What "Aequanimitas" Taught Me About Living in Day-Tight Compartments

🎧 Listen to the Discussion(two hosts talk through their thoughts on this article)

This is an AI-generated audio overview of this article, created with Google NotebookLM. Two hosts discuss the article together, sharing their own thoughts and commentary — it is not a reading of the article text.

William Osler's Aequanimitas — specifically four of its addresses, "Aequanimitas," "Doctor and Nurse," "A Way of Life," and "Bed-Side Library for Medical Students" — is the book behind this personal record of what I've actually started doing at 66. Less a review of the book than a log of my own practice.

For the five years I spent at medical school, there was a name I kept hearing without ever reading a word of the man: Osler himself. Canadian-born, one of the architects of modern medical education, and in his last years Regius Professor of Medicine at Oxford. Back then I was too busy chasing exams to open his addresses. Splitting the year between Britain and Japan, I finally did — and found that what looked like a set of talks to medical students is also a letter to anyone standing at the doorway of old age.

An illustration inspired by the lines from Marcus Aurelius that open the book: "Be thou like the promontory against which the waves continually break." The sea keeps coming; the headland simply stands there.

Keeping it off my face

The title address was given in 1889, when Osler was 39 and leaving the University of Pennsylvania. The first quality he asks of a physician is imperturbability.

Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril. — from Aequanimitas, "Aequanimitas"

What strikes me is that he treats calm not as an inner state but as something visible — a matter of face and bearing. A doctor who looks flustered, he says, loses his patients' confidence fast.

Reading it, I thought not of a consulting room but of myself in front of a brokerage screen. On a heavy down day I say nothing to anyone, and yet my movements around the kitchen give me away within minutes. Living in Britain, I have spent a decade watching prices creep upward until the sensation is in my body; every winter in Japan I feel the strangeness and the relief of prices that simply stay put. Moving between two economies has taught me that panicking about either one alone makes very little sense. So now, on the days the market drops, I close the screen and go out to the garden — not to postpone the decision, but to put one breath between the feeling and my face.

Living in day-tight compartments

In 1913, at 64, Osler spoke to the students of Yale. He borrows the watertight bulkheads of an Atlantic liner to argue for cutting life into single days.

The load of to-morrow, added to that of yesterday, carried to-day makes the strongest falter. — from A Way of Life

The weight, in other words, is rarely today. It is the yesterday and the tomorrow we carry into today.

Of the sufferings the Buddha described, the one I have only lately understood is the suffering that arises from the workings of body and mind themselves. In my twenties it read as an abstraction. Now it is plain: the ache itself is one day's worth, but the worrying about it takes on yesterday's share and tomorrow's too. Osler's ship maps onto it exactly. You do not abolish the water; you close the compartment it can flow into.

In practice, I have made a small morning moxibustion the signal that today's door is open. One cone at the point below the knee, and for the few minutes it takes for the warmth to spread, neither last night's regrets nor next month's diary is allowed in. It is a very small thing, but the shape of the day is different depending on whether those few minutes happened.

A cross-section of an ocean liner, drawn from Osler's bulkhead metaphor. A ship stays afloat not because water never enters, but because what enters stops at one compartment — here, the one with morning light in it.

The longest job of all

In the same address, Osler reaches for Plutarch to explain what character actually is.

"Character," which partakes of both, in Plutarch's words, is "long-standing habit." — from A Way of Life

Character, then, is not something issued at birth. It is a shape carved by repetition.

The first thing that came to mind was the asparagus bed. From planting to the first cut you wait three years. In year one and year two you cut nothing: you let the spears run up into feathery fronds, let them yellow, clear them in autumn, and wait for another spring. The thick spears of year four are made entirely of the care given in the years that produced nothing. I can think of no better picture of "long-standing habit," and nothing else I grow here resembles my own later life so closely.

There is a pleasing coincidence in the dates. Exactly two hundred years before Osler spoke at Yale in 1913, the Japanese Confucian scholar Kaibara Ekiken wrote Yōjōkun, his book on the care of life, in 1713. One is an address to English-speaking medical students; the other is an Edo-period manual of moderation. Yet the core — restraint, regularity, and attention to the single day — is very nearly identical. What Ekiken framed as reverence, Osler called habit. Two centuries and ten thousand kilometres apart, arriving at the same place, suggests the answer belongs to the body rather than to either culture.

An asparagus bed in spring: new spears in front, last year's cleared fronds behind — a reminder that this year's growth was paid for by seasons that yielded nothing.

The last half hour of the day

The shortest of the four pieces is the bed-side library. After telling students not to be satisfied with professional training alone, Osler makes a very concrete suggestion: read for half an hour before sleep, and leave a book lying open on the table beside the bed for the morning.

A liberal education may be had at a very slight cost of time and money. — from Aequanimitas, "Bed-Side Library for Medical Students"

He then lists ten books to live with — the Old and New Testaments, Shakespeare, Montaigne, Plutarch's Lives, Marcus Aurelius, Epictetus, Religio Medici, Don Quixote, Emerson, and Oliver Wendell Holmes's Breakfast-Table series.

