Summary:

In the Emergency Room at 2 AM, a doctor tries to suture a laceration on the forehead of "a huge black man," brought in by the police. The man groans and strains; he won't hold still. Finally, the doctor becomes so angry that he sutures the patient's earlobes to the mattress. Not only that, he leans over the man's face and grins: "It is the cruelest grin of my life." Then he sutures the man's wound.

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Richard Selzer’s memoir is subtitled “A Doctor Comes of Age.” The book is structured around childhood memories, interspersed with stories from more recent times. Selzer’s father, a general practitioner in Troy, New York, serves as the focal point for most of his early memories--a commanding figure of warmth and goodness in his son’s life: “If I have failed to describe father… it is because none of his features did him justice. I should have had to mention wings in order to do that.” (p. 152)

While his father brought science into Selzer’s life, his mother represented the world of art. She was an amateur singer with a “small pure soprano voice” (p. 15), as well as being the doctor’s wife. After the doctor’s death from a massive heart attack when Selzer was 12 years old, his mother had numerous suitors, at least some of whom she eventually married. When he went to college, she began a life-long practice of writing her younger son (Selzer has an older brother William) weekly letters, including such advice as “Rise and flee the reeling faun,” “You do not take enough chances” and “You must learn to be absurd.” (p.227)

Toward the end of Down from Troy, Selzer writes of his parents, “Of all the satisfactions of my life, the greatest is that I have at last fulfilled each of their ambitions.” (p. 251) This is in reference to his having practiced both surgery and writing. He goes on to enumerate the many unexpected similarities between the two professions. The book ends with a narrative that brings together narrative and medicine, the story of a retired surgeon who reaches out to help a young man dying of AIDS.

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This amusingly told narrative by a surgeon/author begins by describing how "wrong-headed [it is] to think of total submersion in the study and practice of medicine." He sets aside time to read at his neighborhood library, where he befriends six elderly, indigent "regulars." In spite of himself, the physician will out. His powers of medical observation and empathetic character lead him to perform a most menial task: cutting the overgrown toenails of these severely arthritic people in order to alleviate their pain.

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In this tale, Selzer juxtaposes the wealthy chair of the Department of Radiation Therapy, Dr. Arnoldo Cherubini, with Luis Figueira, a scavenger of refuse in the teeming Brazilian city they both call home. Cherubini lives in splendor in the wealthy hillside district, while Luis lives in a ramshackle hut by the sprawling municipal dump. What brings the two together is the discovery by Luis of discarded cesium, which had been inadvertently left in an "outmoded" x-ray machine taken to the dump.

Luis believes his discovery to be miraculous--a piece of a star. He buries his treasure each night, only to uncover and behold it the next evening. Fearing that the guards at the dump will steal his prize, Luis takes it to the home he shares with his sister and her family.

Soon, his avaricious brother-in-law finds the treasure and greedily sells pieces of it to the local slum-dwellers. Luis, with hands rotting, eventually seeks, but then refuses medical attention from Dr. Cherubini. The doctor makes a few half-hearted efforts to aid his patient, but returns to his insular world. Luis returns to the dump and dies shortly after in the arms of his lover.

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Summary:

Nathan was born with a strawberry birthmark on his chest, which both repels and comforts him. Sometimes it is an intricate and unique part of himself that sets him apart from other people and has the power to make him feel special. On the other hand, its very strangeness makes it repulsive to others, especially to women. At his girlfriend’s urging he decides to have the birthmark removed. Despite his doubts, he goes through with the surgery only to realize he has made a big mistake. He blames his girlfriend for his decision.

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Bertie Shields, a second year college student, and Joyce Renfrew, a nurse, are conveying the body of a dead elderly woman to the morgue. After a brief lustful look at Joyce, whose plumpness does not go unnoticed or uncommented upon by either Selzer or Bertie, the latter averts his eyes to the leaner cadaver, going from "pubic woolgathering" to ribbon-spotting; for he notes with increasing meditative pleasure that the corpse is wearing a bright blue ribbon, tied in a small bow and sitting "at the side of her head like a butterfly." (p. 122)

Bertie waxes reflective, wondering who put the ribbon in her hair and when. Joyce, who looks thirty-five to Bertie and who has "heard about" Bertie from "one of the other girls", begins making verbal and then physical advances as they approach the morgue. Just as he has put the unnamed cadaver on her tray and is proleptically about to "slide the tray home," Bertie’s last sight of the cadaver as she is entering "the dark recess" is the "winky blue . . . "--a sight that goes unfinished as he feels Joyce’s hand on his buttocks. The inevitable happens, of course, on the now vacant stretcher.

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Summary:

A man dying of pancreatic cancer has reached the point where the pain is no longer controlled by morphine. In the hospital he begs for death. The surgeon tells his wife, "To give him any more would kill him." "Then do it," she says.

He returns with three syringes of morphine and finally injects them, but the man will not die. How easy it would be to suffocate him! But the surgeon rejects this thought and leaves the room, having failed to provide euthanasia.

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Summary:

The surgeon-narrator and his team of assistants (the anesthesiologist, scrub nurse, circulating nurse, surgical resident, and medical student) perform a difficult operation during the night. The patient has an infiltrating cancer of the stomach (linitis plastica) that has eroded his aorta. Because of uncontrollable bleeding, the operation (an exploratory laparotomy with attempted repair of a malignant aorto-gastric fistula) is as doomed as the patient himself.

The surgeon soon comprehends the hopelessness of the procedure as well as the patient's terminal condition. He turns off the oxygen from the gas tank and stops the patient's blood transfusion. Minutes later, the man dies. Blood is all over everything. The doctor must now deliver the bad news to the man's family. He has the medical student tag along.

Members of the patient's family are upset and some are even out of control so he dispenses tranquilizers to them. The surgeon returns to the operating room (OR) and even now finds blood everywhere. The OR team is still working. The doctor showers and then goes back to the OR once more. The room is now dark and empty but clean. The surgeon imagines the dead man's body with a row of abdominal stitches that he likens to hieroglyphics. The unsuccessful operation and the surgeon's actions are thus both concealed and unforgettable.

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Summary:

Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.

Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.

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Summary:

Selzer tells four stories of surgical loss: a surprise loss on the operating table, the drowning of a sick child in a flood in wartime Korea, the sudden death of a professor due to a perforated ulcer, and the loss of some facial mobility in a young woman following the removal of a tumor in her cheek. As we move from one vignette to the next, the narrator's mood goes from despair to accepting to redeemed, with various forms of love the agent.

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