Contemporary Physician-Authors

Exploring the Insights of Doctors Who Write

Nathan Carlin, Nathan Carlin

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000474862
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

This book examines the phenomenon of physician-authors. Focusing on the books that contemporary doctors write--the stories that they tell--with contributors critically engaging their work.

A selection of original chapters from leading scholars in medical and health humanities analyze the literary output of doctors, including Oliver Sacks, Danielle Ofri, Atul Gawande, Louise Aronson, Siddhartha Mukherjee, and Abraham Verghese. Discussing issues of moral meaning in the works of contemporary doctor-writers, from memoir to poetry, this collection reflects some of the diversity of medicine today.

A key reference for all students and scholars of medical and health humanities, the book will be especially useful for those interested in the relationship between literature and practising medicine.

Part I

Two traditional representatives

1 Richard Selzer

Three troubling tales of physicians’ peculiar behavior

Tony Miksanek

DOI: 10.4324/9781003079712-1

What’s so special about doctors who write?

The very best writers possess these six essential qualities: imagination, a keen power of observation, love of language, passion, vivid life experiences, and curiosity. Surgeon-writer Richard Selzer scores high marks in all these areas. Yet he is just one of many accomplished physicians turned writers. In addition to the authors discussed in this book, other celebrated doctor-writers include Anton Chekhov, William Carlos Williams, Mikhail Bulgakov, Arthur Conan Doyle, Lewis Thomas, and Khaled Hosseini.

So why do physicians as a group gravitate toward writing? And how come so many doctors are such effective writers? Physicians enjoy some built-in advantages as writers. Their work days are filled with drama, conflict (disease, difficult diagnoses, bureaucracy), colorful characters, and a fair share of irony. As for setting, physicians ply their craft in a high-stakes, sometimes life and death arena. Few venues can match the spectacle of the emergency room (ER), operating room, or ICU. Even the clinic exam room of a primary care physician can feel like a confessional booth. Regarding characterization, there’s never a shortage of fascinating people in a physician’s practice—silent and suffering, eccentric, stoic, crochety, resilient, jovial, stubborn. And for plot, how about a lengthy list of illnesses, trauma, and misfortune? A multitude of minute and momentous decisions and actions play out for dozens of patients every day. And those judgments often have ripple effects. Selzer is wise to acknowledge the inimitable realm available to physicians who write: “A doctor/writer is especially blessed in that he walks about all day in the middle of a short story.”¹

A doctor’s encounter with a patient fits nicely into a short story’s format. There are time constraints of a visit (limited word count), a protagonist (usually the patient, sometimes the physician), and antagonists (typically a disease but could be the health insurance carrier, a side effect of treatment, or even the doctor himself). Conflict (suffering, patient noncompliance, trouble inputting mounds of data into the electronic medical system) is rampant. And as for denouement, there is diagnosis and treatment (or sadly in some instances, failure to cure, disability, or death). Physicians get plenty of practice writing too—office notes, histories and physicals, consultations. And doctors may have special reasons to write beyond a hope for fame and fortune: as a form of therapy and reflection, to honor and memorialize patients, as a sort of penance for bad behavior.² But physician-writers must be especially careful when translating real-life experiences into fiction. Safeguarding patient identity and protecting patient confidentiality are essential.

Selzer’s start to a writing career and a brief biography

“Writing came to me late, like a wisdom tooth,”³ Richard Selzer recalled. The general surgeon began writing seriously at age 40 and typically wrote between the hours of 1:00 and 3:00 AM. He dubbed his early efforts “nocturnal creatures” and those tales were mostly horror stories because he found that genre especially easy to compose. Even as years passed by and his literary output swelled, his affection for the macabre and the preternatural as subject matter did not diminish. Selzer frequently utilized morsels of the grotesque (and humor) in his stories.

