We do not remember days, we remember moments.
- Cesare Pavese
It is the middle of a long night in the Emergency Room. The surgeon — tired, angry, and frustrated — must repair the drunken prisoner’s long, deep forehead laceration. Although the man is shackled to the emergency room cart, he thrashes his head back and forth.
After several attempts to get the man to cooperate, the surgeon stands and retrieves two heavy sutures and a large needle from the supply cabinet. He places the stitches through the drunk’s earlobes and then through the mattress, tying them tightly. “I have sewn your ears to the stretcher,” the surgeon tells the man. “Move, and you’ll rip ‘em off.” The surgeon clears the blood from the man’s eyes to make certain his patient can see, grins down at him, and sets to work.
The scene, from “Brute,” a short story by surgeon-author Richard Selzer, is told for the benefit of a young doctor as an older surgeon recalls his distant past. The reader “hears” the surgeon’s thoughts — a stream of fury and judgment — even as the sutures are carefully placed and the cut repaired. “Brute” concludes with the wound closed, the patient heading off to jail, and the surgeon reflecting back on what he regrets.
On a couple of occasions, I have brought “Brute” and other physician-written short stories to our trainees and students. Many of the young doctors have been in the Emergency Department in the middle of the night repairing facial lacerations for people who were very uncooperative. Most of the students have yet to have that experience.
Around a conference table early in the morning, we take turns reading aloud. When we reach the end, I look around the room. “What do you think of this story?” I ask. “How does the surgeon make you feel?”
The discussion takes a moment to coalesce. Those who have faced the situation might wonder what the young medical students must think. Eventually, someone speaks up.
“Well, the surgeon was wrong to be so angry. Sewing the man’s ears to the table was out of line. It’s hard, though.”
“Well,” says another, “it’s a tough problem but I will admit that I sympathize a bit with the doctor. He had to get the cut closed. He probably had ten other things to do that night.”
The discussion becomes lively. Someone notices that, for the most part, what the surgeon says aloud is appropriate. His thoughts, however, reveal the depths of his anger and contempt. He characterizes the large patient as an animal.
The lay public — and, by extension, the trainees in the room a few short years ago — sometimes view the story with horror, often assuming that it is autobiographical. Selzer, however, frames it as a cautionary tale, opening the piece with a preamble that begins, “You must never again set your anger against a patient.”
“So,” I ask, “What did the surgeon regret? Why did this story stay with him for twenty-five years?”
Someone rechecks the story. “It’s interesting that the thing he regrets later is not the anger or the contempt. It wasn’t even sewing the man’s ears to the mattress. It is the way he made certain that the patient could seen that he was grinning at him.” The surgeon had intentionally tried to humiliate the man.
I am the oldest in the room by a couple of decades. The first encounters I had with emotions and experiences in my earliest days of training come back to me more clearly now than things that happened more recently. Those moments changed me.
Selzer reminds us that surgeons are human and that we make mistakes. I believe he is telling us that we must learn from each encounter, being mindful as we evolve through our stages of training. Pausing to reflect along the way helps each of us find better ways to care for patients now and leads to fewer regrets later. I remind myself to schedule more conferences like this one.
“Brute” first appears in Letters to a Young Doctor (1982) and is also collected in The Doctor Stories (1998). The Doctor Stories is available in the MCW Library (WZ 350 S469d 1998).