Between Life and Life-Support : IMAGINE A WOMAN : And Other Tales <i> By Richard Selzer (Random House: $18.95; 226 pp.) </i>

The honorable pursuit of professions has been one foundation of our civilization over the centuries. But beyond that solid virtue, a cleansing grace attaches to those who, from within each profession, ask questions about it.

There is the professional soldier who knows how much defeat lies in victory. The lawyer who knows how much injustice lies in the legal pursuit of justice. The journalist who knows how partial a truth is uncovered by his methods. The doctor who knows how life can be marred and insulted by the medical requirements for preserving it.

Such supra-professional questioning may not often raise the practice of the profession but--like the saints who haven’t yet managed to drastically elevate the quality of bishops--it encourages the rest of us. And it has produced some wonderfully good writing.

In medicine, for instance, there are the examples of Oliver Sacks and, particularly, of Lewis Thomas. They use the essay form for their stretching and questioning. So, in the past, has Richard Selzer, a retired surgeon and professor at the Yale School of Medicine. Now Selzer has taken another step in the humane expansion of his original discipline by writing a collection of brief fictions.


There is a writer in the doctor; we knew that. More interesting, there is a doctor in the writer. That may seem a truism; what else would you expect when a doctor writes? In fact, it is two stages beyond.

In the best of these tales, Selzer has transformed himself entirely, if not quite untraceably, into the fiction writer. And back from this graceful fiction blows a breath of healing. Imagine a doctor whose medicines have improved the patient’s body without quite bringing him to health, playing the cello to perform the final cure of re-attachment to life.

The image is a little excessive. So is some of Selzer’s writing, and in the same way. It over-makes its point; it over-arranges. As if intoxicated with the writer’s power to make things as beautiful as he can, the author sometimes makes them too beautiful.

He does so, I think, in “Luis,” a soft tale of a slum child in Brazil who finds a “star” in a garbage dump, and who dies from the radiation given off by what, in fact, is a carelessly discarded hospital isotope. Another story, “Poe’s Lighthouse,” is a narrative by a madman who discovers an unspeakable evil in the base of a lighthouse. It announces horror without drawing us into it, as Poe could do.


Radiation sickness, madness; the other tales each use a different medical phenomenon as a point of departure. They are not about the illness or the procedure; they are about an aspect of the human spirit suggested or affected by them.

“Whither Thou Goest” is, ostensibly, about organ transplants. In fact--its crooked comedy bestrides its haunting message like a circus clown shambling up onto a horse and giving a bravura ride--it is about the mined frontier between human life and the practices of medicine.

Hannah’s husband is shot by a vagrant while helping an old woman change a flat tire. The doctors persuade her to discontinue his futile life-support system, and let them harvest his vital parts. “Harvest?” she asks. “Like the gathering in of wheat?” Thinking it over, she looks down at the chief doctor’s feet. “He was wearing oxblood wing-tip shoes of a large size. They were the shoes of power.”

She gets a letter thanking her. Sam’s liver is working nicely in Abilene, the kidneys in Dallas and Galveston, the lungs in Fort Worth, the corneas in Houston, the heart near the Arkansas border. “She already knew what had become of the rest of Sam. She had buried it in the family plot of the Evangelical Baptist Church cemetery.”


But she is bewildered and unhappy. Is she really a widow when so much of Sam is alive? Widowhood would be better than “the not-here, not-there conditions into which she had been brought by the miracle of modern science.”

She needs to do something. She decides to visit, and writes to the farmer who has Sam’s heart. Angry letters come back from the wife, but one day when the wife is away, the farmer asks her to come. Feeling like a bride-to-be, she goes, and for an hour, listens to her husband’s heart in the farmer’s chest. At the end he asks timidly if she’ll be back. “No need,” she says. The dignity of life’s end had been abused; somehow, Hannah’s quest restores it.

Does medicine, seeking to prevent or postpone death, belittle life by denying death’s place in it? The question is posed with extraordinary beauty in the title story. No medicine will help the narrator; she has contracted AIDS from a bisexual lover. She goes to stay at a pension in a French village near Annecy, on the lake.

There she writes a letter in the form of a journal. It recounts the daily graces of a civilization which, at its best, knows more about the small details that nourish life than any other.


Dying, she is an honored guest of Mme. Durand, who runs the pension; of the servants and waitresses, of the gardener, and of the neighbors who come in the late afternoons to have an aperitif on the terrace. For every symptom, there is not a medicine but a garland.

Her legs begin to fail, and the gardener fashions a walking stick out of a grapevine. She develops shingles; Mme. brings her a loose Arab robe for comfort. A neighbor drinks a glass of the local wine with her; another drives her down to the lake to sit in a cherry orchard. She is carried out to lie in the sun on a stone wall looking over the water. Crusty bread and a fresh speckled egg--all she can eat--are served her. When her hands swell up, she is driven to a bee farm. After two bee-stings the swelling subsides. It is the “bees’ milk,” she is told.

“Nicole and Mme. together disinterred me from the bed and brought me forth for an airing,” she writes one day. “Where did they learn this profound courtesy for the flesh?”

It is an extraordinary phrase. The courtesy for the flesh is the most ancient of healings, and it works when medicines fail--not to prevent death but to make dying a worthy part of life.


Selzer has delivered a message that could easily fall into sentimentality, with an astonishing, exhilarating precision. It was an artist’s decision to set the story where he does. His villagers represent at its most ideal the French way of treating life; but it is an authentic representation.

And when death comes, it is a small, unforced step. One day in the autumn, Nicole no longer brings up breakfast. She no longer sets out the daily fresh napkin in the narrator’s place at table. The narrator is able to record this too; even though--as we realize--it means she has died. Death and life go hand in hand.