Richard Selzer and Ten Terrific Tales

July 20, 2016 at 9:23 am


Richard Selzer and Ten Terrific Tales
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by Tony Miksanek, MD
Family Physician and Author, Raining Stethoscopes

If there were a Medical Humanities Hall of Fame, physician-writer Richard Selzer (1928-2016) would be a first-ballot selection. And likely by a unanimous vote. The diminutive doctor had a very large presence in the field. He energized the medical humanities movement in the 1970's and 1980's with his lectures, readings, writing workshops, commencement addresses, correspondence, personality, and kindness. But it was his writing - earthy and elegant, whimsical and wise - that masterfully mingled the world of medicine with the world of the arts and highlighted the necessity of humanity in health care.
His literary output includes more than 125 published short stories and essays, a work of nonfiction (Raising the Dead), an autobiography (Down from Troy), a novella (Knife Song Korea), and a diary (Diary). Many of his stories reflect an interest (even an infatuation) in decay and death, the beauty of the body, how illness beatifies the sick individual, the power and fallibility of doctors, and the great panacea/contagion - love.
"Writing came to me late, like a wisdom tooth," Selzer proclaimed. Indeed, he was 40 years old when he began writing seriously. His early efforts at crafting stories dutifully occurred between the hours of 1:00 and 3:00 AM. His initial focus was creating horror stories because it was an "easy" genre to handle. That fondness for the macabre and otherworldly never dissipated as he continued to utilize horror (and humor) in many tales. The majority of Selzer's stories involve doctor-patient relationships, surgery, and suffering. Some of his literary work is weird ("Pipistrel"), experimental ("A Worm from My Notebook"), and an exercise in reimagining ("The Black Swan Revisited").
Surprisingly for an MD, he seemed a bit unconcerned about facts in his writing. Rather, he was deeply interested in creating impressions. For Selzer, facts weren't necessarily equivalent to truth. After all, facts change but impressions endure. Still, Selzer stubbornly searched for truth (and love) in his stories. He was enticed by language and the sound of words. From time to time, he manufactured his own words. He disliked gerunds but appreciated onomatopoeia. His favorite doctor-writers were John Keats and Anton Chekhov both of whom died from tuberculosis - Keats at age 25 and Chekhov at age 44.
I don't know which story Richard Selzer considered his best or most beloved, but I suspect that "Diary of an Infidel: Notes from a Monastery" was at or near the top of his list. The rest of us, however, definitely have our favorite Selzer stories. And while there are so many wonderful tales to choose from, I recommend the following 10 not-to-be-missed selections. My list is divided into two sections. Part 1 includes personal favorites and stories that don't get nearly the attention they deserve. Part 2 is comprised of stories and an essay that I find very useful in teaching.
Part 1: Five Fabulous Favorites:
1. "Tom and Lily"
2. "Luis"
3. "The Consultation"
4. "Toenails"
5. "Fetishes"
Part 2: Five Fixtures for Teaching:
1. "Brute"
2. "Imelda"
3. "Sarcophagus"
4. "Wither Thou Goest"
5. "The Surgeon as Priest"
So there you have it. The two greatest stories by Richard Selzer are "Brute" and "Tom and Lily." Of course, that's just my opinion. How do you see it? You are invited to post to the blog with your favorites. (I have a hunch that "Imelda" is going to vie with "Brute" for the top spot.) In the meantime, The Doctor Stories by Richard Selzer is a perfect place for readers to roost - either as an introduction to his work or an opportunity to reacquaint with some notable tales.

States of Grace: From Doctor to Patient and Back Again

April 5, 2016 at 3:39 pm

Katie Grogan, DMH, MA and Tamara Prevatt, MA,
Master Scholars Program in Humanistic Medicine, NYU School of Medicine

 

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Before the accident, Dr. Grace Dammann was a caregiver through and through, in every aspect of her life. A pioneering AIDS specialist, she co-founded one of the first HIV/AIDS clinics for socioeconomically disadvantaged patients in San Francisco at Laguna Honda Hospital. She was honored by the Dalai Lama with an Unsung Heroes of Compassion Award for her service and devotion to this population. Grace was also the primary breadwinner and parent in her family with partner Nancy "Fu" Schroeder and adopted daughter Sabrina, who was born with cerebral palsy and HIV. She lived and worked in such close proximity to illness, death, and disability, but nothing could have prepared her for the devastating injuries she sustained when a driver veered across the divide on the Golden Gate Bridge, crashing head on into her car.