Maybe his day job as a busy surgeon who regularly carved open fellow human beings, placed his gloved hands inside them, and removed diseased pieces of their bodies gave rise, in large part, to his affinity for horror. As a surgeon, to heal a patient meant he must wound them first—make an incision, cut out rotted flesh, slice away tumorous tissue. And then there’s the living fluids and materials of nightmares—spilt blood, oozing pus, leaking contents of guts—that he is immersed in day-to-day. Selzer already knew much about fear before he even picked up a pen. How could terror not find a way to slink into many of his tales?

Rather than employing a typewriter or computer, Selzer relished writing out his stories in longhand using a fountain pen. He likened the writer’s pen to the surgeon’s scalpel—instruments of similar size. He remarked, “Wield a scalpel, and blood is shed. Wield a pen, and ink is shed upon a page.”⁴ It should come as no surprise then that Selzer had a fondness for the eerie compositions of Edgar Allan Poe, or that he was mindful of Emily Dickinson’s line of verse: “Horror, Tis so Appalling, it Exhilarates.”⁵ He realized, “To make the flesh creep is an ancient and honorable literary endeavor.”⁶

Selzer (1928-2016) was born and raised in Troy, New York. His father, Julius, was a general practitioner (GP). The family resided in the top floor of an old brownstone building, and his father’s medical office occupied the first floor. Selzer recalled how he and his slightly older brother Billy were able to hear the moaning and wailing of his father’s patients below their living unit. Selzer was only 13 years old when his father died. In his autobiography, Down from Troy, Selzer not so much recalls his youth as he reconstructs it. In a theme that he would revisit often, pain reverberates throughout his memoir—the pain of growing up in a town suffering through the Great Depression as well as the pain of loss.

Selzer obtained his MD degree in 1953, served in the US Army as part of a medical unit in Korea for a couple of years and later maintained his own surgical practice along with holding a volunteer teaching position at Yale School of Medicine in New Haven, Connecticut. He retired from the practice of surgery in 1985. Selzer invigorated the burgeoning field of medical humanities in the 1970s and 1980s with his unique style of writing, lectures, workshops, correspondence, and commencement addresses. He authored 13 books. Nine of them are collections of short stories and essays. In addition, he has written an autobiography (Down from Troy), an illness memoir chronicling his bout of Legionnaire’s disease (Raising the Dead), a novella (Knife Song Korea), and his diary (aptly titled Diary).

Selzer’s unique literary universe and his most important themes

Selzer’s short story universe is expansive. While many of his tales occur in the places he knows best—the hospital, operating room, or interior of the human body—numerous other stories transpire in locales around the world. A sampling of distinct or distant settings includes the pampas of Argentina, a crematorium, a European monastery, a landfill, Korea, a library bathroom, Zaire, a convent of nuns, Moorish Spain, a cave, a military hospital in Germany, a slaughterhouse.

Understandably, doctors and sick folk abound in Selzer’s stories and essays. His plots often incorporate an unexpected twist or injection of humor. For example, in one story, a woman about to have her gangrenous leg amputated draws a smiley face on the decaying limb prior to the operation. In another, a widow is fixated on listening to the transplanted heart of her deceased husband beating in someone else’s chest. One tale poignantly details the innocent love between two teenagers who are doomed by tuberculosis.

Although Selzer incorporates a variety of themes in his stories, seven of them are recurrent throughout the majority of his work:

1. The experience of being a doctor;
2. The beauty of the human body and its marvelous anatomy;
3. The ritual of surgery;
4. The physician-patient relationship;
5. Pain;
6. Love;
7. How illness can sometimes elevate the sick and even make them holy.

