Literature and Medicine

<£b Richard Selzer: The Rounds of Revelation M. Teresa Tavormina I leaf through Old Testament slices of liver, in the white monuments of the brain I read the hieroglyphs of decay. -Miroslav Holub, "Pathology" The art of medicine has always been an art of reading and revealing. From the earliest Etruscan haruspices to the slides and cultures of SloanKettering , from the astral medicine of the Middle Ages to the green, pulsing cathode traces of twentieth-century monitoring devices, medicine has divined and advised, reading out the riddles of the body, interpreting its arcana, mediating the gap between man and man's own nature. It is a hermeneutic that draws back the fleshly texts that veil the workings and intimate meanings of the human organism. The GP's educated touch, the surgeon's knife, the pathologist's microscope are highly sophisticated tools of revelation, opening the body to understanding and, in times of illness, to the hope of cure. But this explication of the body's book, like other hermeneutics, is itself often veiled, shrouded in its own sophistication. The hard-won knowledge that directs the pathologist's eyes, the surgeon's wrist, and the GP's fingers also creates an order of initiates who can be reluctant to share the full revelations to which they are privy. The very instruments and procedures of medicine create a professional mystique that can distance nonprofessionals from their own healing. What profane observer would not be awed and deferential before the intricate tools, the gleaming machines, the elaborate purifications, vestings, and rituals that accompany the medical art? Behind these mysterious accidentals of medicine lie more substantive secrets. It may well be inadvisable, may even be impossible, for a physician to pass on his or her full knowledge of a patient's body to that patient. Sooner or later, every doctor faces the problem of how to Literature and Medicine 1 (Rev. ed., 1992) 61-73 © 1992 by The Johns Hopkins University Press 62 RICHARD SELZER: THE ROUNDS OF REVELATION share complex and frightening information with the uninitiated. How much to reveal? To whom? When? How to present alternative treatments and their consequences? The answers to these questions will shape the doctor's relationship with the patient and may ultimately affect the healing process itself. They must be answers that avoid bewilderment or terror from too much information, and false security or resentful mistrust from too little; for each patient, they must strike a different balance between the revelation and the withholding of knowledge. Sometimes mysteries are better reserved to their ministers. AU these secondary mysteries, whether accidental or substantive, necessary or unnecessary, exert a seemingly endless fascination over the lay public. We want to know what goes on behind those masks and drapes, that hieratic language and ritual. For many, the inner workings of the medical profession are even more fascinating than the inner workings of the body, which are the profession's raison d'être. But the profession 's arcana, unlike the body's, are hardly susceptible to palpations, incisions, or tissue cultures. To read the body's readers and their reading, different instruments are needed. Perhaps the best of these instruments is the pen of a practitioner, of an initiate who knows medicine from inside the order, but is willing to write about it for those outside. One such practitioner is Richard Selzer. For the last twenty-three years, he has practiced general surgery in New Haven; for the last twenty, he has taught in the Yale Medical School. And for the last eleven years, he has been writing short stories and essays whose primary subject he quite simply describes as "revealing what it is to be a doctor."1 Although he writes about nonmedical topics as well, ranging from medieval saints' legends to birdwatching, travel, and first love, his most characteristic pieces could be written only by a doctor. Again and again he returns to the beauties and terrors that lurk within the body, to human fear and courage in the face of disease, and to medicine's deep roots in divination and interpretation, in religion and art. By confronting, exploring , and finally celebrating these elementary mysteries, he seeks both to reveal and to heal the spirit that manifests itself in this bloody, mortal flesh. Selzer offers his revelations in a variety of modes, each of which sheds a different kind of light on his subject. He weaves dreams and fantasies together with recognizable pieces of the historical geographies of Korea, New Haven, and Troy, New York; he melds realistic fiction with personal musings. He tends to avoid the documentary or strictly autobiographical approach of many other contemporary doctor-writers. Even when he writes memoirs, imagination seems to play at least as M. Teresa Tavormina 63 great a role as reporting; these pieces are impressionistic and