I remember being present when a Jesuit priest in Rome asked Tennessee Williams, “How do you write a play?” and Tennessee said, “Well, I start with a sentence.” Well, I start with a sentence, and that’s how you write a book.

When I was this young assistant at the University of Groningen my responsibility was for four beds, or rather the patients in four beds. That was all I had to do. And, one of these patients was a young man, 22 years old, who slowly and miserably died from renal failure. He became blind, he vomited, and it was a miserable death. And I, as a very, very young physician, had to tell his mother, in a black dress and a little white cap like the farmers have, that her only son was going to die. I couldn’t do a damn thing about it. So, I began to think, “If I could just every day remove as much urea as this boy creates, which is about 20 grams, then the boy could live.” Well, he died, but I began to work on that.

No. I think when I first started writing songs, I was approaching it more literally or narratively in the beginning, but through observing some of my close friends and some of my heroes write, I pretty quickly shifted into at least starting the process from a more subconscious space, or a more instinctual space. And I’ve really come to believe that it’s all there. It’s all already there, and if you can just kind of open the window and step out of the way, at least at the beginning of the process, with your subconscious mind, you can unearth so much raw material, and then go back and sift through that and shape it.

I started with the earliest tools: mashers and cutters, knives and knots. I would cast them in paint, and embed them right in the surface. I was using plastilene clay to make the molds. One day my friend Art Schade said, “Why don’t you just make the paintings on the clay ?” It was one of those moments where you hit yourself in the forehead. So I built a big clay table, eight by ten feet. And I could engrave the surface in all kinds of ways.