Grace spent seven weeks in a coma, hovering on the precipice between life and death, like so many of her own patients. Ultimately, she awoke with her cognitive abilities miraculously intact, but her body was irreversibly impaired, leaving her wheelchair-bound and dependent on others for simple daily tasks. States of Grace, a documentary film about her profound transformation, picks up Grace's story when she is discharged following a thirteen-month stay in rehabilitative hospitals. Members of NYU Langone Medical Center, including medical and nursing students as well as faculty and staff across all disciplines, were invited to attend a screening of the film and talkback with Dr. Grace Dammann and the filmmakers, Mark Lipman and Helen S. Cohen of Open Studio Productions.

States of Grace captures the expansive and rippling effects of the accident, how it left every corner of Grace's life radically altered-personal, professional, psychological, spiritual, and economic. The family dynamic is turned on its head. Fu becomes the primary caregiver to both Grace and Sabrina, and as Grace says, "Sabrina's position in the family was radically upgraded by the accident. She is so much more able-bodied than I am." Fu struggles with the enormity of the role she has signed up for. Grace wrestles with her gratitude for having survived and the frustrations of her new life: "I feel like I've lost a best friend-my body . . . When I first woke up, I was just glad to be alive, plain and simple. Now I'm just annoyed-annoyed at the limitations. I'm bored." In one scene we see Grace argue with Fu about her right to die if she continues to be so impaired.

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Grace grieves for her old life, for how effortless things were. We watch as her fierce resilience pulls her through to acceptance. She credits her Zen Buddhist practice for her ability to keep moving forward: "Nothing lasts forever, even great pain and sorrow." Though some of her ultimate goals-to walk again, to dance again, to surf again-remain unattainable at the film's conclusion, Grace sets, meets, and exceeds new ones. Acknowledging that she only felt completely whole when practicing medicine, she "comes out" as a disabled person to the medical community, returning to Laguna Honda Hospital as its first wheelchair-bound physician, where she is appointed Medical Director of the Pain Clinic. She resumes the caregiver role, but with an intimate knowledge of the lived experience of pain, suffering, and disability. In the talkback Grace remarked, "Once you disrupt the integrity of the body, you're disrupting the integrity of the psyche, and I don't think any of us think about that. I certainly didn't as a physician. I hate to admit how many times I discharged people without even getting them up to see that they could walk." She also brings her Buddhist training to the clinic, where she promotes wellness among the staff and patients by teaching meditation.

As the talkback ended, attendees lingered, eager to chat with the filmmakers and shake hands with Grace, awestruck by her story of triumph, adaptability, service, and the lessons learned on both sides of the doctor-patient divide.

Sabrina will graduate this May with her Bachelor's degree. Grace partnered with the driver who hit her to advocate for a median barrier on the Golden Gate Bridge to prevent similar accidents from happening in the future. The barrier was installed in January 2015.

This screening was co-sponsored by the Master Scholars Program in Humanistic Medicine, the Office of Medical Education, and the Department of Physical Medicine and Rehabilitation. Special thanks to Drs. Pamela Rosenthal and Marianne Sommerville for bringing the film to NYULMC. For more information on States of Grace and to arrange a screening, go to: www.statesofgracefilm.com

 

Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images

March 23, 2016 at 1:17 pm

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NYU Langone Medical Center welcomed author/painter Cortney Davis to the Smilow gallery for the opening of "When the Nurse Becomes a Patient." Laura Ferguson's interview with Ms. Davis appears here.

Exhibition presented at the NYU Langone Medical Center Art Gallery by the Art Program and Collection.
Photo: Art Program and Collection.

 

The Patient Experience Book Club at NYU Langone Medical Center

March 2, 2016 at 1:41 pm

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When an AP reporter called to tell Erika Goldman, publisher of the Bellevue Literary Press, that its novel, Tinkers, by Paul Harding, won the 2010 Pulitzer Prize for fiction, "it was akin to receiving a blow to the head," she said. "It was concussive." For the first time since 1981, a book published by a small press won the award.

