Mahala Yates Stripling, PhD
Fort Worth, Texas, United States

Photography by pikimota
 Photography by pikimota

Richard Selzer was tired. He carried the weight of thirty-one years in the trenches, getting up by 5:30 to operate, then seeing patients on the ward, all the while being followed by medical students eager to learn his art of surgery. He loved his patients, but afternoon office consultations were followed by seemingly endless interruptions of dinner with his family to return to the hospital for an emergency.

Somehow during the last fifteen of these busy years, he had found the time and energy to write four books and dozens of journal articles. It had been difficult to keep his mind on both the patients’ medical needs and his writing ones. A surgeon trained to lay open the human body must stay detached from the horror of the event so that he can be objective. He cannot let the patient’s pain be his own. But Selzer found that impossible to do: “I needed the closeness with the patients as much or even more than they needed mine.” He writes to make art, to give pain a name. Pain—both his and his patient’s—not only fueled his writing, but by bringing it into stories he achieved a therapeutic, even celebratory, stance.

As a surgeon who wrote about his patients, he did not have the luxury of other writers whose subjects were more imagined and less painful. Rather than insulating himself from the inherently violent act of surgery, Selzer perceived it fully, recording the event with the most compelling language he could find, letting subjectivity conquer the scene.  There was no finding equilibrium—he tipped into the writer’s sphere.  But these contradictions could drive a man mad. That’s why there was no other surgeon author in America, maybe the world, when he started writing. “I often wondered why I was the only one. Now I know.  What I had done by picking up a pen at the age of 40 was to make a Faustian bargain.  Yes, I would be a writer, but it would cost me my beloved profession.  So when the time came for me to make a choice, it had already been made for me.”   

He made the transformational decision to leave a long and satisfying career in surgery to become a nascent full-time writer at the age of fifty-seven, retiring ten years before he might have had to. “I was a child of my times and my times were over, besides the fact that I had embarked upon this other path of writing.” His colleague Sherwin Nuland said he was a fine surgeon and did not need to leave. But two factors were beginning to affect his health, making him wonder how long he could continue with an active surgical practice: a forty-five-year smoking habit and an inherited condition known as Dupuytren’s contracture—a benign constricture of his left hand. (Today—thirty years later—it has progressed so that a hard cord can be felt in the palm of his hand that contracts and weakens the affected finger, restricting the range of motion.)

He knew it was time to go, but he had not made this decision easily. It had been a conundrum. If he withdrew from surgery, would there be anything to write about?  At the nexus of his arts of medicine and writing, inspiration gushed as if from a geyser, causing him to harness his energy, leap to his desk, and let the words flow from his pen. In his medical practice were inspirational life-and-death stories that motivated him to write.

A small, unthreatening man, Selzer was very much of the world of surgery but never in it like other doctors. Those who fit the warrior-surgeon stereotype would enter the operating room riding roughshod over the staff, barking out orders for instruments or elbowing at the table for more room. Selzer, instead, in his soft, lispy voice, told uplifting stories to lighten the mood. He was the proverbial doctor with two heads who cut open the human body during the day, and then by writing explored his soul at night.

After a long and illustrious career, Selzer was retiring as Assistant Clinical Professor of Surgery at Yale Medical School, a rank that seemed unimaginably low to those who knew that he had spent the last three decades in the trenches. And it secretly rankled Selzer, especially since Sherwin Nuland, with whom he had been a Yale surgical resident in the mid-1950s, was a Professor of Medicine at Yale, teaching the history of medicine there ever since.  Primarily a private practitioner, not a university academic, Selzer gave back to his profession by teaching medical students.  His title was essentially honorary.  He did not even draw any pay for it from the university.

As an attending physician at Yale-New Haven Hospital, he had relished leading hundreds of doctors-to-be through corridors on daily hospital rounds, teaching them codified procedures as well as subtleties in the humanistic care of patients on the ward. As he left this life behind, he had already achieved immortality through teaching, continuing to serve, by proxy, as long as his students did, and their students, and so on. At the weekly ritual known as grand rounds, a long-held tradition for teaching new medical knowledge and enhancing clinical skills, the familiar audience of his medical students and residents enjoyed it when Selzer presented a case. He often entertained with theatrics, recreating the energy of the early days when scantily clothed patients were brought into the cold amphitheater on a stretcher to answer questions about their medical condition and treatment, giving vital first-hand impressions to the physicians in the audience.

The morning of December 15, 1984, was different from all of the grand rounds that had come before. Selzer arrived early for his 9 a.m. last grand rounds in Fitkin Amphitheatre, nestled in the School of Medicine complex on Howard Avenue.  He paced nervously in the corridor, pausing to study his notes. The hospital had been buzzing for weeks about this highly anticipated event. As he entered the crowded amphitheater, he saw 150 men and women, mostly in white coats, gathered to pay him homage. They sat in a semi-circle around the podium, anticipating that Selzer, rather than presenting the usual patient case, would reflect on his long career. Even though this was a moment he dreaded, he was determined to evoke laugher and to see only tears of joy.

