Fort Worth, Texas, United States
|Richard Selzer in the two-act
play The Doctor Stories
“I am called by the name of Chekhov. Each time I hear it, I blush and cringe. He had true genius; I just do the best I can. There is an enormous difference. I do believe it is important not to become enamored of oneself, or to have one’s head turned by praise. I have always objected to that in others, and really I am just little old Richard Selzer. But I am enormously pleased to know that thirty years later, my books are being read by so many people.” — Richard Selzer1
Richard Selzer was a surgeon at Yale-New Haven Hospital for over thirty years, from 1953 to 1984. To his peers, he was a fine surgeon, and his patients thought of him as a famous one. But not a day passed without Selzer doubting his abilities. At times he wondered, if he had more knowledge or skills, could the outcome of surgery have been better? He carried this guilt to the end of his days.
After leaving surgery in 1985, he wrote full-time for the next thirty years. Taking his discipline as a surgeon into writing, his output was prolific. He published thirteen books and hundreds of stories and essays in newspapers and medical and literary journals. He was also a novelist, playwright, and teacher of medicine and writing. And yet, up until his death on June 15, 2016, at the age of eighty-seven, he had obsessive feelings of worthlessness and self-loathing. These personality traits commonly accompany the impostor syndrome.2
A creative writer, Selzer probed the authenticity of the medical profession through characters posing as something they are not: the infallible doctor in ”Imelda” and the unschooled healer in “Impostor.” One of his most anthologized stories, “Imelda” illustrates that perfection in medicine is not always attainable. It is told from the perspective of a medical student narrator who is a photographer and translator for the heroic yet remote Dr. Hugh Franciscus, the protagonist reconstructive surgeon on a volunteer medical mission. His name refers to the Franciscan order of monks who take vows of poverty and serve the sick. He is scheduled to operate on Imelda, a girl of fourteen, who is “a beautiful bird with a crushed beak.” Her cleft palate makes her appear “still attached to the unshaped clay from which she has been carved.”
A surgeon and anesthesiologist work in concert, but Imelda has a severe reaction to general anesthesia before Dr. Franciscus can make the first cut. She dies from malignant hyperthermia, a rare inherited abnormality that causes a fast rise in body temperature and severe muscle contractions.3 No one on the team could have predicted it. Hours later, when Dr. Franciscus leaves the operating room, he tells the waiting mother her daughter is muerta. “Then he looked and saw the grief corroding her face, breaking it down, melting the features so that eyes, nose, mouth ran together in a distortion, like the girl’s.”
“God had decided,” the mother believed, “happy now that the harelip had been fixed so her daughter might go to Heaven without it.” The mother’s expectation makes Dr. Franciscus feel like an impostor. Spurred by her desire, he did not tell her the truth. And motivated by his inability to live with failure, he will reorder the events. That night in the morgue, by candlelight, in an action “demented, or at least insanely arrogant,” he stealthily repaired Imelda’s disfigurement. “She was his measure of perfection and pain – the one lost, the other gained.” While the fear of losing control is basic human nature, in a surgeon it drives the need to be perfect.
The next morning the stricken mother beholds her dead child. Consoled by Imelda’s appearance, she proudly says, “My daughter is beautiful.” She believes the doctor “finished the work of God.” He “had not done it for her,” Selzer concedes; rather, “The dire necessity was his. He would not accept that Imelda had died before he could repair her lip.”
Dr. Franciscus is the product of a brutal training period run “en militare,” Selzer says, remembering his early days. Although portrayed as blameless in the untimely death of Imelda, he is the “captain of the ship” and responsible for everything under his command. His imposture, as seen in other humans put under extreme pressure, is the result of perfectionism unrealized.
Franciscus’ fall from grace, according to Selzer, results from his pretense to be perfect – even his name puts him on a saintly (yet humble) level. “We are not God’s surrogate on Earth,” Selzer affirms. “So many doctors, myself included, often have the feeling we are posing as something we are not. ‘Imelda’ reveals the shallowness of that pose.”4
Its compelling theme – the impracticality of expecting and receiving perfection in medicine – makes “Imelda” a favorite of teachers and was adapted into readers’ theater.5 Did Dr. Franciscus operate on a corpse as an act of kindness, for the mother’s sake, or was it self-serving, to not only assuage his guilt and the need for perfection but to create before and after slides showing his surgical expertise?
Another confessional story, “Impostor,” was Selzer’s favorite because it connected him to his father, whose early twentieth-century medical practice resembled the main character’s. Both relied on human instinct and intuition rather than technology. This time the protagonist is a man called N., for no man.6 He is a military orderly with epilepsy and an unschooled healer. One day in the surgical wing, without warning, he has a seizure and accidentally kills a wounded solider. Court-martialed and convicted of murder, N. is sentenced to death.
He escapes from where he is stationed to a remote Asian village. In the absence of faith, superstition did the villagers very well. Wanting to fit in and to use his talents, he proclaims to them, “I am a doctor.” He becomes a healer, seeming “to know the villagers in some profound and ancient way.”
