Dr. William Casale displays his favorite photographs across from his desk, where he can see them all the time.
One shows a boyish Dr. Steven Silverman, leaning back in his chair and laughing, while a dark-haired Casale smiles into the camera.
“That picture was taken in 1978 at 3 in the morning,” says Casale, his now-white hair pulled back in his signature ponytail. “We’re so young! Steve looks like a teenager.”
In the middle of that long-ago night, in a room at Good Samaritan Hospital, the two obstetricians waited.
A baby was about to be born — one of nearly 10,000 babies Casale and Silverman would deliver in almost 44 years in practice together in West Palm Beach.
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“I don’t remember if it was my patient who was in labor, and Steve came in to help me, or if it was Steve’s patient, and I came in to help him,” Casale recalls. “We wanted to be there. We got to know our moms. They became our friends … their husbands, too.”
The doctors involved expectant moms in decisions about their own deliveries — a new idea at the time — and moved the dads from the waiting rooms to the birthing rooms.
“We got to start natural childbirth in Palm Beach County,” Casale says. “In 1975, people were beginning to use Lamaze; there was a lot of talk about it, but few people were doing it. Moms were sometimes put to sleep and tied down. We knew there had to be something else, a better way.”
That something else was to give moms the choice to experience labor, pain and all, and to let dads help pull their babies out and cut the umbilical cords. The doctors would guide and intervene only when medically necessary.
“Our favorite deliveries were when we were doing nothing — just taking pictures,” Casale says.
And what a thrill to participate in that miracle.
“It’s unbelievable,” he says. “The fact that we can help make someone’s birth experience so great, and it’s the biggest thing in their life; how great is that?”
It’s so great, it’s hard to give up.
Casale looks at the 1978 photo again: “Can you believe it? We never had one fight in 44 years. Not one argument.”
Casale and Silverman loved their work and loved working together so much, they never thought about retirement — until COVID.
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“We were playing cribbage one day at the beginning of the COVID shutdown, and I asked Steve: ‘How much longer do you want to hang in here?’ He said, ‘Till I’m 80.’ Steve was 71 then, and I’m three years older, so I said: ‘OK! I’m going to try to hang in there with you.’
“But you can’t plan life.”
‘We came from the same place’
“Bill and Steven — their relationship was like a marriage,” says Silverman’s wife of 44 years, Valerie.
Physically, they were a mismatch: Casale was the laidback hippie in flip flops and ponytail. Silverman was the clean-cut, soft-spoken, business-savvy guy.
Emotionally, they clicked, a connection Casale says he “felt in his gut.”
“We came from the same place,” he says, both in literal geography — they’re New Yorkers – and the geography of the heart.
“We came from poor families with great parents. We had an appreciation for education and work. And neither one of us was in it for the money.”
Their lives became a buddy movie, like Butch and Sundance — with scrubs and stirrups, hot flashes and heartbreak, bone density and breast scans, menopause and many, many mothers and babies thrown in.
Obstetrics and gynecology are special fields; not the same as, say, podiatry.
Women’s health is personal and powerful: The physical intensity of pregnancy is like running a 40-week marathon, and menopause shifts a woman’s total identity into a new chapter.
Casale and Silverman understood that, says Kim Pino, their office manager for 29 years.
She sums up their chemistry like this: “You go to some physicians, and you’re just a patient. But when you see them, you’re a friend. They take an interest in you — a true interest in making sure women are comfortable in all the various stages of life.”
Casale and Silverman stopped delivering babies in 2004, as they and their patients got older, but they continued a playful atmosphere in the office.
Doctors and staffers were like family to generations of local women
When patients are waiting for their gynecological exams — in that awkward feet-in-stirrups position — they look up and see funny stickers and pins stuck to the ceiling with messages: “I brake for Elvis.” “I refuse to grow up.” “Did we make you smile yet?”
“It’s just one way to make women feel comfortable,” Pino says.
Few women look forward to their annual pap smears; but these doctors and their longtime staffers felt like family to generations of local women — going back to 1952, when Dr. Theodore Gerson, now 101, opened the practice that would become the Comprehensive Women’s Medical Center in West Palm Beach.
Gerson was getting tired of delivering babies at all hours, so Casale joined the practice in 1975, fresh from his ob/gyn residency at University of Connecticut School of Medicine.
Casale grew up knowing he would be a doctor (his buddies called him “Doc” when he was 5), even though that dream seemed far-fetched for a longshoreman’s son from Brooklyn’s Flatlands neighborhood.
“My mother was the only one in my family who had graduated from high school,” Casale says. She helped him with his homework and got extra jobs to pay for his education.
He got that education fast: Casale delivered his first baby on his first day of medical school.
“I didn’t even know where a baby came from,” he recalls. “It was my first day at Newark City Hospital. I figured I’d have two weeks of orientation; but a nurse ran up to me and said, ‘Are you a medical student? Scrub up!’ She talked me through my first birth, and the moment the baby came out, I knew I wanted to do that for the rest of my life. It was such a thrill.”
Silverman grew up in Greenwich Village, in a close Jewish family of modest means. He graduated high school at 16 and got a college degree in psychology. Then, he taught sixth grade for two years before going to medical school at Wake Forest University in North Carolina.
When his father, Abe, died during his first year of medical school, Silverman went to the Wake Forest dean and told him he’d probably have to drop out and get a job.
“The dean said, ‘Don’t worry, we’ll work it out,’” Valerie Silverman recalls. “Steven ended up graduating with a $75 debt, which we paid back at $5 per month.”
A mutual friend led Casale to Silverman.
