Passion and Pathology: Richard Selzer's Philosophy of Doctoring

PASSION AND PATHOLOGY: RICHARD SELZER'S PHILOSOPHY OF DOCTORING CHARLES I. SCHUSTER* TL·se are hard timesfor a Humamst in Medicine. In a discipline where only statistics and equipment are chic, tL· humamst becomes a curiosity .—Richard Selzer, "Not Quite a Humanist" [1] I Richard Selzer is indeed a curiosity—a humanist in medicine, a surgeon and a writer, a man equally at home with ligatures and literature. He is the author of four books: The Rituals of Surgery (1974), Mortal Lessons (1976), Confessions ofa Knife (1979), and, most recentiy, Letters to a Young Doctor (1982). He is perhaps best known as the author of nonfictional narratives, chilling accounts of operating room dramas— medical miracles and mishaps. Many of his accounts are drawn from his own experiences in New Haven, Connecticut, where he has been a general surgeon for over 20 years and a member of the faculty of the Yale University School of Medicine. Selzer, however, is more thanjust a gifted essayist and storyteller. He is a committed idealist who is firm in his notions about what is right and wrong with his profession. Throughout much of his writing, in book after book, Selzer focuses on a central problem. In essence he addresses the issue ofhow medical practitioners can maintain their humanity amid the welter oftests, data, and quantitative measures. How do they prevent themselves from being overpowered by the technology oftheir practice? The paper referred to in [1] has never been published. Two interview-visits with Richard Selzer were conducted, August 1982 and June 1983. AU the direct quotations from Richard Selzer in this essay are taken from the August 1982 interview sessions. The author is gready indebted to the Graduate School Research Fund ofdie University ofWashington for making mis research possible and to Dr. Selzer for making himself and his work so available to him.»Department of English GN-30, University of Washington, Seattle, Washington 98195.©1984 by The University of Chicago. AU rights reserved. 0031-5982/85/2801-0417101.00 Perspectives in Biology and Medicine, 28, 1 · Autumn 1984 \ 65 It is this dehumanization that Selzer deplores most. His answer is a simple one which takes many forms throughout his books: doctors must reintroduce into their doctoring the imaginative and empathie qualities of art and humanistic thought. They must develop their sympathies. As Selzer states in the opening essay ??Letters to a YoungDoctor, "You cannot separate passion from pathology any more than you can separate a person's spirit from his body" (p. 14). In order to be true healers of men and women, Selzer is saying, doctors must learn to feel, to care, to love. "There is no more beautiful sight in the world," Selzer informs us at the end of the same essay, "than that of a kindly, efficient doctor engaged in the examination of the body of a fellow human being" (p. 20). Selzer, ofcourse, writes eloquently about this subject in his books. But he also incorporates this same philosophy within many of his stories about surgeons and surgery. Within these accounts, Selzer expresses his philosophy of doctoring, but he does so quiedy, as it were, within the unfolding of events. As Selzer himself said to me during a conversation we had about his writing, "I want to teach, which is incidentally an essential part ofmy writing. ... I want these polished sentences to signify something. I don't want them to bejust surface dazzle." It is these stories that concern me here, the ones in which Selzer's "mortal lessons" seem least in evidence. They sweep us forward by the power of their subject, the artistry with which they are told, yet within them are expressed some essential aspects of Selzer's philosophy of doctoring. II One of Selzer's most disturbing critiques of current-day medical practice occurs in "Abortion" [2]. Perhaps more than any other surgical procedure, an abortion demands that the doctor remove himself from the ultimate consequences of the operation; for no matter how idealistic the principles involved, the outcome of an abortion is the death of the fetus, the termination ofa life. Selzer refuses to sidestep this Hippocratic controversy. On the contrary, he forces his readers to feel...