I do not expect to finish all ten. What I took from this section was not the list but the half hour and the open book. The difficulty at this age is not reading but retrieval: a name or a title comes up to the back of the teeth and stops there. Proper nouns, in particular, vanish cleanly. So I now leave a tab on the open page and start the next morning from it. Simply not closing the book takes a surprising amount of load off memory.

And in a sense this blog is my other bedside table. If I forget things as fast as I read them, the answer is to write them down before they go. Memory weakens; the ability to keep editing a life by writing it does not. Since I began thinking that way, I have stopped feeling self-conscious about keeping a record.

Adding to life rather than taking from it

In 1891 Osler addressed the first graduating class of nurses at Johns Hopkins. Near the end of that talk are the two lines I sat with longest.

Happiness lies in the absorption in some vocation which satisfies the soul. — from Aequanimitas, "Doctor and Nurse"

He goes on: we are here to add what we can to life, not to get what we can from it.

What happiness is, what goodness is, what any of us was born for — I have never had answers to those. But those two lines moved the question for me from "what will I become" to "what will I hand over." What is handed over need not be large. Spare seedlings go to the neighbours. Things seen on winter journeys get written up for English-speaking readers; the small texture of British life gets written in Japanese. All of it sits within ordinary daily life — and yet the days when something has been handed over really are a different colour.

Connected to people whose faces and names I will never know, through nothing but shared experience: I think there is room in the world for that kind of quiet solidarity.

Where I part company with the book

This last one is not in Osler.

In "Aequanimitas" he is faintly pessimistic about calm: the quality is largely innate, he says, and some are born without it — though practice and experience can carry a person a long way toward it. For a man not yet forty, equanimity was something to be earned.

My own suspicion is that age itself hands out this so-called gift, only later. When stamina goes, hurrying is no longer available. When all-nighters stop working, worry cannot be extended past dawn. Anger that would once have burned through a whole night now fails to catch at all. A way of seeing life that was unavailable to me at thirty arrives not through effort but through physical decline — one of the few dividends of growing old.

The same address contains this line:

One of the first essentials in securing a good-natured equanimity is not to expect too much of the people amongst whom you dwell. — from Aequanimitas, "Aequanimitas"

At thirty I would have read that as a cold piece of worldly advice. It sounds different now. Lowering expectations is not writing people off; it is seeing them at their actual size. A rich old age, I suspect, is largely time spent looking at the world at its actual size — a thought I have while waiting for asparagus to show.

The suffering does not go away. The body concedes a little more ground each year. Still: cut the day off at both ends, put one breath before the face, keep the last half hour, hand something over. Words written for medical students more than a century ago are still doing useful work in the hands of one retired gardener.

The book mentioned here:

William Osler, "Aequanimitas: With Other Addresses to Medical Students, Nurses, Doctors and Practitioners of Medicine"

(As an Amazon Associate I earn from qualifying purchases.)

---

The world William Osler lived in

A medical school lecture theatre around 1889, when the valedictory address was given: tiered wooden benches, a bearded lecturer, light from a high window — the era into which Osler was pushing bedside teaching.

William Osler (1849-1919) was born in a settlement in Ontario, Canada, the son of an Anglican missionary and one of nine children. He first followed his father toward the church, and it was at theological college that two teachers — Johnson, a keen naturalist, and Bovell, a physician — turned him toward medicine. In "A Way of Life" he says plainly that his course was set not by a great decision but by a chance encounter.

The 1870s, when he qualified, were years in which medicine was being rebuilt from the foundations. Anaesthesia and antisepsis were spreading, bacteria were being identified as causes of disease, and the microscope was becoming a diagnostic instrument. At the same time hospitals still carried the odour of places where the poor went to die, and nursing had only just become a profession. Osler's enthusiasm for the historical dignity of nursing in "Doctor and Nurse" makes sense when you realise the profession was taking shape in front of him.

His career maps neatly onto the addresses collected here: McGill, Pennsylvania, Johns Hopkins, and finally Oxford. "Aequanimitas" marks his departure from Pennsylvania; "Doctor and Nurse" belongs to the Hopkins years; "A Way of Life" was delivered at Yale after he had settled in England. The book is, among other things, the record of a man moving between the North American and British traditions of medicine — which is part of why someone who divides his own year between two countries reads it with such recognition.

Two things seem to me to run through his thinking. The first is the classics. He read Greek and Roman authors closely and quoted Marcus Aurelius and Plutarch as everyday speech; the title Aequanimitas itself is taken from the watchword the Roman emperor Antoninus Pius gave as he lay dying. The second is a humour he never gave up. Osler joked on the wards and once published a spoof paper under a pseudonym, and the sudden lightness that breaks into these solemn addresses is the man's own grain showing through.

He was also, thoroughly, a man of books. He collected rare volumes all his life, and that library survives at McGill as the Osler Library. The ten titles in the bed-side list were not a casual suggestion; they were the books he kept beside his own bed.

His last years were not simply happy ones. In 1917 his only son, Revere, was killed in the First World War — the man who preached equanimity met the one event in which equanimity is least available. Two years later he died of pulmonary complications during the influenza pandemic, at seventy. I suspect his words are still read because they were never the optimism of someone untouched by pain, but the practice of someone who had taken pain on.