(continued from Part 1)

Yancey: Dr. Selzer, you led the two lives, surgeon and writer, simultaneously for how long?

Selzer: Seventeen or 18 years. It was difficult because, as a surgeon, I had to work every day or else I'd lose my nerve.

Yancey: Your nerve?

Selzer: Right. You see, it is an unnatural act to lay open the body of a fellow human being. If I missed a few days, it was difficult to go to the operating room and proceed. What is that phrase by Montaigne-la nonchalance bestial. It describes the process of becoming accustomed to the most awful things, like harvesting the organs of the brain-dead, for instance. We surgeons must develop that nonchalance in our work.

Komp: The same thing happens when I do a bone marrow aspirate on a little kid. It finally dawned on me when a grandmother came in and she went out like a light. The rest of us, including the parents, had grown accustomed to the horror.

Yancey: When I ask myself about your appeal as writers, I think of how your writing goes against the grain of science, which has become so reductionistic. You are rendering whole persons, whereas science is always breaking human activity down into tiny molecular actions and synapses.

Selzer: Unweaving the rainbow.

Yancey: Yes, Keats's phrase. Both of you resist that urge to atomize humanity. You retain--even heighten--the mystery of the person. In fact, I've noticed that both of you choose almost heroic, uplifting characters. Yet I know what doctors see: people who abuse their bodies, and sometimes their children; gunshot victims; diabetics who eat a half-gallon of ice cream and neglect their insulin. You see the cesspool of life, in many ways, yet you don't really write about those people.

Selzer: My own subject as a writer is, I would say, the wound. The wounded self. Whether it is abuse of the body or a gunshot wound or a gangrene of the leg or pus dripping, the wound seems to me to have a certain dark beauty in which I have reveled as a writer--and also, I think, as a doctor.

Emily Dickinson wrote "Horror, 'tis so appalling it exhilarates." If I am perfectly honest, it was the wounded self that drew me to the dissecting table, and then the operating table, and that now governs my subject as a writer. I'm always moved and uplifted when I enter the presence of someone who overcomes, transcends the wound.

Yancey: Yet you must often see the opposite.

Selzer: Yes, but one is not to judge. Judge not. One learns to be forgiving. My job as a writer is to be a receptacle, to receive without judgment that which I see.

Yancey: A friend of mine in medical school heard an address on "The Doctor, the Clergy, and the Prostitute." The speaker said that all three have in common an obligation to treat the individual above the society, even to value the individual more. Perhaps we should add Writer to her list? In a sense, medicine gives a wonderful gift to the culture as a whole--a gift of grace. A doctor's office is the one place where you're rewarded for being honest, for exposing yourself.

Komp: That's the ideal, at least. For the doctor to understand and respond with compassion. On the other hand, the patients feel very free to be judgmental of the professionals.

Yancey: I commented to you once that you excel at conveying other characters' feelings, but when you write about your own feelings, a kind of screen goes up.

Komp: I remember that comment well! Part of it is personality type. Most people think of empathy as touchy-feely, putting yourself into the feelings of another person. True empathy also has an intellectual component of knowing what's appropriate. In neither medicine nor writing do I lead with my feelings for the first reading of a situation. I think first, feel later.

When an editor says to me, "All right, Diane, we need more of you in there," I have to switch gears and approach it from another side of the brain. I also have to go back and add in sensory detail. What did it look like? What was the color? I learned that process from interviews with journalists. They would ask me, "What color eyes did she have?" I don't know. "What color was her hair?" Well, she didn't have hair. She was bald. I had to learn that good writing must be visual.

Selzer: We differ there. I lead with the emotions and with the details. I'm a very unrestrained writer. If I could sit on the reader's lap and whisper it all in her or his ear, I would. I have never learned the art of covering myself. My books are all so open and almost confessional in a way. That makes it very difficult for me to reread myself.

There are two parts of writing. One is the initial "inspiration." I hate to use that highfalutin word, but there is indeed an initial impulse, very brief, and you try to catch it with a net of words.

Afterward comes the long and endless tinkering, the selection of words, arranging them on the page. That has its own delight. I was 40 when I first began to teach myself the craft of writing. I read in the dictionary every day to improve my vocabulary, and I read textbooks in syntax and grammar to learn what not to do. I still don't know when to use "which" and when to use "that." Sometimes I'll spend a whole afternoon changing all my "whiches" back into "thats."

Komp: Do you know when I do my first draft? When I'm sleeping. Many times I have got up at four or five o'clock in the morning and written something that was better than I could do in 20 drafts. Same thing happens when I go cross-country skiing. I usually have a notebook in my backpack, but it's not always convenient. I've learned to discipline myself to remember, and not to lose something just because I didn't have access to writing it down.

Yancey: That reminds me, Dr. Selzer, of a scene you cite in your memoirs: of Sir Walter Scott out hunting one day when suddenly he thought of the sentence he had been trying to write all morning.