These were his people. They knew he was not the funny little man those outside of the hospital saw at first glance. And for his part, there was none of the shyness he felt singing for his supper before large groups of strangers at medical and literary conferences.  Savoring the moment, he began slowly, giving a melodramatic account of his first operation, an appendectomy at Albany Medical College. Then, with a calculated change of pace, a “droll gaiety” took over, and with “an archness in his voice, an affected and affecting delicacy of manner that makes one think of plumed hats, scented handkerchiefs, the lilting gait of renaissance courtiers,” according to Charles Schuster who flew in for the event,1 Selzer approached his real subject, using a hybrid language that melded medicine and metaphor:      

Today, it is with mixed pleasure and pain that I, Richard Selzer, author of Mortal Lessons, Confessions of a Knife, and a lot of other flatulence and eructations, announce that after thirty-one and one half years as a surgeon I have decided to retire from the practice of surgery as of January 1st. For the past fifteen years, as you well know, I have stabbed intermittently at an inkwell, and all in all I have felt myself privileged to have been allowed to swim and shoulder halfway across the river of Art.  It is to immerse myself fully in that current that I take my leave from your midst, absent myself from all this felicity, don’t you know.

And who can say what will arrive at the doorstep of my mind, what hitherto undiscovered way of saying something about a liver, the eschar of a burn, a toenail, or—wild, wild hope—one of you? Believe me when I tell you that to be a surgeon is a fine and noble thing, and, compared to psychiatry or dermatology, it is satisfying to the boisterous spirit.  I think myself wonderfully honored to have been brothered and sistered these many years by you.

Cloaked in white-coat conviviality, Selzer had put his audience on a familiar rhetorical rollercoaster ride of high and low art—Latinate constructions, poetry, and its opposite, whimsy—so enthralling that beepers went unanswered. 

Then he turned serious, sighing with the weight of all those thirty-five years since he was an eager medical student at his first grand rounds at Albany Medical College in 1949. With an earnestness that his colleagues had come to expect from him, he explained that fatigue was causing him to leave surgery. All those long days and nights at the hospital had caught up with him.  He confessed that his body was intact only “because it cannot decide in which direction to collapse,” but that he feared leaving the hospital would cause his Muse to desert him or that he would die before he had a chance to write what had welled up in him.

But the biggest fear in his life, he confessed, was an entirely different sort of unknown from opening up the human body in surgery every day. He even wondered if his surgeon’s ego would survive outside of the hospital. Was it like a swan’s that seems to exist only in its own reflection, “The moment it is gone, he begins to die,” he said to the audience who laughed knowingly.  Would he find himself at the hospital’s doorstep “pleading to be taken in to be propped up at the operating table to clamp a few more bleeders before he dies?” He felt somewhere between contentment and longing—“Where all of us are, really, if we but delved into our souls,” he told them. 

He had been a faithful servant to thousands of New Haveners, removing their gallbladders, appendices, and fibroid cysts; now he hoped his writings would help people live better, as they inspired and consoled. As for his sentences, he wished that they “may love each other as they are to lie together until the last of my books is destroyed.” His works apposite to medicine would outlast all of the colectomies he had ever performed, but what a fickle future held for him could not be known. “And so,” he said in taking a long soulful parting glance at the new friends and old colleagues, “I be the bastard offspring of Medicine and Literature which signs itself ‘Yours Faithfully, Richard Selzer.’”

He brought down the house, ending his surgical career. As he stepped back out into a life of sunny afternoons and healthy people, he also returned to a house emptied of the children and to a desk with a blank page of paper. He had retirement savings and a small amount accruing from the sales of his four books. Sporadic sums would come from well-placed journal articles, writing classes, and speaking fees. Money had never been a concern before, but now he would have to build a readership to bring in enough income to live and to help his children. Along with the discipline of a surgeon, he would still need inspiration to double his writing output. As he left one art behind to embrace another, he felt like the fool in King Lear who needed to survive by his wits alone.

Notes

  1. Schuster, Charles. "The Last Grand Rounds of Richard Selzer."  Pennsylvania Medicine 88.9 (Sept. 1985): 42 50. All eye-witness quotations about this event come from this source, otherwise they are from Selzer-Stripling interviews.     

 


MAHALA YATES STRIPLING, PhD, a Yaddo fellow, is an independent scholar who lives in Fort Worth, Texas. Her publications include Bioethics and Medical Issues in Literature (U Cal MH P, 2nd updated edition, 2013), a medical humanities textbook used worldwide, and articles appearing in Teaching American Literature, Medical Humanities Review, and The Journal of Medical Humanities. She has lectured at Yale Medical School, the University of Texas Medical Branch-Galveston, and in the Great Hall of the Atheneum on Nantucket Island. She is writing The Surgeon Storyteller, a literary biography of Richard Selzer, MD, in two parts: “Reinventing his Life” and “Living by his Wits Alone.” Visit her website, Medical Humanities, for information about the Selzer biography as well as Dr. Stripling's other publications and lectures.