Surviving the Fall: The Personal Journey of an AIDS Doctor - Hardcover

Peter A. Selwyn

Hardcover

ISBN 10: 0300071264 ISBN 13: 9780300071269

Publisher: Yale University Press, 1998

Synopsis

In this memoir, Selwyn (medicine, Yale U) explains how his experiences with the first wave of the AIDS epidemic in the Bronx brought to the surface his subconscious grief over his father's apparent suicide. He then shows how his awareness of a relation between the stigma of AIDS and the stigma of suicide led him to overidentify with his patients and become excessively dedicated to his work, and how his eventual understanding of this situation caused him to resume his proper roles in his family and as a father. Annotation c. by Book News, Inc., Portland, Or.

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Reviews

Physicians have made substantial contributions to the autobiographical literature, but not many have passed the test of soul-baring, Augustinian self-analysis required by confessional literature. William Carlos Williams is among the few. More recently, Rafael Campo and Jack Coulehan -- like Williams, both are physician-poets -- have made their marks on the literature of private thoughts. Now Peter Selwyn brings us Surviving the Fall, a wrenching account of his search for self-discovery. Selwyn's story of how he confronted his past is much more than autobiography. It is an examination of a personal crisis brought on by the stress of working with patients afflicted by both drug addiction and AIDS.

I was drawn to Selwyn's book because it contains a strand of remarkable parallels in our lives. He was born the year I graduated from medical school, we were both medical house officers at Montefiore Hospital in New York, and we both went on to Yale, where I continued my medical training and he accepted a faculty position after spending eight years as director of Montefiore's drug-abuse-treatment program. As children, both of us had lost a parent. There was also the jarring fact that in 1985 Montefiore Hospital was sponsoring a methadone-maintenance program for 950 patients in the Bronx. When I was there in the 1950s, we knew little of drug addiction. Montefiore was a place where elderly patients, mainly of eastern European origin, went for treatment of heart failure, diabetes, or cancer. It housed a living neurologic museum where almost every known eponymic hereditary neurologic disease could be found among the patients who had lived there for years, and it was one of the few research hospitals in New York with the capability for very long term metabolic studies.

In the 1950s and when Selwyn began his internship in 1981, Katz's delicatessen on nearby Jerome Avenue was redolent of hot pastrami and the counterman's arm bore a tattoo of blue numbers -- a souvenir of Auschwitz. But during Selwyn's time in the Bronx, Katz's disappeared, tattoos grew more decorative, and AIDS began to bark at the gates of Montefiore. The days of stately rounds in starched whites were over. Selwyn found himself at the epicenter of the onslaught because of his position in the drug-abuse-treatment program. "Epicenter" and "onslaught" are not exaggerations, for Selwyn was stuck by a needle from a patient infected with the human immunodeficiency virus (HIV) at a time when it took weeks to get the result of an HIV test. He escaped infection, fortunately, but until the result of the test was known, he suffered mightily from grief, guilt, and worry about his young family. Selwyn was living, as he says, by Nietzche's dictum, "Whatever doesn't kill me makes me stronger."

By 1986, Selwyn was an authority on AIDS in users of illicit intravenous drugs, but with little to offer his patients except moral support and relief from suffering. Ironically, at the same hospital 30 years earlier, I had only the same to offer my patients with heart failure or cancer -- where I saw cardiac cachexia, he now saw wasting from AIDS. Selwyn points to the difficulties of treating AIDS in drug-addicted patients. For them even the promising new multidrug anti-HIV therapy has limited value, because addiction and borderline resources are formidable obstacles to compliance with such complex and costly treatment. Selwyn's thoughts on drug addiction are important. He makes no judgments but tries to understand the addict's agony and the physician's frustration: "This phenomenon is beyond blame and mortality.... Neither can we save them nor do we have the right to condemn them."

At about its midpoint, Surviving the Fall becomes a confessional, and we learn the meaning of the book's title. After six demanding years in the AIDS maelstrom, Selwyn has reached a crucial point in his life. Exhausted by daily tragedies and too many funerals, he at last succumbs to the blow of his father's death 30 years earlier. For three decades his well-meaning mother and aunts hid the story of Aaron Selwyn's fall (or leap) from a skyscraper window. They even suppressed memories of the dead father, leaving only some faded photographs and a few personal possessions (a wedding ring, an old razor) for Selwyn to discover later. No wonder Selwyn conflates suicide and AIDS as variations on the theme of secret stigmas.

Helped by workshops conducted by the Elizabeth Kubler-Ross Center, Selwyn slowly discovers ways to mourn and to begin to resolve the discord of his childhood. Forty years after his father's death, Selwyn at last obtains from his mother the information he needs to find the window on the 23rd floor of 30 Broad Street in the financial district of Manhattan, the window from which Aaron Selwyn, at the age of 35, fell or jumped in 1955. The scar heals only when Selwyn visits the crematorium holding his father's ashes and orders them moved from a neglected corner to the Hall of Tranquility. With this gesture, Selwyn finally lets go.

