Book Review

Raising the Dead: A Doctor's Encounter with his Own Mortality

N Engl J Med 1994; 330:1835June 23, 1994

Article

Raising the Dead: A Doctor's Encounter with his Own Mortality
By Richard Selzer. 118 pp. New York, Penguin Books, 1993. $17.50. ISBN: 0-670-85414-X

Early in the 19th century, Fanny Burney, one of the most noted novelists of her day, felt a lump in her breast. It persisted. Eventually, she underwent a mastectomy, with all the travail that the medical care of the period involved. She received little advance notice of the surgery, which would have spared her much anxiety in its anticipation. Later, she wrote a novelistic account of her experience. Richard Selzer tells us this story in the first part of Raising the Dead.

Late in the 20th century, Richard Selzer, a surgeon and author, fell ill with legionnaires' disease. Like Burney, Selzer had little advance notice. After being rushed to the hospital, he spent 23 days in a coma, followed by a long and slow recuperation, with all the travail that current medical care involves. Like Burney, Selzer wrote a novelistic account of his experience, which is the main part of Raising the Dead.

And an amazing account it is, a rhapsodic tale of wonder, of noble beauty and mundane tragedy, a tale like none other; it is a tale -- as the title states -- about “raising the dead.” Selzer describes his illness with amazing imagery and metaphors. The prose is musical and poetic; it flows and evokes images and ideas that the reader will carry about for some time after reading the book. Selzer has written many books, but none as moving and profound as this one.

As he tells the story, Selzer is admitted to the intensive care unit, a place he knows well from the other side. He sees the place anew, describing the earnest doctors who work there as “poor farmers who, year in and year out, turn with their hoes the same exhausted patch of soil, planting and replanting it, flogging it, cherishing it. But there will come the day when the pathetic patch of dust will no longer yield. Only then will they let it be.” The hanging bottle of intravenous solution is a “crystal chandelier,” which later “sends light streaming through his body until he is something radiant and glowing in the bed.” “The moans of his sick neighbor are the sound of an oboe being played in another part of the house.”

Trouble awaits:

All day, night, silt has settled in his veins, turning them solid. Only the bubbles of saliva in his teeth continue to wink bravely in the light. A slow slide of clot advances through his body. It began in the venules of the arms and legs, filled the larger veins, the iliac, the inferior vena cava, flowing slowly toward the heart. By morning it will have achieved the right auricle. A single muffled thump, it will be hurled to the lungs. And there it will stay, hardening into a cast of the pulmonary circulation.

What more poetic account of a pulmonary embolism could there be than this? So he dies.

But he is resurrected from death, and “from that moment on, his vital signs -- pulse, blood pressure, temperature -- are normal. His oxygen saturation, 100 percent. There is no longer any doubt he will recover.” It is, however, a slow recovery. Selzer's description of a patient with a difficult convalescence can teach medical personnel a great deal about what is important for such patients. Unable to see as a result of the lack of one form of technology (his eyeglasses), unable to talk as the result of the use of another form of technology (prolonged endotracheal intubation, which has left him hoarse), and fresh from a stay in the intensive care unit, the sleep-deprived author lives a rich and fruitful nocturnal fantasy life, floating down the Nile, living in a monastery. Few patients have written with such eloquence. Selzer's tales left me wondering what wonderful worlds other delirious patients create in their minds' eyes.

As he gradually improves, Selzer focuses on the crucial realities of hospital life, such as incontinence and the “carnivorous” mattress on which he spends almost all of his days. What is most important, Selzer underscores, as many patient-authors have done before him, is the humanity of medical care and the centrality of nursing care. For Selzer and most other patients, the nurses are the ones who are always there and who matter the most.

But what is this book really about? Some readers will come to the end of this review wondering what “really” happened to Selzer. Some will finish the book asking the same question. Selzer has an answer for them: “The facts are not always where the truth lies. Ask the great historians, for whom the facts are there to be interpreted anew by each generation of scholars. Facts have a way of changing from time to time. The truth lies beneath the surface of the facts.” In this tour de force, Richard Selzer has given us one writer's truth about life and illness and, perhaps, death.

Joel D. Howell, M.D., Ph.D.
University of Michigan, Ann Arbor, MI 48109-0376