Being a physician is simultaneously the most honorable and impossible occupation, the highest privilege and the heaviest burden. Medical training is lengthy and arduous. Perfection is the strived-for standard; a goal that is unattainable from the start. Selzer provides a peek at the mental, emotional, and physical toll physicians must withstand. His images of doctors highlight their strengths and fallibility. Peter Graham, in his essay about three particular doctor-writers, points out that the physicians portrayed in Selzer’s stories “are neither angelic nor demonic,” adding that these fictional doctors demonstrate ordinary human flaws and virtues but “are professionals first and last.”⁷

As a surgeon, Selzer is privy to the exquisiteness of the body, especially its inner anatomy. Danger and dread lurk everywhere inside the opened chest or abdomen during an operation—a mistakenly nicked blood vessel or the detection of a previously hidden tumor metastasis, for example—but the splendor of how human bodies are designed and function is never lost on Selzer. On the other hand, flesh is transient and perhaps no one knows this more than a surgeon (or a mortician).

Selzer is smitten by the ceremony of surgery. One commentator, Enid Rhodes Peschel, notes Selzer’s profound reverence for the ritual of surgery likening his depiction of operating on patients to “a metaphysical Mass.” In her view, surgery is a kind of sacrament where Selzer can pursue grace.⁸ The operating room is a temple where the devoted (patients) place all their faith in the surgeon and his acolytes (nurses, assistant, anesthetist). The patient is carefully cleansed and draped before being positioned upon the altar (operating table) with the anticipation that they will be cured, their body made whole again. Blood is often present in the proceedings—spilled from its vessels, sometimes replaced. Surgeons are priestly, outfitted in their vestments (sterile gown and gloves, cap and facial mask), who laboriously scrub their hands before beginning the solemn procedure. Prayers are usually offered up—by the patients themselves prior to the operation, their loved ones, and quite likely a considerable number of the surgeon-priests.

In any of his stories that feature a doctor and a patient, Selzer pays homage to the physician-patient relationship. It is a mystical bond—sacred and mighty, complicated and fragile. On the doctor’s side, it draws its life force from his compassion, truthfulness, and advocacy for what is in the best interests of the patient. On the patient’s side, the relationship survives and prospers mostly from faith in the physician, past experience with that doctor, and trust in him. Communication is the critical conduit.

Pain is obviously a universal experience. A sizeable portion of a doctor’s workday involves confronting and managing the pain of his patients. The concept of pain (the physical and emotional pain of patients, the anguish of the physician) permeates the pages of Selzer’s writing. He digs deep into its nature but decides that language and words are inadequate to convey its experience and depth. Love also has a heavy presence in many of his best stories, such as “Tom and Lily.” Peschel believes that Selzer’s stories express “a longing for love”—from God or from the physician’s patients.⁹ In Selzer’s fictional universe, love is the greatest emotion of all. Love can serve as a remedy, but it might be a sort of contagion too.

Selzer believes that sickness and suffering can expose the soul. For him, disease sometimes has the potential to elevate, even beatify the ill and injured. In his essay, Charles Anderson explores Selzer’s notion that illness has dual properties—the ability to harm, the potential to augment. He writes:

If there is a single source of Selzer’s power as a writer, it must be his ability to look unflinchingly at his patients and to see in their suffering that sickness both destroys and ennobles, wounds and heals, and creates the possibility of transcendence.¹⁰

Selzer has a wobbly affinity for the truth. In fact, he is forthright about how little he is concerned with facts. Rather, impressions are what matter most to him. On this matter, he spots no conflict between fact and fiction; each can be employed in the service of the truth:

When the subject is that of the human body, how it’s made, how it works, and what goes wrong with it, I have kept faith with the factual. In all other matters, I’ve committed the gentle treason of poetry and betrayed mere fact in search of truth, the real real that lies just beneath the real.¹¹

For those individuals without the time or ambition to read the entire compendium of Selzer’s stories and essays, which tales are must-reads?¹² A perfect place to start is his collection The Doctor Stories, which includes an informative “Introduction.” Selzer’s finest work includes the following five tales: “Tom and Lily,” “Brute,” “Imelda,” “Luis,” and “The Consultation.” “Toenails” or “Fetishes” (kinder, softer stories) ...