Ms. Goldman told this story to the members of the Patient Experience Book Club at NYU Langone Medical Center, a group that includes physicians, nurses, administrators, analysts and social workers among others. On a recent Friday afternoon, the group met to discuss Tinkers.

Tinkers recounts the last days of George Crosby. Lying in a hospital bed in the middle of his living room, surrounded by the members of his extended family, George's thoughts drift between the scene around him and memories of his boyhood. His father, Howard, a peddler of home goods in rural Maine, had epilepsy. Faced with the possibility that he would be committed to a psychiatric hospital Howard Crosby abandons the family leaving George, his mother and siblings to fend for themselves.

Time is a thematic thread running through the novel (George repairs clocks) as the narrative flows between memories of his childhood and his adult life. Harding describes his book as unlineated poetry. Its rich, descriptive language requires readers to settle into the prose, avoid distractions, and allow themselves the space to fully experience the story.

After a brief introduction by Ms. Goldman about how the Pulitzer Prize process works, the group turned to a discussion of the text. Their interpretations were filtered through their individual experiences working with patients and families. A social worker compared some "not so great" deaths she has witnessed to George's death at home with his family. A neurology administrator pointed out that the stigma attached to epilepsy remains a problem for some of the patients she encounters. Tinkers draws attention to the silence surrounding illness, another commented.

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The Patient Experience Book Club was started by Dr. Katherine Hochman in 2012. She came up with the idea after attending a conference on patient experience that was organized by the Institute for Healthcare Improvement in Boston: "What I took away from that was in order to have an engaged patient, we need to have an engaged staff." She decided to hold meetings every two months to discuss books that related, even tangentially, to patient care. A small grant funds box lunches and copies of the selections. The books are made available in advance of the meeting. Sessions typically draw from 10-30 people from all areas of the medical center. For many, it's a chance to meet co-workers who they do not interact with in their normal daily routines.

Locksley Dyce, a hospital administrator, loves to read and is a regular attendee: "It affords me the opportunity to meet in a multi-disciplinary group and exchange thoughts with healthcare professionals whom I probably would not meet otherwise."

The Club invites a faculty or staff member with expertise in a particular area to lead the sessions. Dr. Joseph Lowy from the palliative care service led the discussion of Being Mortal by Atul Gawande. David Oshinsky discussed his book Polio. And during the Ebola scare, the novel Blindness prompted a discussion of what it would be like for a whole society to be affected by an illness. During that session, Hochman and the group wore blindfolds to experience blindness for themselves.

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Mr. Dyce finds the sessions particularly thought-provoking. "We try to apply the material from the book to healthcare - especially patient care - and the individual roles that we play in it," he said.

As the session on Tinkers drew to a close, and the members prepared to go back to work, ordering tests, analyzing metrics and attending to their patients, they reflect on the issues brought up in the meeting and acknowledge the importance of taking time to connect with their patients.

The group meets next in April to discuss When Breath Becomes Air by Paul Kalanithi.

Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images (Part II)

June 9, 2015 at 2:00 pm

(Kent State University Press, 2015)

[Editor’s Note: This is Part II of a dialogue between author and painter Cortney Davis and our Art Editor Laura Ferguson. Part I can be read here.]

Laura: I'd love to know more about your studio process. I see that some of the pieces are acrylic, some oil, and some include collage. Are they as unselfconscious as they seem? Did they come into being easily and quickly, without a lot of working over - or did you just make it seem that way? You let us feel your pain and your aloneness, you invite us to understand, and you allow us in to your experience. I suspect that may be in part because your paintings are not too perfect and polished.

Cortney: The paintings were painted very rapidly with no working over. I was discharged in mid-July, and the first painting was done at the end of July. Most of the paintings were done in August, six of them, one after the other, usually only a few hours per painting, or less. Three were done in September and two in October. I actually didn’t know what I was doing, technique wise. I painted in my basement in front of an open sliding door, with music playing (most often "The Tallis Scholars Sing Thomas Tallis" or "Agnus Dei, Music of Inner Harmony"). Painting also took my mind off my body (I was having a lot of medication side effects) and I really felt blessed to be alive, to be home, and to be standing by the open door with summer all around me, doing something that seemed totally free from "thought." When I finished the last painting, I looked at them and wondered exactly how they came about. It seemed there was no "planning" to them, just the painting.

