Here’s an excerpt from a Harvard Magazine piece that covers many of my favorite blog topics: cleft lip, cleft palate, restorative medicine, patient care, and the role of doctors. Are they just healers or are they prophets? Are they sometimes heroes, villains, or fools? In the story told below, there’s a transformation, almost a miraculous one.
To set the stage: the piece below is also about writing and storytelling—activities I’ve had to master, esp for the most recent of my several books, Cleft Heart: Chasing Normal. The piece was written by someone observing Professor Jerome Groopman teaching an undergraduate seminar at Harvard.
A cleft palate girl . . .
. . . “This week, the third of the semester, Groopman and his students were reading Letters to a YoungDoctor, a collection of autobiographical essays and stories by Richard Selzer, a surgeon and longtime Yale faculty member who, as Groopman once wrote in The New York Times, “helped usher in the modern genre of medical writing in which the physician puts his experiences under the microscope for the lay reader’s scrutiny.”
A Catholic whose writings—like those of many physician-authors the students will read this semester—echo with religious undertones, Selzer views medicine as a calling, an almost holy exercise. The relationship between doctor and patient is sacred. And he finds beauty in disease and suffering. “Rendered helpless by their afflictions,” Selzer’s narrator tells a younger physician early in Letters, the sick “know something you and I do not yet know—what it is to live with the painful evidence of your mortality.” Now 87, Selzer first published Letters in 1982.
On this February afternoon, nine students sat around a broad table that filled up the whole room, and a tenth, home sick, joined in by FaceTime, on a classmate’s phone propped against a water bottle. (“Hello!” Groopman waved at her from across the table. “We miss you!”) Before the cookie break, the class had started in on a story called “Imelda,” whose title character is a young girl with a harelip and cleft palate whom Selzer met when he was a medical student accompanying an eminent plastic surgeon on a mission to Honduras. The surgeon, whom Selzer calls Hugh Franciscus—a name heavy with metaphor—is the center of the story and its tragic figure: when we first meet him, he is remote and affectionless. He shrinks from his patients’ touch. As a physician healing their deformities, however, he is driven, relentless, and seemingly infallible. His colleagues and subordinates idolize and revere him. Describing his white coat as “monkishly starched,” Selzer writes that Franciscus had “the appearance of a prophet.”
“Do you believe that?” Groopman broke in suddenly, stopping the student who’d been reading the passage aloud. “Are doctors prophets?”
A few students vaguely shook their heads. “No,” ventured one young woman.
“No,” Groopman affirmed. “Uncertainty and unpredictability are essential to medicine. They call it the uncertain science; you can do everything absolutely right as best you know, and the outcome for the patient is poor. But Hugh Franciscus is a ‘prophet.’ So he’s a seer—maybe.”
In a Honduran village, whose landscape and people Selzer calls airless and made of clay—godforsaken, in other words, missing the breath of life God gave to Adam—Franciscus’s pedestaled perfectionism crashes into reality. Young Imelda has a toxic reaction to the anesthetic and dies on the operating table before Franciscus can make his first cut.
“So,” Groopman said, “now let’s look at this great monkish starched Hugh Franciscus on page 30.” He signaled a student to pick up the reading at the passage where the surgeon comes out to tell Imelda’s mother that her daughter is dead. Trying to maintain his aloof untouchability, Franciscus begins by standing over her—“why all the stage directions? Look at what they’re saying,” Groopman said, looming over a student to drive home the point. But instead Franciscus breaks down. He cannot speak. The mother rises to her feet in front of him, and she is the one who finds the courage to speak the awful truth: “Muerte.”
“Suddenly he’s losing it, this guy who was so controlled,” Groopman said. Standing up behind his chair, he paced back and forth slightly, and then took over reading Selzer’s text: “At that moment,” he read aloud, Franciscus “was like someone cast, still alive, as an effigy for his own tomb. He closed his eyes. Nor did he open them until he felt the touch of the woman’s hand on his arm, a touch from which he did not withdraw.”
Groopman halted, looked up from the page. “Remember, no one touches this guy,” he told the students. “All of a sudden he’s humbled, he’s falling apart. And this mestizo woman, whose daughter is dead—at his hands, presumably—is touching him. She becomes the healer. Shebecomes the comforter.”
That night, Franciscus goes into the morgue and fixes the harelip on the dead girl’s face.
“Why would you do that?” Groopman asked the class. “Why would you have the most meticulous sutures of your life on a dead body?”
A young man at the other end of the table spoke up. “To reassert the control that he lost.”
“Right. He’s reasserting his perfectionism.…Let’s read on.”
A couple of pages later, the class arrived at Groopman’s favorite line in the story: “She was his measure of perfection and pain—the one lost, the other gained.”
“That’s a beautiful line of prose,” Groopman said, interrupting his student and reading it again, more slowly, drawing out the words. “And what does it mean? I mean, it rhymes; it’s poetic. What does it mean?”
“That she was the breaking point—,” the young man at the end of the table offered.
“OK,” Groopman said. “And what does he gain and what does he lose?”
“He loses perfection.”
Groopman: “Is anyone perfect?”
Another young man, sitting at Groopman’s left elbow: “No.”
“If you imagine yourself to be perfect, what happens to you?” Groopman looked around the room.
“You break, ultimately.”
“Right. Because there’s going to come a time when you’re not perfect.”
Franciscus ends the story as a hollowed, haunted man. Reading the last lines, Groopman pressed his point about perfection one more time, and it seemed perhaps he was talking about more than just Hugh Franciscus. “So, if you have a god complex, you’re in trouble,” he told the students. “Whether it’s in medicine or law or business or teaching or whatever, you strive for perfection, because the stakes are high, but recognize that you’re not perfect. And you have to have this psychological and emotional ballast, right? Anybody know what ballast is?”
They did, sort of. Something about a boat and balance and weight. Groopman filled in the gaps. “And without ballast,” he continued, “there’s nothing to keep Hugh Franciscus up. He’s in free fall.”
. . .