AAMC Reporter, February 2000: Longtime Surgeon Carves Out Second Career as Writer

VOLUME 9, NUMBER 5

JORDAN J. COHEN, M.D., PRESIDENT

FEBRUARY 2000

Longtime Surgeon Carves Out Second Career as Writer

Interview by Bill Schu

Richard Selzer, M.D.

Richard Selzer, M.D., is not the only medical doctor to try his hand at writing. But at 71, the former surgeon and Yale School of Medicine professor may be one of the most accomplished. At the least, he is one of the few actively pursuing what many call "literary nonfiction." Later this year, Dr. Selzer's 11th book, "The Exact Location of the Soul," will be published. Like his earlier works, which include "Rituals of Surgery" and "The Doctor's Stories," his latest book will draw heavily from his 40-year career as a surgeon. The AAMC Reporter talked with Dr. Selzer about his influences and his ambitions.

Tell us a bit about your writing style.

I like to use as much of the English language as I can. I know that ever since Hemingway, we're just supposed to use words of one syllable and make it all immediately intelligible. But I suppose it has to do with having been a surgeon, where you have to restrain, hold back the scalpel all the time. When I put down the scalpel and picked up a pen, I reveled in letting go.

Your father was a doctor-turned-fiction writer.

He wrote one novel, called Goldie. He wrote it at night after his office hours. He'd scratch away for hours, year in and year out, at this novel. My brother Billy and I found it when we were very young, and we read it. It was a sentimental tragedy that would have made the death of little Nell seem hilarious by comparison. But then it disappeared. My brother and I-now two old men-we remember having read it together and cried over it because it was so sad.

Tell us about your parents and their influence on your dual careers.

My mother was a fascinating woman. Flamboyant. She was a diva, an operatic diva. She gave me my fascination with art, poetry, and literature. And my father was a wonderful, old-fashioned general practitioner, in the days when you couldn't do anything for anybody. They didn't have antibiotics, you couldn't treat tuberculosis-you couldn't do anything.

But my father was a brave man, and he did the best he could to deliver babies and take out ruptured appendices, and just try to keep the city of Troy in reasonable shape. My entire childhood was spent watching him, in wanton pursuit of everything he did. The reason I became a doctor-I'm convinced-was that my father died when I was 12. And I gave myself over to medicine then and there, the way a monk gives himself to God. I thought it was a way of keeping a piece of him.

Did your fascination with writing come along gradually, or was it always there, waiting to be discovered?

It was never there. I turned off everything else at the age of 12, and with a singleness of purpose, went on to become a doctor. But when I was 40, and my career was established as a doctor, something happened. All of this impulse toward literature, language, and art was free to emerge. I had fulfilled my obligation to my father, and now I suppose I was going to pay homage to my mother and her wishes. So I became an artist. That was at 40, and I had to teach myself the craft, as I had learned the craft of surgery before that.

How did you go about teaching yourself? It was mostly experimentation.

I began to go to bed early in the evening; I was the first grown-up in the state of Connecticut to go to sleep around 7 or 7:30. I gave up everything else. I didn't go to concerts or to movies, dinner parties, I didn't play bridge, I didn't do anything. It was the life of a paramecium, without the rapture of binary fission. I went to bed early, and got up at 1 a.m., put on a pot of tea, and wrote every night from 1 a.m. until 3 a.m. when I wasn't on duty. I wrote horror stories. I chose that genre because it's easy.

I did that every night that I could for about three or four years, until I had mastered a little bit of the technique, and then my stories began to be published in a small mystery magazine. I thought I had died and gone to heaven. I was published in Esquire and Harper's, and I became known after that. And then the books appeared; every three years there has been a book. I now have 10-too many. There should be a legal limit on the number of books a person can write.

Many of your stories walk a fuzzy line between what has happened factually and what you're representing for us on the page.

That's true. I'm not a stickler for the facts. What I'm after is the truth, which is something other than the facts. Whenever it comes to medicine, I keep it straight and try to be as accurate as possible. But I do commit the gentle treason of poetry whenever I want to. Sometimes there are lifted eyebrows about that, but I don't care. I'm not trying to write a scientific treatise or a medical paper. I'm not trying to keep a patient's hospital chart anymore. I did that. Now I'm trying to make something else of this material, so I allow myself the latitude of embroidery.

