cleared up. They were almost normal." The patch of pneumonia that remains "really amounted to nothing" Chest and abdomen are in "excellent shape." Then the doctor opens the head. As for its convolutions, they were "unusually well developed." Then the coolness falters, when he admits that he kept thinking that it was incredible "that that complicated mechanism of the brain has come into being just for this," an autopsy. It is in the head that the doctors succeed in their quest—their inquest—as the pathologist takes up the brain. Here Williams describes his next professional move. He "made the long steady cut which opened the left lateral ventricle." Only at second or third thought, perhaps, does one realize the violence of the pathologist's act and its attending violation of the child's brain. But the clinical cut "opens" that part of the brain, and reveals the mystery. "The left lateral sinus was completely thrombosed and on going into the left temporal bone from the inside the mastoid process was all broken down." The breakdown is exposed, and the "diagnosis" cleared up. It should be noted that diagnoses are usually in the service of life and potential health, and therefore patient-oriented. But here there is no longer a patient, merely a cadaver for which all diagnoses are bootless. In what sense is it still a satisfying diagnosis? And in what sense is it still health-oriented? Uncovering the breakdown of the mastoid process, discovering the logic of the disease, serves the doctors, of course. When a third physician, the "ear man," is called down to see for himself what has been found, he conjectures that they made a mistake. "A clear miss, he said. I think if we'd gone in there earlier, we'd have saved her." But the narrator-physician will have none of such talk. The autopsy has apparently served its neutralizing purpose. The doctor dismisses the "ear man's" comment with a political quip. "For what? said I. Vote the straight Communist ticket." To which the ear man counters: "Would it make us any dumber?" Satisfaction has come with postmortem knowledge. The child has disappeared into the inquest. The physician's faith in his science and craft is intact. And besides, who needs another unwanted child, let alone an unwanted voter? The doctor, after his infatuation with the child ("we all got to be crazy about Jean"), has reverted to the self who, making rounds in the morning, would tell the nurses that the "miserable specimens" who would survive would "grow up into a cheap prostitute or something." Of course, what gives this story its power is that the wisecracking and the running diagnosis cum treatment cannot eradicate the narrator's affections. They can, from time to time, encapsulate them.

Collected in Make Light of It (1950), "A Night in June," set in that fabled month for love and marriage, calls for a doctor to attend a woman at term. Settling in for a night of waiting for the delivery of what will be the woman's ninth baby, the doctor falls asleep. He sleeps at the kitchen table in a pleasant and comfortable position. He dreams; and in his half sleep he begins to argue with himself—"or some imaginary power." The argument turns on a conflict between "science and humanity." The dream, as the doctor describes it, runs like this:

Our exaggerated ways will have to pull in their hours, I said. We've learned from one teacher and neglected another. Now that I'm older, I'm finding the older school.

The pituitary extract and other simple devices represent science. Science, I dreamed, has crowded the stage more than is necessary. The process of selection will simplify the application. It touches us too crudely now, all newness is over—complex. I couldn't tell whether I was asleep or awake.

But without science, without pituitrin, I'd be here till noon or maybe—what? Some others wouldn't wait so long but rush her now. A carefully guarded shot of pituitrin—ought to save her at least much exhaustion—if not more. But I don't want to have anything happen to her.

Within the dream the doctor's options take the form of conflict. Shall he use a substance that will speed up the processes of labor or shall he wait patiently for nature's course? Shall he risk injecting pituitrin in the case of a woman whose uterus after eight deliveries is more than commonly susceptible to tearing to save them both time and fatiguing effort, and in her case possibly something "more," a something that he does not name? This conflict he sees as one between Science and Humanity. What makes its resolution into professional action difficult—after all, the doctor will choose to inject the pituitrin or he will choose not to do so—is that within the doctor another antagonism is playing itself out: the desire to act under the control of neutralized feelings in the face of emotions that threaten to break through the technique with which the doctor practices his artful science. In his dream the doctor sees such conflicts in terms of competing schools that are "older" and "newer." Significant, too, is his claim that as he gets older, he is finding "the older." It is the school of Humanity that is older, the school of Science younger. It has been hardly casual, one recalls at this point, that the doctor began his narrative with a two-paragraph summary of his failure years earlier—as a young man—to deliver successfully the woman's first baby. "It was a difficult forceps delivery"—of course that delivery would call for Science—"and I lost the child, to my disgust." Significant, as well, is the feeling that this failure engenders in the young doctor. He does not feel disappointment, which would be more neutral, more professional, nor grief or pain, which would be more humane. Rather, he feels disgust. He feels aversion, abhorrence; he is, perhaps, offended. If he feels that he is at all to blame for the failure, however, he quickly exonerates himself: "without nurse, anesthetist, or even enough hot water in the place, I shouldn't have been over-much blamed. I must have been fairly able not to have done worse." In short, we are to infer, the doctor had done the best he could given limitations and circumstances outside his professional control. There was no failure of technique, obviously, and therefore no reason for disgust, at least not self-directed disgust.

But all this is preliminary to a story centering, years later, on still another delivery. And by this time the doctor is a seasoned professional. The story celebrates his preparation and judgment, and, in the end, his success. There runs through the narrative a strong sense of contentment and self-congratulation. For example, because seldom are women any longer delivered at home, the doctor must seek out that "relic" of a satchel he had tossed under a table "two or three years" before. Nevertheless, a check shows that it contains just about everything the doctor will need.

