Fort Worth, Texas, United States
|Dr. Selzer, 2000. Photo courtesy of James L. Stripling.|
A Yale-New Haven surgeon-writer, Richard Selzer wrote stories about his patients that illuminated their souls. But he did not really know what it was like to be a patient until a dramatic, transformational event occurred on the last day of March, 1991. Returning home from a long speaking tour to Nova Scotia and Hawaii, he unpacked his bag, ate a pleasant dinner out with his wife Janet, and then went upstairs to his second-floor study. He “felt fine,” attributing any symptoms he was experiencing—slight chills, shortness of breath, and muscle aches—to fatigue. Then “everything grew wobbly,” and he fell. Janet heard the thud and ran upstairs to find her husband sprawled on the floor. She immediately called an ambulance that took him to Yale-New Haven Hospital. It was Easter Sunday.
Richard Selzer had treated over 20,000 patients but was now seriously ill himself. The diagnosis, made later through elimination, was Legionnaires’ disease—a pneumonia caused by lung-loving bacteria that thrive in the duct systems of air-conditioned hotels and planes. It was first detected in 1976 at an American Legion convention in Philadelphia where one hotel was infected and many people died. Selzer’s was an isolated case caused from exposure somewhere in his travels. In those days, half of the people who got sick with Legionnaires’ disease died. Because of his age and history of smoking, the doctors did not expect him to survive.
After arriving at the hospital, Selzer would remember nothing else for the next three weeks. The nurses stripped his clothing, restrained his flailing wrists and ankles, and drew blood. When his doctor, Gordon Reid, arrived, he put his feverish patient on antibiotics. An endotracheal tube was inserted to enable him to be on a ventilator. Then he put his extremely agitated patient into an artificially maintained coma to prevent him from pulling out the tube. The medical team put ointment in his eyes and taped his eyelids shut to protect the corneas. Next, a catheter went into his bladder and another tube into his nostrils to access the stomach.
Once stabilized and settled in the ICU, Selzer entered the state of deep unconsciousness that is coma. A long period began of dislocation, disruption from his ordinary physical and mental condition. “Hooked up. Kept alive. I was a piece of machinery—a preparation they had to maintain,” Selzer explained later. “My body was taken over by others and studied in all its particularities, of which I knew nothing.”1
Janet was told to wait and see if the antibiotics worked. She summoned her family home. They sat vigil. But every day she made the short trip to the hospital to visit her husband. Soon he was physically desiccated from the diuretic used to remove excess extracellular fluid and reduce pulmonary edema. To prevent foot drop, a weakness of the muscles caused from long-term immobility, Janet got him a pair of high-top sneakers to prop up his feet—he looked like a small boy who had taken his new shoes to bed with him.
But then, in a last-ditch effort, Dr. Reid and the medical team decided to put their patient on experimental steroids to prevent brain swelling, hoping that would turn him around. There was more waiting to see what would happen.
When Sherwin Nuland, who had known the patient since their residency days, heard Selzer was in the ICU, he went to visit. “It was unbelievable what he looked like,” Nuland said, describing his old friend (and sometime rival) as “swollen and awful, literally on the point of death. They were expecting him to die within the next couple of days—and I kissed him as he was lying there because I thought I’d never see him again.”2
Suddenly, on the twenty-third day, Selzer woke up. “I had walked in the valley of the shadow of death,” he said later. When he first opened his eyes, he was disoriented but felt “elated,” learning to his astonishment that he was in the Intensive Care Unit of Yale-New Haven Hospital. After the nurses stabilized him, Selzer was moved into Unit 55, specializing in infectious diseases, where he experienced an equally long period of delirium.
* * *
Selzer said of his doctor-colleagues, “They were never my people; I was different, and they knew it.” He always loved the hands-on nurses. Patrick Cunningham, a big Irishman with a graying black beard, walked into Selzer’s room one day to discover his patient clinging onto the inflating and deflating airbed, believing that he was on the Nile River and afraid the creature he wrestled was carnivorous. Feeling helpless, Selzer suddenly slid off between the rails and— whoosh—landed on the floor. Cunningham planted his feet on either side of his patient, bent down to place his burly hands under Selzer’s armpits, and easily hefted his air-starved patient—now weighing well under a hundred pounds—into the roller chair.
“Here’s your oxygen,” he told the panting man. “Look up here; watch my chest and breathe along with me.” Taking Selzer’s hand, he placed it on his own chest, holding it there, and breathed emphatically. “In. Out. In. Out. Much better,” he assured the powerless man who smiled up at him through the myopic haze of someone with delusions.3 Cunningham’s firm grip gave his patient something real to experience. It was the caring touch of a nurse.