episodic, shaped more by inner personal truth than by external factuality. Yet the straight biographical data of Selzer's life, especially his professional life, cast their own light on "what it is to be a doctor," on the revelations received, and on the hardships and satisfactions of reading them aright. Even more, they show how closely his writing is intertwined with all aspects of his medical career, from its earliest stages to his teaching to his relationships with colleagues and patients alike. Selzer traces the beginnings of that career back to his early adolescence . His father—a general practitioner in Troy—died suddenly when Selzer was twelve, and Selzer describes his own study of medicine as "a boy's search for his father and finding him through his work." He speaks movingly of seeing men who looked like his father on the streets of Troy, after his father's death. As he talks, memory flickers into the present, and he shifts back and forth between general and specific terms, between now and then; he raises his hand and voice to point down the remembered streets: "I would follow them. I was convinced that that man was my father, and that he was alive, but that for some reason unknown to me he must stay away. I would follow them and I would race up and call out and they would turn"—his voice slows and falls— "and I would see that it . . . was . . . not . . . he." But a fascination with medicine, and even with the specialized art of surgery, had been with Selzer from before his father's death. Like many GPs in the smaller cities of the time, Selzer's father occasionally performed surgery, and the son noticed how deeply his father loved his surgical work. "One of the few memories I have of him is his reverence for the operating room—it seemed to him a holy place. When he spoke of it, his voice changed, his eyes changed. . . . After his death I wondered what could have gone on behind those closed doors. It was always a pull, an attraction to a mystery." As Selzer says in "Down from Troy," his father sometimes involved the whole family in medical projects; at all times, household activities revolved around the paternal office hours, during which filial silence was strictly enforced.2 Selzer describes the years of his childhood and adolescence as hard, often painful. To be a child of the Depression in Troy was merely to know an acute phase of the chronic poverty that had plagued the city for decades. Tuberculosis was similarly endemic; Selzer recalls it as a vaguely romantic sickliness that fell sooner or later on family, friends, and enemies alike. He remembers a school bully, outwardly healthy but riddled with the invisible disease, an unseen corruption revealed only by a desperate, lucky blow from Selzer's own fourteen-year-old hand. 64 RICHARD SELZER: THE ROUNDS OF REVELATION "Raising one terrible fist above my face," writes Selzer, "he brought it down ... to his own chest, pressing. Then he coughed, . . . and I was splashed with his blood."3 A week later, the bully was in the Pawling Sanatorium, being treated for the tuberculosis of which he would die. "One can see in the story—'The Spoils of Troy'—the emerging at puberty , of the puberty of my development as a physician. I could imagine even then being inside of that body." He remembers also the family's struggles to make ends meet, first during the Depression and then in the forties, after his father's death. "We lived in deprivation—it was something that we had to endure, that we got through. But now that it is over, it is painful to look back. . . . When I write memoirs, . . . they are laced with humor—I cannot spare to write about my true feelings." Perhaps the most anxious of those feelings was the worry that Selzer and his brother felt for their mother during their teens and twenties, as she worked to support the family and put them through school. Partly because of this concern, Selzer attended college and medical school in places near Troy—Union College in Schenectady, medical school in Albany. With time, the family's fortunes improved and these worries gradually receded, taking with them Selzer's need to stay near Troy. But Selzer's attraction to the mysteries of his father's work, and his need to explore those mysteries, remained as strong as ever. Medical school was a joyous revelation. The very first day, in the calm majesty of the anatomy lab, Selzer found a Grail that could satisfy his hungry searchings: "The great vaulting stone room, with skylights here and there, from which slanted shafts of pearly light, each of them coming to rest upon one of the stately dead. I was instantly made profoundly happy, as if I had returned to a place from which I had been exiled." Here death was given dignity, beauty, perhaps meaning. From the struggles and worries, the pains and inexplicable losses of childhood and adolescence, Selzer had broken through to a place of light and peace, of unexpected familiarity and awe. This