There was just one sterile unbilical tie left, two, really, in the same envelope, as always, for possible twins, but that detail aside, everything was ample and in order. I complimented myself. Even the Argyrol was there, in tablet form, insuring the full potency of a fresh solution. Nothing so satisfying as a kit of any sort prepared and in order even when picked up in an emergency after an interval of years.

In the course of the early morning hours the doctor periodically examines the woman, assesses probabilities, and decides on procedures. All runs largely on course until the moment for delivery. "The woman and I then got to work," announces the doctor. Her "hands grabbed me at first a little timidly about the right wrist and forearm. Go ahead, I said. Pull hard. I welcomed the feel of her hands and the strong pull. It quieted me . . ." No forceps are needed. There is no need for the doctor to resort to instrumental intervention. The delivery will be natural, becoming a collaboration of the woman and her doctor. The situation provides the doctor with a moment of quiet self-perception: "This woman in her present condition would have seemed repulsive to me ten years ago—now, poor soul, I see her to be as clean as a cow that calves." The head is born, and then the rest of the baby. There has been no injection of pituitrin, no need for forceps; it has been in every way, a natural delivery. It is as an afterthought that the doctor reminds himself: "Oh yes, the drops in the baby's eyes." But, he quickly decides, there is "no need. She's as clean as a beast." Yet, the professionalism within him reminds him that he can't know for sure. Again there is a professional conflict. "Medical discipline says every case must have drops in the eyes. No chance of gonorrhea though here—but—Do it." The resolution to the allegorical conflict between Science and Humanity—the claims of the younger school and those of the older—is that they can go hand-in-hand when united by the experienced, judicious doctor. There have been employed no "exaggerated ways"; the horns of Science have been pulled in. For once, all's right in Doctor Williams' medical world. Mother and baby are doing fine.

"A Night in June" had begun with a doctor's memory of a forceps-delivered child he had lost. Although he had rather quickly absolved himself of blame, he nevertheless was disturbed by his failure. And, of course, the infant was dead. In "Jean Beicke," the eleven-month child loses her fight, and she, too, is dead. If the Beicke autopsy serves to bring the doctors back to the right professional note, there is no sense that all's right with the world. Curiously enough, though, that is exactly the note sounded in Williams' "Comedy Entombed: 1930," also collected in Make Light of It (1950). The story is thoroughly comic, or would be if it were not for one thing: the culminating event of the story is the delivery of a dead fetus. On second thought, there is no exception to the story's comic thrust. Not only does everything turn out for the best but, in certain respects, rather well. It is, as the doctor says, "just a five months' miss." The fetus was a girl, information the mother uses to taunt her husband who, after several boys, wants a girl. It is the mother, as it turns out, who controls the emotional ambiance of the whole procedure, who "knew it was all right," and who laughs at her husband's bellyache. She taunts him about his couvade: "You'd be more famous than the Dionne quintuplets . . . You'd get your pictures in the papers and talk over the radio and everything." In all likelihood the mother's sustained equanimity has given the doctor's narration its particular coloration and its sense of order-within-disorder. The story is about the discovery of that order, one unexpected and certainly unsuspected. The details of the house—its "greasy" smell to its "soiled sheets"—anticipate the potential messiness of a "birth" four months short of term.

The whole place had a curious excitement about it for me, resembling in that the woman herself, I couldn't precisely tell why. There was nothing properly recognizable, nothing straight, nothing in what ordinarily might have been called its predictable relationships. Complete disorder. Tables, chairs, worn-out shoes piled in one corner. A range that didn't seem to be lighted. Every angle of the room jammed with something or other ill-assorted and of the rarest sort.

In a story in which a dead fetus occasions a mother's not-so-black humor, however, matters are not readily predictable, and the observant doctor does not stop with these observations. He has an insight, an artist's epiphany.

I have seldom seen such disorder and brokenness—such a mass of unrelated parts of things lying about. That's it! I concluded to myself. An unrecognizable order! Actually—the new! And so good-natured and calm. So definitely the thing! And so compact. Excellent. And with such patina of use. Everything definitely "painty." Even the table, that way, pushed off from the center of the room.

"An unrecognizable order! Actually—the new!" That new knowledge will inform the doctor's experience with the collected mother and her dead fetus of a daughter (it's 'born' "still in the sack . . . It all came together . . . the whole mass was intact"). Indeed, since death and disorder are seen to be very much in the nature of things, it is almost as if the whole thing were a joke on the comic father.

"Comedy Entombed: 1930" offers an unmatchable key into Williams Carlos Williams the physician-poet. Williams' aesthetic impulse was in certain ways at odds with his doctor's scientific training. His aesthetic was profoundly Dionysian ("a new order") but his profession calls for an Apollonian temperament. The artist was always looking for new order; the physician always trying to engender the known, predictive, scientific order. As in the past—the scientist would say—so again, so now. The artist: never so before, but now, anew, so.

For the physician the fear would always be that the order would breed chaos, that it would be discovered that at the heart of order will be a disorder (an unknown, unrecognized, unrecognizable disease). The dream of the artist, and the artist's reward, is that his skill and technique and vision will discover for him the new order, and that there will always be such new orders. Williams displayed this most often and most lyrically in his poetry. But these truths were also there, amidst the everyday dust and dirt of his realist's observations, in his stories.