Another incident at the heart of Selzer’s recovery occurred in the tub room. Cunningham had already cleaned up his frail patient, who was painfully self-conscious about his incontinence, and replaced his soiled cotton Johnny-shirt. But then he decided to take a risk. It would not do Selzer any harm because he was not hooked up to an IV or anything else, even though he was a bit unstable. “Well, he wants it so bad. He figures getting in the tub is going to do something.” So he added a little bit of shampoo to soften the warm water and lifted him into the tub. “You could see the change. It was like something he wanted all of his life that he finally got. It was like he reached an oasis, and that was where he was headed.” For twenty minutes, Cunningham poured water over his head and lathered his scalp, massaging and rinsing. Selzer breathed quietly now, the agitation lifted and the delirium temporarily gone.4
After three weeks in a coma and three more in delirium, Selzer had his life back. Saying goodbye to his patient on May 5, Cunningham suggested, “There’s a great book in here.” Selzer swore at the time he would never write about these events. In his whole career, Cunningham saw only one other like Selzer with such a dramatic switch. Of Cunningham, Selzer later said, “He couldn’t be any better. He served me; he cured me; he healed me. I love him.”5
* * *
Richard Selzer returned to his hilltop home on St. Ronan Terrace, looking at the world with new eyes after having come back from a near-death experience. That spring, sitting in the garden with the sweet scent of Janet’s yellow irises wafting over him, in his lap was a notebook and in his hand a pen, held “out of habit and hope.” Even in this early period, he felt obsessed: I want to know what happened.6 Attempting to remember and animate the experience of being in a coma, he felt discouraged; the words he managed to jot down into sentences had no value, even as he recalled certain sensations.
Two months later, Dr. Reid phoned him.
“I just finished reading one of your books. You made me cry,” he told his patient.
“Well, you made me cry plenty of times, too,” Selzer deadpanned.
“Are you writing anything?”
“No, I can’t write anymore.”
“You know, the long periods of oxygen deprivation to the brain.”
“Where did you get that?” Reid asked. “You’re just taking the easy road out.”
“No. I know what happened to me a little bit.”
“Oh, come now. Just try writing.”7
Even in his weakened state, Selzer focused on that period when his body was taken over by others. The memories returned in flashes. His “image-maker,” which had stopped working for several months during his convalescence, suddenly went into overdrive. The experience was like someone who knows a second or third language and can shift into that language. His chronicle became Raising the Dead: A Doctor’s Encounter with His Own Mortality, literary nonfiction that weaves together what he knew about coma as a doctor with his writerly art to describe these experiences. “Man’s greatest pleasure is remembering,” he believed, and when it was necessary to fill in the gaps to reclaim what had been taken away, he used his imagination—and some confession.8
* * *
A year after his coma, Selzer took an evening walk, returning up the steep driveway to his home and opened the front door. A band of light—yellow light—flooded across the front steps. Stepping into that liminal space from the chilled night air, he declared the light to be like life itself, the patch between the two immense blacknesses: before you were born and after you die.
“I remember feeling the thrill of stepping into that stripe of life and wanting to pause there,” Selzer said, reflecting on his illness—a deep black well.9 This instance of transcendence, typical in Selzer’s work, manifested the spirituality he sought. He might have thought he was writing about illness and death, then realized the story was really about life.
- Richard Selzer, interview with author, 1998. (Hereafter RSI 1998.) Unless otherwise noted, all of his quotations come from this source.
- Sherwin Nuland, interview with author, 2001.
- Richard Selzer, Raising the Dead: A Doctor’s Encounter with his own Mortality. (Washington, DC: Whittle Books: The Grand Rounds Press, 1993): 61. (Hereafter RTD.)
- Patrick Cunningham, interview with author, 2000. (Unless otherwise noted, his quotations come from this source.)
- RSI 1998.
- RTD 71- 72.
- RSI 1998.
- RTD 72.
- RSI 1998. The word liminal evokes how Selzer stood on the threshold of hospital rooms, spying on patients. See Selzer’s story “Four Appointments with the Discus Thrower.” (Selzer, Richard. The Doctor Stories. New York: Picador, 1998: 227-30.)
DR. MAHALA YATES STRIPLING knew Richard Selzer (1928–2016) the last twenty-five years of his life. Her many interviews with him and others who knew him contributed to her understanding of his life and groundbreaking work. In her forthcoming biography, Richard Selzer: A Literary Life in Medicine, she describes his unusual life and how he inspired a new genre.