passage of initiation seems to underlie his continued faith in the possibility of such enlightenment, a faith that gives meaning to his continued involvement in the dark and painful mysteries of human suffering. The hope of passing from the mysteries of the dark to the mysteries of the light runs throughout his work; by confronting the griefs and terrors of human illness, he also "sings the body electric," celebrating the courage, vitality, and love that can spring out of such illness into health. Just as his writing keeps returning to the body, so Selzer kept returning to the lab; he recalls feeling at home and happy there, "even M. Teresa Tavormina 65 when it became as busy as a Brueghel painting." His reaction, he says, was rather different from that of another, more desultory medical student : "I remember that Keats wrote in one of his letters that he was seated at his dissecting table and looked up and saw this shaft of sunlight coming through the skylight. And in it he saw a host of imps and fairies and sprites, dancing in the air, and he rose from his stool and ascended that sunbeam to the skylight, and then through, and into the open air. And he never went back again." But Selzer stayed at the dissecting table, content to work with the illuminated body—"It was a place where I belonged." From the Albany Medical School, Richard Selzer went on to Yale for his residency, only to be sent to Korea and Japan for two years of military service. The results of this temporary transplant are superficially inconsistent, certainly complex. Selzer professes a tongue-in-cheek indifference to a lovingly detailed alien beauty in "Going No Place";4 he shows an agonized awareness of the disease, love, and guilt in the relationship between a man and a country in "Korea."5 He can recall sharp, sensory memories of two "years of bliss" in these countries where "I awakened as a writer, long before I started to write," where "I tried very hard to open myself to this very foreign—to me—culture, to become permeable to the art and the customs." Even a small thing—stones, a bowl of water—can take him swiftly across twenty-five years and ten thousand miles to a land of wind chimes, peonies, rice-screen window panes, cooking smells, fireworks, and lichen-covered lanterns. Selzer's appreciation of the external alien beauties of the Orient is intriguingly similar to his fascination with foreign presences inside the human body—the independent life that skulks within an abscess, or flutters within a tumor, or flourishes in an intestinal tract. In Japan and Korea, of course, the "foreign" was the native, and a visitor might well be expected to make himself permeable to its otherness. But Selzer's sympathies go far beyond a mere receptivity to the alien in its natural place. He finds intrinsic beauty even in the tumors, parasites, and fantastic flora and fauna that grow within his patients and his characters. To be sure, a surgeon must extirpate these terrifying alien presences to heal his patients; a tumor, Selzer grants, is "a diabolical thing, satanic, evil." And yet, "oddly enough, I have come to love the disease itself, because I think you can only conquer by loving." In addition to its capacity to call forth human courage, the disease has its own vitality, which deserves to be answered "in some noble way, some way other than just technically." He refers to "Korea" to explain further: "When Sloane [the surgeon-protagonist] removes the thyroid gland, and it lay 66 RICHARD SELZER: THE ROUNDS OF REVELATION in his hand like the heart of a saint—even evil, threatening, terrifying as it had been for him and for the patient—when he holds it there is something noble, saintly, religious about the thing itself." Given Selzer's experience of alien, Oriental cultures, it is not surprising that the most attractive statement of his sympathy with the "other life within" comes in an essay on the "alien" medicine of China. In "The Twelve Spheres," he recounts the legend of a man with a tumor between the eyes: The famous Dr. Hua PO examined it, and said there was a bird in it. When the tumor was opened, sure enough, a canary flew out, and the patient was cured. The appealing poetics of this story are a statement on the independent life of disease, that it flourishes, waxes, and wanes much as do all other living processes. Here, it is a canary released from the body where it was trapped, to fly freely toward some other destiny. A very Chinese idea. We, of course, would like to have seen the canary dead, its little head cut off, its body stomped— take that and that, you dirty bird—which says something about the difference in subtlety between Chinese medical thought and our own.6 Selzer returned to America in 1957 and finished his residency; in 1960, he began his practice of general surgery in New Haven and joined the staff of the Yale Medical School, where he still teaches and practices. But his teaching and practice are