Book Review : A Physician-Writer Dissects Experience

Taking the World in for Repairs by Richard Selzer (Morrow: $15.95)

Trained to think intuitively and analytically, to be simultaneously involved and detached; a daily participant in dramas of life and death, a physician-writer can bring uncommon dimensions to literature. Like others who work in that double tradition, Richard Selzer manages to reconcile these contradictions in books glowing with facts and insight. Though the dozen essays collected here range from reportage through novella to whimsical pensees on subjects as disparate as slaughterhouses and parasitical worms, they’re unified by a set of autobiographical pieces in which the author introduces himself and presents the scientific humanism from which he views the world. If metaphysician hadn’t been preempted by philosophers, it would be the perfect noun for Selzer.

The long first selection, “Diary of an Infidel,” is the chronicle of Selzer’s extended stay at the Abbey of San Giorgio Maggiore, a medieval monastery on a Venetian island. By the time we’ve lived among the monks, shared their monotonous diet, seen them in ecstasy, misery, tranquility and anger, we’ve not only entered a hermetic religious community but we’ve also been admitted to the skeptical but receptive mind of the man who took us there.

First-Person Account

The title essay is a first-person account of a trip to the Peruvian highlands undertaken by a team of reconstructive surgeons. (Somehow neither plastic nor cosmetic seems the right word for these particular volunteers.) Interplast was founded in 1969 to train Third World doctors in specialized techniques while offering American doctors an opportunity to treat problems less frequently encountered here. The visiting teams operate on as many cases as possible in the time allowed, teaching by example, learning by doing. So far, the organization has worked in Mexico, Honduras, Ecuador, the Philippines, Jamaica and Peru; the doctors, nurses and technicians all donating their services. Here in the Arequipa hospital “Rubber gloves are mended and reused the next day and the day after that. Each scrap of gauze is retrieved from a bucket, washed and folded and made ready to blot another patient’s blood. The scalpels of Arequipa enjoy longevity . . . each procedure here is dictated by the cost of the material needed to do it.” If the patient himself cannot pay for the sutures, gauze and knife blade to be used in his operation, the resident physicians will buy these essentials themselves; something to ponder when you casually hand your insurance card to the hospital cashier.

Waiting in Arequipa, the Americans find hundreds of people who have made the pilgrimage in the hope of having some disfigurement corrected; patients seeking neither youth nor beauty but merely normality. The incidence of congenital deformity in these mountains is unusually high--inbreeding, malnutrition and multiparity all contributing factors. In poor Peruvian Indian families, 12 or more children are usual, and in time, the genetic material simply gives way. Though the visitors work day and night, scores of deserving people are turned away with priority slips for the next year; the more fortunate families draw lots to decide which child will be cured. Selzer includes us in this humanitarian adventure, neither sensationalizing the case histories nor patronizing the reader; quietly eliciting our responses to the project as if we were his colleagues.

In order to finish his books, the author takes occasional sabbaticals from his double teaching schedule as professor of surgery at Yale Medical School and of creative writing at the college, spending the time either traveling or at writers’ colonies. The stay at San Giorgio represents one such foreign sojourn; the curious tale of the African parasitic worm could be derived from another. “The Bee” shows Selzer in a classic situation in Paris, the ultimate innocent abroad befriended by a man with a profession even older than the author’s. “Brother Shaman” is a short ironic meditation on medical rituals in primitive and technologically sophisticated societies; “The Romance of Laundry” proof that there are no trivial subjects; a soiled shirt as inspirational as any natural wonder.

Tribute to Thomas Mann

“The Black Swan Revisited” begins with a tribute to Thomas Mann, a writer also concerned with the intricate relationships of mind to body. Here, Selzer uses the original framework of the Mann story as a foundation for a far more elaborate fiction, imagining a complete life for an old woman he glimpses through the open doorway of her hospital room as she struggles to fasten a gold earring. “Fetishes” seems inspired by a similar chance incident, exploring the subtle factors affecting a patient’s welfare. “Tom and Lily” is presented in a fictional form, but told factually, without the least contrivance or melodrama, so that the story of an adolescent boy’s passion for a girl dying of tuberculosis seems more recalled than invented.

Fascinating, surprising and instructive, these essays and stories function as a specific antidote to the anomie pervading contemporary medicine and literature, but most essential of all, they remind the reader that medicine was an art before it became a science, and in the right hands, it continues to be both.