The villagers embrace N., “bound by a thousand cords of trust,” as he tends to their needs with primitive medicines gathered from the forest and uses tools crafted out of animal bones. N.’s diagnoses and treatments appear infallible to the impressionable villagers. “What he said was the matter with someone became the matter with someone. As though all disease hastened to mold itself to corroborate his intuitions.”
Although perceived as a miracle-worker, N. cannot heal himself. His seizures, though, which he only saw as detrimental before, marshal his intuitive forces and allow him to apply his insights to diagnosing and treating the people. He is also a mystic who understands their suffering. All N. needs to treat the villagers are intuition, compassion, and craft.
A suspicious health inspector visits the village and asks for N.’s credentials. N., who has been there three years, replies quietly, “I have no papers. Doctoring is my work.” Ironically, N’s epilepsy gives him both an ability and disability to cope in life. But with no diploma, he is barred from practicing medicine. The law is the law, the inspector says, but he admits to the villagers, “The truth is that most things will cure themselves if left alone by doctors. The less meddling, the better. The human body knows how to take care of itself. You insist that this man meant well? So be it. Motives are not my concern. Credentials are.” N. believed in the body’s fierce energy to be whole and was sanguine about being caught.
Fleeing the law, N. takes refuge in the forest. “On and on he slogged. He would not choose the exact place; he would know it when he arrived. He had only, when the moment came, to turn and face it without imposture. At the end point of life was honesty.” Pressing his face into the forest soil, he inhales deeply and dies. “Nothing but immense and endless comfort, a sense of being reclaimed. No pain! But this was the death of a righteous man. He had not earned it! Pushing in, he filled his lungs with the benevolence.”
Learning of N’s death, the villagers told stories of his healing, and their recollections became legends. And as Selzer tells it in “Impostor,” he lifts N. up into the spiritual; thereby he continues to exist. “The story has many layers in it,” Selzer says, “and I consider it one of my best pieces. To me, there’s a lot of me in ‘Impostor.’”7
The simply written “Impostor” says, “But we are all impostors of one sort or another. The worst thing is not to know you are one. That is the real pity. And falseness can collapse under the weight of good work.” The theme is prevalent in “Imelda” wherein Selzer asks us to remember doctors can never know enough, with the outcome of a particular case impossible to predict with absolute certainty; and it is central to “Impostor,” showing how it takes more than rote medical knowledge to be a healer, with the human mind, body, and spirit powerful sources of self-healing.8
A humble man, Richard Selzer felt himself to be an impostor who had done little to merit the worldwide stature he received. An early proponent of the literature and medicine movement, he lectured widely and taught writing workshops. His feelings of being an impostor as a surgeon followed him into his life as a writer. He read the works of Shakespeare, Keats, and Chekhov, so he knew he was not good enough. These basic insecurities made him feel unworthy of the praise and recognition heaped upon him. In the end, the measure of respect he attained from his readers and other writers helped neutralize the impostor syndrome in him, and the self-doubt partly melted. He at last felt valued – not from fan adulation – but through authentic reader response.
- RSE 4-1-06 to author (Richard Selzer at Savannah Reads Selzer.)
- See: Leonard, David J. “Impostor Syndrome: Academic Identity under Siege.” Chronicle of Higher Education 5 February 2014.
- See Malignant hyperthermia: https://medlineplus.gov/ency/article/001315.htm
- RSE 9-14-06 to author.
- See “Imelda.” Medical Readers’ Theater: A Guide and Scripts. (Ed. Todd L. Savitt). University of Iowa P (Iowa City), 2002: 71-87.
- RSI 1997 with author.
- RSI 1997 with author.
- See: Selzer, Richard. “How Proudly it Heals: In Praise of the Body Republic.” A Richard Selzer Reader: Blood and Ink (Ed. Kevin Kerrane). Newark: U of Del P, 2017. “The impulse of the body is to be whole, intact. Toward that purpose, there is a fierce energy at work” (53-6).
This article is excerpted from author’s biography-in-progress, Doctor of Arts, the life of Richard Selzer, the man who transformed the literature of medicine. See Contents: http://medicalhumanities.net/selzer_biography.html. Quotations from “Imelda” (21-36) and “Impostor” (175-99) are in Letters to a Young Doctor, published by Simon and Schuster in 1982. It won the American Medical Writers Association Book Award in 1983.
MAHALA YATES STRIPLING, who knew Richard Selzer for the last twenty-five years of his life, is finishing his biography, Doctor of Arts: the life of Richard Selzer, the man who transformed the literature of medicine. She came to understand how as a writer he was both a craftsman and vehicle for the divine with an “Angelic Imagination.” She shares this view in other excerpts from her biography published in the Journal of Medical Humanities, Voices in Bioethics, and Medical Humanities Review, as well as in lectures at Stanford University, the Yale School of Medicine, and the University of Texas Medical Branch-Galveston.