not really separable. In spite of his ability to hold an audience by reading his work (or perhaps because of that ability), he finds it difficult to lecture "tidily" on a straight medical subject. In the midst of a talk on peptic ulcers, for instance, he has found himself suddenly expatiating on the black frustration, terror, and rage that can eat through an innocent stomach lining—much to his own and his students' shocked surprise. "There was silence in the room, as though I had taken leave of my senses, and I said, Ί can't talk about this/ and I stopped that. I don't give lectures." Instead, he teaches on rounds and in the operating room, asking his students to call on all their senses in examining a patient, to notice color, smell, texture, and their own imaginative responses. Selzer believes that a good doctor, like a good writer, is marked by keen observational powers and wondering curiosity, by the capacity for imagining "that he is Adam, the first man, and that any patient he sees is the second, so that he is examining something he has never seen before." It is in such wide-eyed examination that the doctor discovers himself in his patient, and learns that the patient is indeed "bone of his bones, and flesh of his flesh." M. Teresa Tavormina 67 Selzer shares his own imaginative responses to his work with his students, as in a recent operation on a young woman: "It was a breast operation. Before the operation began, I noted that her breasts reminded me of the blue-and-white china teapots on my grandmother's shelf. They were so fragile and I was always afraid I would break one, and here I was, going to break one now. Then of course that stopped, I became totally engaged in what I was doing. . . . But when I go home—at one in the morning when I wake up [to write until three]—I think about it and write it down." Still, for all his insistence on the common ground between doctors and writers, Selzer does not try to mold young doctor-writers in his own image. He does hope that all his students would learn to sharpen their observations and their descriptions: to describe things "as though to a blind person over the telephone, so that person will see, smell, and feel." But this is not to say that everyone can or should try to turn such description into art: "I don't think we are all writers, I don't think we are all poets, we are not all pianists, we are not all"—he pauses and shrugs —"everything!" Besides, being a writer has special costs for a doctor. "I don't want to seem to be encouraging everyone to kick over the traces and come write with me. . . . It's a very dangerous thing, very dangerous. ..." One of the special costs that Richard Selzer has borne, at least at the beginning of his writing career, is a disapproving mistrust from his colleagues in the "surgical priesthood." Like his father, Selzer sees the operating room as a holy place; when he speaks about it, his eyes also change. Unlike his father, however, he has opened the doors to that room, revealing the mysteries within it. For showing surgeons as human beings and not as gods, for admitting to the fallibility and pain that afflict doctors as well as patients, Selzer feels that he unwittingly invited "if not a stoning, at least a shunning" by some of his fellow-practitioners. To a man with his empathetic capacities, such shunning was inevitably distressing, whether it manifested itself in explicit disapproval of his revelations or in a sudden reluctance to talk freely about work. It marred and diminished the open comradeship of shared labor, conversations, and feelings, and it troubled his affectionate and generous spirit far more than any reviewer's criticisms of his style or subject matter. "I felt bad, because I love my colleagues and I enjoy collegiality and I feel a great compassion for the men and women laboring in the same vineyard." But as his works have become more widely and better read, this unfavorable reaction from colleagues has faded. Indeed, he says, now "a strange and wonderful thing has happened—doctors from all over the 68 RICHARD SELZER: THE ROUNDS OF REVELATION world have written to me saying 'Yes, that's just the way it is, and you've said it!' " More and more doctors have let him know, directly and indirectly , that they understand what he is doing, what he calls his central subject: "revealing what it is to be a doctor." Although he feels that he writes for himself, he is clearly delighted to learn that other doctors can find their voice in his work, and he hopes that his writing might reinfuse the medical profession with a strong sense of its own fundamental humanness , "with dignity, and with grace." He would remind both physicians and patients of the humane compassion and the human limitations that attend the art of medicine. Selzer's writing is thus like medicine itself, an act of mediation. Much of his mediating art operates by way of compassionate selfrecognition ; his medical protagonists