How Dr. Silverman got the nickname ‘Dr. Vacation’
“I remember when Dr. Gerson and I were first interviewing Steve, we called his boss at his residency in Hartford,” Casale says. “He said, ‘Steve is the best resident I’ve ever had … and, wow, he really does love his vacation time.”
When Silverman showed up at the practice, he took one look at the exhausted Casale and said: “You need a vacation.”
Casale starts chuckling at the memory. “Steve told me the best hotel was the Hyatt in Maui, and that’s where I should go. He set up that vacation for me.”
This is where Silverman’s nickname — “Dr. Vacation” — began.
The man loved to travel. Really loved to travel. Africa three times. Antarctica. The Arctic Circle. Alaska. Israel. Name the country or name the best hotels and restaurants in the country, and Silverman knew. His photographs from his travels filled the walls of the office.
“We had patients call the office simply to get Steve’s vacation tips,” Casale says.
Vacations were a proof of life for Silverman, his wife Valerie says. “He believed life was to be enjoyed. And he knew how fragile life is. Every time a friend of ours would pass away, Steven booked a trip.”
Live life all the way and every day, he’d say. Exude gentleness and warmth, he’d say.
“We were great together,” Casale reflects, as if he still can’t believe his good fortune that this loving man, this Dr. Vacation, showed up to work and play alongside him.
“We had such fun, such a good time. Ninety-five percent of the time, our profession is a happy one.”
In the hard times, when a patient got sick, or got divorced or lost her spouse or parents, Silverman sent handwritten notes of support. He and Casale kept albums full of thousands of photographs of babies they had delivered. The walls of Casale’s office are covered in photos and notes and tokens of affection from his patients.
“As my grandkids will tell you, I can never go anywhere without someone coming up and saying, ‘You delivered me!’” Casale says.
His life philosophy remains the same as it was back in Brooklyn.
“The key is to be consistent. Wake up every day. Exercise. Go to work every day. Be nice to everybody. Then your life is simple.”
‘Going on ventilator. 50-50 chance.’
Valerie and Steven Silverman bought cemetery plots at the South Florida Jewish Cemetery in June 2020. The threat of COVID had scared everybody.
“We thought we should prepare, find a spot our children would be able to visit,” Valerie says. With that paperwork done, she headed to Maine, her home state, for her annual summer trip.
She left on June 22. At the end of July, her husband called and said he “felt off” and had a cough.
No big deal, he said. Please don’t worry. Please stay in Maine and don’t worry.
He was in great shape, a regular runner, like Casale. He had been cycling that morning and walking their dog, Zoey.
What happened next still feels like a slow-motion nightmare: one day, Silverman would feel halfway decent, and the next day, he’d feel so off and so tired, he could barely do anything. Then, he’d rally and feel well enough to walk Zoey. Then he’d feel exhausted again.
Kim Pino called Silverman on Aug. 8, when her daughter, Ariane, went into labor. “He was home sick, but he said he felt pretty good. He called Ariane’s doctor, Dr. (Glenn) Collins, to check on her. He treated my daughter the same way he treated his own daughter.”
That was the last time Pino talked to Silverman.
He went into the hospital on a Tuesday and sent one last text that Friday: “Going on a ventilator. 50-50 chance.”
Valerie never kissed her husband goodbye. She and their children, Aimee and Michael, talked to him when he was on a ventilator, sedated and separated from them. They said “I love you” through the phone.
Dr. Steven Silverman died on Sept. 10, 2020, from complications of COVID-19. He was one month shy of his 72nd birthday.
Did he get the virus from a patient? Who knows? Casale racked his brain, but there’s no way to know.
In the immediate sting and shock of grief, Valerie felt angry and bereft.
And then the notes and letters flooded in, and the calls, and the messages of gratitude from the thousands of women her husband had cared for and comforted, and the mothers of those babies who had entered the world in her husband’s hands.
Patients called the office, sobbing. They were devastated at the loss of this good doctor, this good man, this good friend.
On Silverman’s tombstone are these words: “Beloved family man. Caring physician. Best friend to all.”
‘I have witnessed the beauty and wonder …’
William Casale retires on July 22. Without his best friend, it’s time to move on.
“With a heavy heart, I formally announce my retirement from a beloved career that has spanned over 47 years as an obstetrician-gynecologist in Palm Beach County,” he wrote in an announcement in The Palm Beach Post. “The honor and privilege of managing the health of countless remarkable women have been life-affirming. The enduring friendships, endearing family bonding and collegiate camaraderie are rewards I will forever embrace. … I have witnessed the beauty and wonder of new birth and expanding families for five decades and shared the heartache and tragedy of life’s inevitabilities. Thank you for allowing me to be part of your life’s story, as you have been of mine.”
He feels lucky, he says.
How blessed can one man be, after all — to be part of so many life stories, to do what he was born to do, and to do it alongside a human like Steven Silverman?
“He was my brother,” he says.
Heartbreak is entwined with happiness, of course.
Casale plans to keep volunteering. He was the volunteer medical director of Planned Parenthood for years, and his devotion to women’s health continues.
He visits Silverman’s gravesite regularly. “I’m an Italian American. I go to the cemetery,” he explains.
He sits and he thinks. He talks about their patients and their families — and how much it hurts to miss someone.
In August, Casale and his wife, Pat, are taking their first cruise, to Alaska.
“Can you believe it?” he says. “Steve planned that trip for us two years ago, and we’re finally going.”
He smiles at the memory of Silverman plotting each detail of their trip.
It’s almost as if he can hear Dr. Vacation whispering in his ear: “Go for it, Bill. It’s time. Live life all the way.”
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