Peter Selwyn spent the first ten years out of medical school at Montefiore Medical Center in the Bronx, caring for HIV-positive patients--mostly intravenous drug users and their families--in the early years of the AIDS crisis. As he worked with dying young men and women and their families, Selwyn returned to his own unexplored pain surrounding the loss of his father, who fell or (more likely) jumped from a 23-story building when Selwyn was a toddler. Mirroring their function in Selwyn’s life, the stories of the five patients who most affected him serve in this book as the threshold to the narrative of how Selwyn investigated, mourned, and commemorated his father’s death, finally revaluing it as central to the person and doctor he became.


This book is a riveting narrative of pre-AZT, "Hey, it’s an epidemic" AIDS medicine (p. 53), and a reminder of the disease’s impact on families and entire communities. As well as a significant commentary on the particular status of AIDS--and AIDS patients--within hospital culture, the book offers provocative perspectives on all fatal and untreatable illnesses and the challenges they pose to the philosophy and practice of medicine.

If facing patients’ deaths carries deep personal resonance for many doctors, it doesn’t always make them more compassionate. In fact, Selwyn asserts, "the physician’s fear of death, and his or her own unexpressed grief, are the biggest impediments to true empathy, and result instead in pity, despair, revulsion, and the kind of numbing detachment that finds refuge in technological interventions and a narrow medical model of care." (pp. 126-7)

When Selwyn explored and accepted the grief his dying patients evoked in him, however, he was able "to be with my patients in their pain, to support them without feeling the blind compulsion to rescue them from something from which they could not be rescued, and to accompany them as they approached death without feeling that I had somehow betrayed their trust." (p. 125) The book’s most memorable anecdotes develop how his patients helped Selwyn evolve a more receptive mode of doctoring, one in which hearing a patient’s anger and fear, feeding a dying patient oatmeal as he would feed his own young children, or simply being there, were his most important contributions.

This is a readable, intimate contribution to contemporary explorations of the doctor-patient relationship and the difficulty--especially within palliative care--of finding a balance between shutting the heart and keeping it too open. Selwyn’s narrative structure sometimes makes for frustrating reading because his own unexplored story is both mentioned and deferred until close to the end of the book, when he devotes several chapters to it. The deferrals, however, mark Selwyn’s insistence on honoring his patients’ stories as well as his own, and the fact that only through them did he gradually recover his past and integrate it into his present.


Yale Univ. Press

Place Published

New Haven



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