share their patients' struggle and pain, and come to recognize their own death and life in the dyings and livings of those patients. Even in drawing characters who are not doctors or patients, Selzer focuses on people who, like doctors and patients, "are under great stress . . . usually solitary figures, pushed to the extreme of their endurance, and a little beyond. And I observe them struggling, in extremis." One wonders how Selzer's own patients respond to a surgeon who is willing to "reveal the fact that surgeons suffer, and are afraid, and that they fail." He admits that revelations of this sort may make some people insecure; some people "don't want their surgeon to be anything but an infallible machine." But he has found—to his initial surprise— that his patients, and many others whom he meets in the hospital, actually find the self-revelations in his work quite valuable, and even reassuring. He explains: "Just as the patients expose themselves to me, now I expose myself to them, and it makes the relationship dynamic and resonant." His essays and stories remind and reassure his readers that the doctor-patient relation is one between two human beings, not between a human being and a god, nor between a human being and a machine. It is a two-way transaction that can ennoble both parties, a transaction in which both sides can learn and teach, give and receive. He speaks very decidedly about the lessons and gifts he has received. "There's an infusion of strength from the patients. They replenish me, restore me." His patients and his patients' families often worry about him as much as he does about them; they have taught him, he says, about courage and joy, the value of suffering, and "the real meaning of the tending relationship." In talking to Richard Selzer, it becomes clear that all his professional relationships, whether with students, colleagues, or patients, have both M. Teresa Tavormina 69 influenced and been influenced by his writing. The aspect of Selzer's profession that is most inextricably intertwined with his writing is, understandably , the daily bloody practice of surgery itself. He writes of sickness because it is sickness that faces him each day, asking to be made whole, and because it is sickness that can be made whole. "It is the marred and scarred and faulty that are subject to grace," he says in the opening essay of Mortal Lessons.7 As another healer put it, "Those who are well have no need of a physician, but those who are sick." His characters—solitary, in extremis—are Everyman cast on the lonely, agonal stage of the operating theater. Medical metaphors even occur in his nonmedical stories; in one memoir, "Jacob Street," he writes of a music "half-heard, half-palpated," of its thumping rhythm like a muscle contracting slowly and erratically beneath a street.8 Just as Selzer's practice has informed the subject, theme, and imagery of his writing, so writing has affected his practice. He finds that the keen, imaginative awareness that his writing has helped him develop follows him on rounds and into the operating room. He cannot escape it without quitting either surgery or writing; its haunting presence is a mixed blessing, one of the special costs that a surgeon-writer must bear: The price I've paid as a surgeon is a very great one. In the operating room, the patient must be anesthetized, so that he does not feel the pain. The surgeon, too, must be anesthetized. When he cuts the patient, his own flesh must not bleed; he must remain at some distance from the emotional confrontation. But the surgeonartist is unanesthetized: he sees everything, censors nothing. So as I have developed as an artist in the operating room, my own protective mechanism against this awful fact of laying open a fellow human being has weakened. There are chinks in my own armor—I find it more difficult to face the terrible facts of this work. The writing has made me a better doctor, because it has made me look at my patients with the dilated pupils of a poet, and I have seen many things that other doctors have not seen. But it also has drained from me some strength with which I distance myself. To be a surgeon and a writer "is a dangerous thing, very dangerous . . . ." In part, it is Selzer's sensitivity to the "terrible facts" of surgery, his daily contact with the "exuberant bloody growths"9 that are human beings, that makes his writing so characteristically his own, and so different, say, from that of his friend and sometime colleague Lewis 70 RICHARD SELZER: THE ROUNDS OF REVELATION Thomas. "We are often lumped together," Selzer reports, "to our amusement , usually to my detriment, by the book reviewers." And he goes on to insist that Thomas's cool, rational essays and his own lush, often disturbingly nonrational tales are "different things entirely"; he smiles and adds, "We might as well be different species." He readily accepts the hypothesis that the differences between his