Physicians engaged in high-stress medicine often pay a hidden price for continuing their professional work. Trauma surgeons, oncologists, and AIDS specialists, among others, call it burnout, an exhaustion of the personal resources required for technically demanding procedures and humane medical care. Surviving the Fall is not really about burnout, but the turmoil engendered by the AIDS epidemic in a literate and sensitive physician who was already psychologically wounded. Under pressure, Selwyn's suppressed childhood hurts burst forth and merge with the trauma of watching young patients die of an infectious disease. Surviving the Fall tells an ennobling story of how one physician sorted out his professional obligations and his life.

Reviewed by Robert S. Schwartz, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

A moving personal account of a doctor's discoveries about himself as he struggled to care for his dying AIDS patients. In 1981, when the AIDS epidemic was just beginning, Selwyn, newly graduated from Harvard Medical School, joined the Montefiore Medical Center in the Bronx as an intern in family medicine, later becoming medical director of its drug-abuse treatment program. For nearly ten years, his only patients were the HIV-infected, mostly intravenous drug users and their sexual partners and children. Surrounded by dying young men, widows, and orphaned children with whom he found himself making deep connections, Selwyn began to explore his own history and eventually to come to terms with it. His father had died in a mysterious fall from a window when Selwyn was an infant, his apparent suicide a family secret. Selwyn came to see parallels between the stigma of AIDS and the stigma of suicide, between the drug addiction of his patients and his own addiction to work. The stories of five patients had special resonance for him: Nelson, with his idealized family; pregnant Milagro, bent on a path of unalterable self-destruction; Delia, whose infant child would soon be orphaned; Javon, determined to leave his son a legacy; and Betty, with her irrepressible zest for life. Selwyn is led to explore his grief and sense of loss in Kubler-Ross workshops, press his family for information about his father, recover his father's ashes, and finally to visit the site of his death. Going through fear, pain, and darkness, says Selwyn, is a prerequisite to becoming an effective caregiver, as he comes to see the physician's primary role not as an all-powerful conqueror of illness but as a companion to those going though an illness and as a witness to their suffering. Poignant revelations from the heart of a physician. -- Copyright ©1998, Kirkus Associates, LP. All rights reserved.

Selwyn entered his residency at an inner-city Bronx hospital in 1981, just in time for the arrival of AIDS. Medical school had prepared him to be a healer, but in the face of a devastating, incurable disease, he found his most important role was as a "witness and companion." There were certain characteristics of the disease that made it more personal, and in the devastating effects of AIDS on families, Selwyn began to sense parallels with the suicide of his father: "Like AIDS, suicide is something that stigmatizes both those who die and those who survive, something that is shrouded with shame, guilt, and secrecy." Selwyn successfully intertwines his own story with portraits of his most memorable patients, resisting the temptation to turn them into martyrs. He admires drug addicts' "yearning to live intensely in every moment" and eventually, as he becomes more and more obsessed with his work, recognizes that he shares some of their patterns of addictive behavior. As befits a memoir, this book's best moments are the intensely personal ones: Selwyn's secret fear that any weight loss meant the onset of AIDS; his attempt to trace his father's last steps in the building where he died. Selwyn credits his journey through the AIDS epidemic with making him a better doctor, but the healing went both ways as he found a new understanding that would allow him to treat the untended wounds left by his father's death.
Copyright 1998 Reed Business Information, Inc.

Selwyn's contribution to the literature of doctors writing about their AIDS patients is a two-fold story. It is about treating patients and comforting them and their families, and it is concerned with linking Selwyn's relations with his patients to his long-submerged feelings about his father, who had fallen from or, more likely, thrown himself out of a 23-story building when Selwyn was 18 months old. Selwyn's AIDS work followed directly from serving some of New York's poorest citizens in a family health center in the Bronx. There and in his later work with AIDS patients as medical director of a methadone program, he came to know many patients and their families as well as he knew his fellow workers, establishing relationships that grew in understanding to the benefit of all. The parallel emotional search for his father Selwyn renders credibly and so movingly that at the end, after the transfer of his father's ashes to a brighter and more open location, we join him in an unburdening sigh. William Beatty

This is not so much a book about AIDS as it is the story of a physician's coming to self-understanding by means of his work with AIDS patients. Selwyn, associate director of the AIDS program at Yale, began working with the disease as a new resident. Increasingly consumed by his work and concerned about his patients, he began to recognize that he was becoming less emotionally available to his own family. Selwyn attributes this and other problems to the death of his father, who died suddenly, probably a suicide, when the author was an infant. While Selwyn's profiles of AIDS patients are lovingly and beautifully written, and he paints an involving and realistic picture of the devastating impact of AIDS, readers might wonder at his tendency to attribute virtually every emotion to his father's death. Not an essential purchase, this book will nevertheless appeal to readers interested in AIDS or stories of self-discovery.?Linda Gleason, Univ. of Medicine & Dentistry of New Jersey Lib., Newark
Copyright 1998 Reed Business Information, Inc.

Edition details

• Publisher: Yale University Press
• Publication date: 1998
• Language: English
• ISBN 10: 0300071264
• ISBN 13: 9780300071269
• Binding: Hardcover
• Edition number: 1
• Number of pages: 176