In Memoriam Richard Selzer (1928–2016)

It may be difficult, now that so many physicians write with such success about their work, to appreciate the significance of what the surgeon Richard Selzer did when he decided to take up literary writing. While he is of course the descendant of an extensive line of clinician-writers—like Chekhov, Bulgakov, Williams—he was, from his start in horror stories, interested less in clinical situations, doctors’ interactions with patients, or narratives of illness and treatment than in representing the human body as he knew it, as the object of medicine and, especially, of the benevolent violations of surgery. Selzer’s most significant contribution to literature and medicine was, I think, to construct a poetic language for the parts and places in human bodies that had been, until then, the sole domain of surgical textbooks, pathology, horror, and perhaps the occasional war story. In this way, he opened up the way for a more vivid and visceral kind of literary-medical writing than had been possible before.

We are so accustomed now to reading (and seeing on screen) accounts of internal organs and emerging disease processes, intrauterine life and surgical procedures, we might forget how new it was when, in 1974, Selzer invited the serious reader of respectable essays to join him inside a living body: “Do not fear the yellow meadows of fat, the red that sweats and trickles where you step. Here, give me your hand. . . . All at once, gleaming, the membrane parts . . . and you are in.”¹ He writes as tour guide and high priest, having us visualize (and hear and smell and feel) a richly conjured sensory world that is at once alien and very intimate: our insides. He induced (certainly when I first read Mortal Lessons as an undergraduate) a complex aesthetic response combining horror—fear, disgust, curiosity—with the sort of amazement we feel before vivid and maximalist allegorical elaborations of the material world like those in, say, Spenser’s Faerie Queene or Rossetti’s Goblin Market. Imagine a baroque tapestry depicting close-ups of a liver transplant.

Selzer’s primary effort was to capture for the reader what he called “some meaning in the ritual of surgery . . . a devilish hard thing to transmit,” and which, since he cannot extract “a lobe of the liver, a single convolution of the brain, and paste it to a page,” he has to reconstitute with words.² He loved words and was profligate with them, drawing on archaisms and neologisms wherever needed to illuminate (in the sense of medieval texts, ornately rather than clinically) the aspects of the human person we usually ignore or avoid, or trust only the cold eye of biotechnology to capture. His accounts of organs merge precise anatomical description with a verbal embroidery that reveals the metaphorical and etymological—and sensational—layers already embedded in medical terminology.

These descriptions often anchor his short stories, many but not all about medicine, in this vivid materiality. Some of these have become both canonical and controversial, texts that many in medical humanities have mulled over with generations of students. I recently spent almost two hours reading the few short pages of “Brute” with a group of medical students, seeing them react first to the shocking emergency room events—is this an ethics case, they wonder? of course we’d never do that to a patient—then to the shocking language—this man is a racist! (wait, which man?)—and then to the layering of narrative, embedding action in a story within a story that may or may not be remembered, rather than made up, by the writer, who may or may not endorse the words he has his narrator use. The students disagree with each other and argue, focusing closely on the particulars of Selzer’s rich textual surfaces, until they find that the story is reading them.

Selzer tends to address his narratee directly, often advising or leading, but also doubting and doubling back and leaving readers to decide. The very first issue of Literature and Medicine included an essay by Selzer, “To a Would-Be Doctor-Writer,” in the form of a letter...