Down from Troy: A Doctor Comes of Age (review)

Abstract

128 BOOK REVIEWS the multifactorial etiologies of disease or fiction, and the inability of any one schema to encompass all that might occur. In summary, Vital Signs fulfills some of the urgent needs of literature and medicine as a discipline through its rigorous historical and intellectual scholarship, its perceptive close readings of several texts in the canon of literature and medicine, and its challenging assertions of the intimacy between clinical medicine and realism. Had the author more experience with medicine, he might have avoided some of the unfortunate overstatements that cloud his arguments. As I was reading the text, the paper closest to hand for a bookmark was a copy of an electrocardiogram of a woman whose atrial fibrillation, an abnormal heart rhythm, had recently been converted to normal sinus rhythm, a healthier state for her heart. The sight of the tracing evoked multiple sensations: an initial flush of victory in having brought about the conversion to normal sinus rhythm, an instantaneous reliving of all aspects of what had been a complicated and draining hospitalization, and then the recollection of alarm experienced earlier on noting an abnormally prolonged interval in the tracing, something most likely caused by the medical treatment. That is, the medical text not only contained disembodied pathological information about the corporeal fact of the patient, but also biographical material about her internist. If Rothfield could realize the depth of medical practice, the extent to which the physician inhabits nonironic corners of the universe, and the intimacy that doctor and patient can achieve, perhaps he could make even more lasting contributions to this field. —Rita Charon Columbia University Richard Selzer, Down from Troy: A Doctor Comes of Age. New York: William Morrow, 1992. 288 pp. Clothbound, $20.00. As a prelude to my reactions to Down from Troy, I would like first to describe my perceptions of Richard Selzer's writing in general. To begin, I suspect that response to Selzer's work tends to separate his readers into two camps. Many find his writing overworked and flowery. For them, his use of language is too rich; it is too "literary." These readers like their prose focused, tight, and do not wish to struggle with meta- Book Reviews 129 phorical flights of fancy. They see the purpose of writing to be direct communication in as clear a fashion as possible, and they do not esteem anything that interferes with this directness. This type of writing occupies an essential place in many dimensions of our personal and professional lives. Many aspects of medical discourse must be simple, direct, and objective so that factual information can be communicated easily from one practitioner to another. As a scientist, I usually place high value on prose that is simple, descriptive, and direct. Despite the necessity for concise, nonmetaphorical prose in human affairs, however, the human condition would be very poor indeed if all our written work were so constructed. Humanity is such a complex state of being that the concise prose of science is often inadequate to capture humanistic essence. Recognizing this, the second camp of Selzer's readers delights in the literary and metaphorical complexity of his writing style, believing that he has done much to illuminate and clarify the fundamental complexity of our shared humanity. Like many others, I have always been awed by Selzer's breadth of cultural understanding and his often brilliant use of language. He is a writer able to create words, images, and metaphors that capture the essence of what it means to be human. At his best, Selzer can finely balance the essence of both writing styles. Some of his stories, such as "The Consultation" or "Brute," demonstrate lean and precise prose that quickly conveys powerful messages about both doctors and medicine. Much of his other work, however, is more complex and requires greater engagement from the reader. This requirement for engagement is illustrated by his essay "Abortion." Although Selzer himself holds a "pro-choice" position in the abortion controversy , I believe that this essay is one of the best antiabortion statements ever put to paper. It is a complex and convoluted essay, with many seeming stops, starts, and diversions. Nevertheless, in it Selzer does...