As I recovered, however, by October I could sense the paintings becoming more "thought about" and less unselfconscious. I began to wonder if I was painting "correctly" and I found myself being more careful, more precise with the last two paintings. It was as if when I regained control of my body and my illness was less central, less in command of my day, I also moved, little by little, away from the totally un-thought-about and un-planned-expression that marked the paintings. (The paintings in the book, by the way, are not in the order I painted them - they have been arranged, in the book, in a chronological order to tell the story. I painted the images without rhyme or reason, just painting whatever seemed most urgent.)

The commentaries were added in November and December, at a time when words seemed to return to me, certainly the creative medium in which I was most comfortable and felt most proficient.

The Dark Night

Laura: You say that "painting seemed to be all about the body" but also that "painting took my mind off my body." Is that a contradiction? Did it feel like getting back to your body the way it felt before the illness?

Cortney: Painting felt physical, messy. It felt more like my body if my body only consisted of the senses.

When I painted the last one (which is the last in the book, "Angel Band") I noticed it was very neat - it felt less messy than the earlier ones - and I knew it was a sign that my head was taking over again. I haven't really done any more painting since then.

Laura: I wonder if being so vulnerable and out of control, and in a situation that forces us to live in our bodies in a very basic sense, opens us up, frees up that kind of expressiveness. The side of ourselves that needs to get things right becomes unimportant.

I'm thinking about the med students in my Art & Anatomy drawing class. I find myself trying to get them to loosen up, to enjoy being messy, to let go of trying to get it "right" - which is hard, because it's so important in every other aspect of med school. I think this is related to the issue of control that you bring up. You speculate that "maybe turning illness into something creative is a way of taking control," and I think that's true. It allows us to organize the experience, to present it as we see it. But paradoxically, it's a control that comes from letting go of control. As you say, it works best when it's messy and just comes out, without a lot of thought or oversight from one's internal editor.

This tells me that there's the potential for tremendous creativity in the world of medicine, from both patients and caregivers - and that art is a great way for each to communicate and open up the reality of their experience to the other.

Cortney Davis - When the Nurse Becomes a Patient: A Story in Words and Images

June 2, 2015 at 9:40 am

(Kent State University Press, 2015)

A dialogue with Art Editor Laura Ferguson (Part I)

Carol Donley, in her annotation of Cortney's book in the LitMed Database, writes that "the vivid paintings speak for themselves, and they add a different way of knowing not available through words." As an artist whose work explores the experiences of her own body, I believe strongly in the power of art to express things that can't be as easily communicated in other ways, especially about experiences that go deep, like illness, pain, and isolation. Because Cortney is both a medical professional and a wonderful writer, I welcomed the opportunity for a dialogue with her about the expressive power of visual art.

Laura: You chose painting to express your feelings about the experience of being a patient, even though you are also a writer and poet. Can you say more about why it felt more right to express yourself without words? Do you think it was because the experience was so physical, so much about the body? For me, drawing seems to come directly from my body - it allows my body to express itself directly, through my hand. Is that how it felt for you?

Cortney: I didn’t really choose painting, rather it sort of chose me. When I was finally discharged after the second hospitalization my friends wondered if I was going to write about my experience. I felt the need to respond to my illness in some creative way (maybe turning illness into something creative is a way of taking control?), but I really could not find the words. It felt as if there were no words to adequately express what I had been through or what I’d experienced in the hospital. Words seemed too intellectual, too distant and too controlled to express something that felt raw, profound, and frightening. Also, since I’m primarily a writer, there is always an internal editor that watches over my shoulder when I write, and I didn’t have the emotional energy to embark on a writing "project" that I’d be trying to make "good" or "worthy."

My urge to paint took me a bit by surprise because I’m not a painter. A few months before my surgery, a painter friend had invited me to her house to paint with her, and she had introduced me to acrylics and oils - that was the first time I’d put paint to canvas. But after a few of our painting sessions, I was hospitalized. When I was discharged, I remembered that I had paints and some blank canvases at home. I felt drawn to paint images that I recalled from my hospitalization. My illness was all about my body, and painting seemed to be all about the body too: the smell of the paint and the feel of the paint and the brush on the canvas, the movement of my hand and arm, the lack of an internal editor (since I really had no idea if I was doing the painting "right" or not), the emotional impact of the colors and shapes, and the lack of the need to "intellectualize" the process.