Selzer: Yes, he quickly shot a crow, whittled a pen from one of its feathers, and wrote the sentence in crow's blood. Diane, I'm fascinated with your story about sleeping. I used to set the alarm to get up at odd hours; I'd try to remember my most recent dream and jot it down. I remember Rilke wrote that he would sit all day and try to write, but nothing would come; and he would go to bed without having accomplished anything. In the middle of the night, he would wake up and there would be, as he put it, an angel holding out on a silver tray a perfect poem.

Yancey: As doctors who write about your patients, don't you run into issues of confidentiality?

Selzer: I regret very little of my writing life, but I do regret one incident. I wrote a piece on assisted death in an AIDS patient. I wrote to exorcise, to rid myself of the experience which was, for me, very troublesome.

I changed the names and details--and I also got permission from the survivor--but evidently I didn't change enough. When it was published, the people were recognizable to their colleagues. The survivor turned on me and said it was a terrible thing I had done. He and his 2,000 best friends attacked and ostracized me.

Yancey: Over the suicide issue?

Selzer: No, the issue was confidentiality--the relationship of the two characters. I never regretted anything more in my life. I'm not in the business of causing pain. It seems to me I've caused enough pain as a doctor. I don't want to cause any as a writer.

Komp: As a doctor you have such a strong instinct for confidentiality that you find yourself censoring the story. I realized, though, that if I tell only the sweet, triumphant stories, I'm not doing good writing. Being an adult means you have your shadows. If I can't write about that, then I shouldn't be writing about adults at all. I finally went to the composite short story form, because confidentiality ruled out using the juicy stories and writing about the patients directly.

In my last book, I wound up going back to biblical stories to try to find leitmotifs, and there I found the same honesty. My book includes the story of Tamar, David's daughter who was the victim of incest by her half-brother. The marketing department would have loved to make that story disappear. I understand, in a way, because we feel the same way in the hospital. What is the incest victim like when she comes to the hospital? She's not the one who brings me cookies, I tell you. She's the patient we want to disappear, the one I drag my feet before seeing.

Yancey: And how did these people respond when the book came out and they recognized themselves?

Komp: What surprised me is how honored patients felt to be included. You realize how forgotten the sick feel, how small.

Selzer: It's a kind of desire for immortality. Ironic, isn't it? The writer worries about the patients recognizing themselves in a book, and all the while the patient longs to be in the book. Was that me on page 34? It was, wasn't it, Doctor?

Komp: One of my patients got a bone marrow transplantation from his sister. He died anyway. The family made every effort to protect the sister, anxious that she not consider it somehow her failure that he died. They sent her to psychologists, but she wouldn't open up. Nothing was reaching this kid. I gave her mother a copy of the Hannah story--based partly on her--before it was published, and she gave it to her daughter. That was the first time her daughter revealed her feelings about her brother's death. Because of the story, she could see and understand her mother's point of view--what it must be like to lose your child.

Yancey: I've often wondered that same thing about you, Dr. Komp. You're not a mother biologically, and yet you've been a surrogate mother to so many of these children. And many of them die.

Komp: At one funeral, the mother responded to me as if I were the one who had lost a child. She said, "Diane, I'm so sorry. You lose so many children. I wanted to give you one child that would live."

But I believe, of course, that the children still live, even after death. And the stories I write ensure that the children will live on in memory, too.

Selzer: The power of literature.

Komp: One reason doctors' stories have power is that we live in a pain-avoiding and death-denying culture. The stories force us to think about what we normally don't think about.

Selzer: Wait a minute. Stop. Christianity is not innocent in this matter.

The fear of death, denial of death, is a very big part of Christianity, it seems to me. I don't know many Christians who accept the idea of death with equanimity. And that business of creating a hereafter and making sweet use of adversity . . .

Komp: Redemptive suffering is the term.

Selzer: Right. But what is there lacking in Christianity that does not console people or prepare them for death?

Komp: I don't think I'll accept the total load on Christianity as death-denying. It strikes me that the apostle Paul gave the most balanced view: "For me to live is Christ and to die is gain." He literally lived in a win-win position.

Selzer: When the ship the Deutschland went down--"The Wreck of the Deutschland" that Hopkins wrote about--one survivor left an electrifying description of five nuns standing on the deck of the ship as it was sinking. They were holding hands, and the Mother Superior was leading them all in prayer. As the water rose and the boat sank, she called out "Christ, come quickly." I can never get over that. It wasn't fear of death or denial of death or whining about the inevitable. It was simply, "Come quickly."

Komp: That's the final sentence in my first book. "Maranatha," the Aramaic for "Even so come, Lord Jesus." Ultimately, that's what I learned from the dying children.

(continued in Part 3)

Copyright (c) 1996 Christianity Today, Inc./BOOKS AND CULTURE Review

Volume 2, No. 2, Page 10

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