Mortal Lessons has often been cited for the difficulty of many of the topics that you chose to tackle, including abortion. Was it difficult for you to take such an honest look at medicine while still practicing?

It was. I was still practicing surgery, and I was a member of the medical community. To express myself about these politically and socially complicated matters was very difficult. I received a lot of criticism from various quarters. But I didn't care. It cost me a great deal to be a writer, and I wasn't going to do it to please anyone. I needed to do it my way, honestly and with candor. So I had to let the chips fall where they may. Frankly, I was brave, or at least I tried to be.

What does the future hold for you?

Well, I've just finished a manuscript of a new book of nonfiction prose [see excerpt] that will be published in 2000. And I'm in the midst of a collection of lectures on art-paintings and sculpture. I give little lectures at the Yale art gallery, and then down in New York at Cooper Union. When I get enough of those together, I will have a volume of lectures on art. After that, my journals will be published. Each day when I get up, I think, well, maybe it's over. But I'm not worried about that. I don't want to do it one day more than I'm supposed to. I see all these writers whose ego is so involved in it that they can't give it up, and they write long after the inspiration is gone. I don't want to be one of them. I don't take myself that seriously. I just want to love it as I love it now, do a little of it every day, and see what happens.

Do you have any advice for doctors in training?

I would hope that everyone who becomes a doctor now would have some other abiding interest or passion, be it art, theology, or whatever. Because there comes a point in one's life when tending the sick becomes debilitating to the tender. It just saps you. I know that for young doctors-including medical students, interns, and residents-they're exhausted all the time. But there should be something that you keep for yourself.

Excerpt from The Exact Location of the Soul, By Richard Selzer

The summer I turned seven, in short pants, knee socks, and sandals, I was promoted to keeping Father company on house calls. If it can be said of a 7-year-old that he has passions, mine was for the house call. I remember him walking up to a bed, observing its contents for a minute or two, then, without a word, scooping up a young girl quickly, as if she were melting and he didn't want to lose a drop of her. Into the backseat of the car she was deposited, now whimpering like a dog dying to be petted, then up to the Samaritan Hospital. An hour later, when he came out to the car, I asked.
"She died," he said under his breath. Then added, because I had to know: "Sugar diabetes."

"Sugar?"

"Too sweet," he said. "She was too sweet." I didn't know that anyone could be too sweet. He glanced sideways and saw whatever he saw in my face. "It's all in the cards, Dickie. We do what we can, but Fate has her own way with everybody."

"What's Fate?" I asked. He gave a small laugh, the kind I knew was make-believe, and started humming to himself, the humming that was a cocoon about him that meant no more questions. On another visit, the patient was a man with an injured hand that had become infected. Two fingers had turned black with gangrene. There was the smell of putrefaction. Father advanced into the stench, parting it with his hands as he stepped into the bedroom.

"Let me have your hand," said Father. The man held it up to him as though he had no hope of ever getting it back.

"I don't know, Pat," Father said in a voice saturated with regret. The man's Adam's apple ran up and down his neck like an elevator. My legs were so heavy, you'd think I was being hanged by the neck. Long after we had left that house, my eyes retained the sight of that hand. A buzzing followed me from room to room. I went out into the backyard to escape, but it was there too. That night, in my bed, with my head under the covers, I smelled it. After a while, I opened my eyes to see Father standing by my bed. I raised my hand to touch him. I met his hand coming down to me.

Already my eyes were in wanton pursuit of everything that Father did, the way the lips of a wound would open wider as if to welcome his penetration. It seemed to me that he could snuff wounds as if they were the flames of candles. A person who could do that would waste his time doing anything else. After each house call, Father would give a brief explanation of the clinical condition, why he did what he did. As though I were a colleague instead of a small boy.

"Why did you put your hand on his forehead?" It had hovered for a moment above the man's face before drifting away.

"It's for me-to give me courage, and for him too-to break down the natural mistrust a man feels when his body is to be confided to another man."

"Why do you need courage?"

"Wait til you're a doctor, then you'll find out why."