writing and Thomas's are related to the differences between their specialties, and between the kinds of personalities drawn to each. "Lew is a pathologist, a research doctor. His is an intellectual pursuit. Mine is a matter of touching and gazing, and being involved." In fact, Selzer seems to delight in disclaiming the intellectual aspects of his work, not infrequently asserting, "I'm not an intellectual. Just a simple sawbones. I don't have ideas." These protestations are made in a humorous, self-deprecating tone, perhaps lighter than William Carlos Williams's "No ideas but in things," yet the position is similar: "No ideas but in the body." In the anatomy lab at Albany, Selzer chose to keep his feet on the ground and his hands on the illumined body, instead of floating up the illuminating shaft of light with Keats's imps and fairies. In his writing, he says, he is "rooted to the ground, to the patient's body; all my strength comes from being able to touch the ground, like Antaeus." For him, the body ¿s the ground; moreover, it is the world. He anatomizes that world into "beefy cliffs," "yellow meadows of fat," "estuaries of pearl."10 A tumor forms a "great hard craterous plain" across the back of a patient's stomach; entering the body in surgery is an act of mountaineering, with sutures for pitons.11 In "The Surgeon as Priest," he confesses his admiration of the Yeshi Dhonden, personal physician to the Dalai Lama, who diagnoses a patient's congenital heart defect as a gateway in her heart, opened by a wind that blew before she was born, through which flows a cascading river that floods her breath.12 And "The Twelve Spheres" approvingly recounts a Chinese creation myth that takes the world to be the body of the Son of Heaven: For eighteen thousand years the Son of Heaven labored to fashion the universe, and when his work was done, he gave up his life, settling into his masterpiece. His head became the mountains, his breath the wind and clouds. Thunder was his voice, the sun his left eye, the moon his right. AU the strata of the earth were his veins and muscles. The soil was his very flesh, the rain his sweat, and the lice upon his body became man.13 M. Teresa Tavormina 71 Where Lewis Thomas's world is "most like a single cell," Richard Selzer's appears to be most like the human body. The body contains the world in a man-sized frame; it gives the world its measure. To reveal the body's mysteries is to reveal the world's: it is to unveil the interpenetration and deep unity of disease and health, of suffering and transfiguration , of the other and the self. In the daily rituals of surgery, Richard Selzer regularly penetrates the skin and flesh that seem such a firm boundary between self and other. As he says in more than one essay, this surgical assault upon another human being is a simultaneous act of love and violation. Its justification can only lie in the discoveries and cures that such a drastic invasion of privacy makes possible. And yet, in the end, it must lead to the discovery of the temporary nature of all cures. For the surgeon soon discovers that his trespass into the patient's physical self is not the first such breaking and entering of the body's sanctuary. As he draws back the flesh to reveal the terrifying, alien presence of disease, he also reveals how deftly and secretly the disease has preceded him, sidling through the barricades of skin, antigen, and leukocyte with an almost natural ease. And in learning that he is not the first to violate the body's integrity, the surgeon must come to realize that he will not be the last. Even if he can eliminate the present invader, others will follow—some harmless, some hurtful, and eventually one that is mortal. For Selzer, death itself is an invasion: not a passive change of state but an active, pervasive entry into the body by the world's surrounding otherness. In one of his recent notebooks, he sketches a man running into a forest, seeking his own death: "The forest enters him the way night enters a house. Through a window, a door, a chimney. Or the way the sea enters a sinking ship." More literal, and more macabre, is his essay "The Corpse," with its graphic detaiUng of the microbial, maggoty invasions that constitute the process of corruption and decay.14 These are the mysteries of darkness that Selzer's work reveals. Doctors, especially surgeons, are terribly privy to such revelations. To know them in one's patient is to know them in oneself. It is to know one's own mortality, to see that one is neither a god nor a machine, but a human being subject to pain, sickness, and death. As a surgeon who writes, Selzer is able to share the fearful mysteries of his medical work with us; if his revelations seem grotesque or painful or alien, it is because we find disease and death to be so. But through the mysteries of darkness and beyond, there lie the mysteries of light. Disease and death can call forth greatness of spirit. 