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Laura: Why did you then decide to add words? How would you characterize the relationship of your words to your paintings, or what you felt their purpose was? Do you think the paintings can stand alone?

Cortney: After I’d painted the twelve images, I wanted to share them with some of my nurse friends and with my family. I took photos of the paintings with my iPad and wanted to send them around, but I knew that viewing the paintings alone, unless someone knew a bit about what had happened, might be confusing. I added the commentaries in an attempt to make my very personal experience more universal, and to put down in words why those particular images stayed with me. By the time I added the commentaries, I was months into my recovery and feeling as if I might now find the words. The painting had helped me enter once again into the illness in an attempt to make emotional sense of it, and maybe the words helped make intellectual sense of it.

I now think the paintings could stand alone (now that I can see them more objectively), or at least a viewer might get a general sense of the story if he or she viewed the images as a series. But, since I’m a writer and not an artist, I felt the urge, eventually, to explain to others and to myself just what was going on in each painting.

Laura: Would you say that you made the paintings more for yourself or for other viewers? Do other paintings convey powerful, deep feelings to you? Do you think the paintings allow viewers to empathize with your experience?

Cortney: I think some artists and writers "do" their art in spite of illness, and some because of illness. In my writing about being a nurse, I write because of others’ illnesses as an observer. But painting as a patient, I was painting and then writing because of my own illness. Interesting! I never would have come up with those specific images if I’d not been a patient.

Laura: You told me that some people were "creeped out" by your paintings, or found them too depressing. - but I don't think people who've been there, who've been through experiences like this, will find them depressing. I think it's great that you go right to the heart of suffering, not sugar-coating it. You're willing to admit how out of control, how vulnerable you felt - and I think that totally comes across in the paintings. I'm sure you were an empathetic nurse, so can you say more about why you needed to experience being a patient yourself in order to understand what it was like to feel that vulnerable?

Cortney: I had been a patient many times before this last illness. But I’d never been close to death as a patient, or so sick for an extended period of time. I believe it might have been the very real possibility that I could die that made a difference in my understanding of the power of illness. I experienced a deep hopelessness and even a wish that I would die quickly, if I was meant to die. I had time to contemplate suffering and to review my life, realizing all the ways in which, while I’d been empathic, I had failed to understand the depths of suffering - mental, physical and spiritual - that gravely ill patients can experience.

In addition, my prolonged hospitalization was the direct result of a surgical mishap and, during my hospitalization, there were other complications that stemmed from lab and medication errors. Not only was I seriously ill, I was for the first time a patient who was unable to rely completely on those who were caring for me. Because I was a nurse, I could see the events and complications of my illness both from the inside - my personal experience of them - and from the outside - my inability to make sense of why or how these errors had occurred and were occurring.

As a writer, I’d always thought that I had the vocabulary with which to express what my patients might be experiencing, and to express what I was experiencing as their caregiver, in my poems and non-fiction. But during this illness, I felt in a very profound way the metaphorical inadequacy or incompleteness of my vocabulary. There is a level of vulnerability that can’t be intuited from the bedside but can only be experienced.

Laura: Related to that, do you think it's possible that nurses (and other medical professionals) get a sense of control from their jobs, that makes them feel protected from being in the patient role - a kind of magical thinking?

Cortney: I believe that all caregivers are acutely aware, especially after years of practice, that it only takes one second for someone to be thrust from the role of caregiver to the role of patient. And I believe too that there are many instances in medicine and nursing in which caregivers feel totally out of control - not wise enough, not quick enough, not prepared enough. I never felt that I would be "in control" by virtue of being a nurse, or that being a nurse combated any fear of dependency. I was more often in awe, feeling great vulnerability, but always both enriched and humbled by my interactions with patients.

[Editor's note: Part 2 of this dialogue will be published next week, with more about Cortney's studio process, and thoughts about artmaking as a way of both holding on to and letting go of control.]