72 RICHARD SELZER: THE ROUNDS OF REVELATION The body itself may respond gamely to the challenge, like the cirrhotic liver whose brave self-repair Selzer describes in his essay on that organ.15 Some alien presences may enhance, rather than detract from, a person's life—a symbiotic plant, for instance, in the whimsical "Myself Healed," or the engrafting of the divine Other in "Midnight Rising."16 And we all recognize Selzer's portraits of people who respond to sickness with humor, courage, and generosity. Such ennoblements deserve celebration even if they sometimes disappear when the disease is cured, and even though no cure lasts forever. But Selzer celebrates more than the human spirit that flames out when shaken by suffering. His preoccupation with death is, finally, not morbidly negative but vividly affirmative. Having faced the horror of bodily corruption as a terrible feast for ravening microbes and flies, "The Corpse" goes on to sing the disintegration of the body as a reintegration into all Nature. A body that has not been "plasticized" by embalmer's fluid can decompose naturally, at the foot of a tree, say, where it can "melt and seep into the ground, to be drawn up by the roots. Straight to the top, strung in the crown, answering the air. There would be the singing of birds, the applause of wings."17 The limited, self-defining body of the individual rejoins the body of the world, a body united by the mutual communion of branching and breathing life. Selzer applauds the Chinese medical tradition for its "immediate sense of man as part of nature";18 along the same lines, his work asks us to recognize our inextricable relationships to other lives, sometimes human, but more often animal, vegetable, or bacterial. To heal is to make whole. To heal the body faced with disease, it is often necessary to reveal that which disrupts the whole—the part that fails to function, or worse, does not even belong to the whole. Once this diagnosis is made, the cause of illness can be repaired or removed by the appropriate treatment; with luck, the treatment will return the patient to wholeness and health. To heal the spirit faced with death, Selzer finds a simpler treatment—the diagnosis itself. By revealing the wholeness of which the body is a part, and to which it will return, he offers a vision of order and dignity that can, if we let it, give meaning to the dark mysteries of death. This sense of wholeness enables him to celebrate life and death together, using his medical and his literary arts to mediate between them, and to mediate them both to us. Given such arts, with their deep roots in his professional and personal history, it is not surprising to discover the following self-revelation in Selzer's notebooks : M. Teresa Tavormina 73 As to the matter of autopsy—mmmmm, no. Hypocrite, you cry. You above all people should recognize the need, the debt. I have a greater need, another debt, I say. This one to myself. And that is to go to my reward corpus intactus. Let the ants and worms perform their own autopsy. Let them crawl into my eye-sockets and find them glowing still from thirty years of operating lamps beneath which I have worked. Let the ants in my ears find smudges of ink where I have tugged a lobe in thought. Let beetles and snails peer into my heart and find there the flight of a scarlet tanager. And in my skull, no brain, but a tree in full and trembling leaf. And on my belly glistening, a drop of lover's sweat. One could do worse for a final disposition. NOTES 1. Quotations in the text of this essay, when otherwise unattributed, are drawn from a set of interviews with Richard Selzer conducted in the spring and summer of 1980. A partial transcript of these interviews may be found in the Centennial Review 25 (Winter 1981): 20-40. 2. Richard Selzer, "Down from Troy," in Mortal Lessons: Notes on the Art of Surgery (New York: Simon and Schuster, 1976), 177-91. 3. Richard Selzer, "The Spoils of Troy," in Confessions of a Knife (New York: Simon and Schuster, 1979), 68. 4. Richard Selzer, "Going No Place," in Confessions of a Knife, 91-99. 5. Richard Selzer, "Korea," in Rituals of Surgery (1974; reprint, New York: Simon and Schuster, 1980), 62-102. 6. Richard Selzer, "The Twelve Spheres," in Mortal Lessons, 167. 7. Richard Selzer, "The Exact Location of the Soul," in Mortal Lessons, 19. 8. Richard Selzer, "Jacob Street," in Mortal Lessons, 207. 9. Selzer, "The Exact Location of the Soul," 19. 10. Richard Selzer, "The Surgeon as Priest," in Mortal Lessons, 25. 11. Richard Selzer, "Sarcophagus," in Confessions of a Knife, 52. 12. Selzer, "The Surgeon as Priest," 35. 13. Selzer, "The Twelve Spheres," 173-74. 14. Richard Selzer, "The Corpse," in Mortal Lessons, 136-37. 15. Richard Selzer, "Liver," in Mortal Lessons, 76-77. 16. Richard Selzer, "Myself Healed" and "Midnight Rising," in Rituals of Surgery, 185-93, 175-84. 17. Selzer, "The Corpse," 140. 18. Selzer, "The Twelve Spheres," 167. ...