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Surviving The Fall

The personal journey of an AIDS doctor

By Peter A. Selwyn. M.D.

Foreword by Sherwin B. Nuland, M.D.
Hardcover, 145 pages
Published by Yale University press
Publication date: March 1998
ISBN: 0300071264

Synopsis

Peter Selwyn came to Montefiore Medical Center in the Bronx as a young medical intern in 1981. For the next ten years he worked on the front lines of the AIDS epidemic as a physician working with injection drug users, primarily heroin addicts. Now a well-known researcher and clinician in the area of HIV and drug abuse, Dr. Selwyn has given us a moving memoir of his personal journey as an AIDS physician during the crucial early years of the epidemic.

In his foreword to the book, physician Sherwin B. Nuland writes that "Medicine's and my great problem and great fault consist of what might be called the intellectualization -- the enrapturement with science and technology -- by which that legion of men and women who are today's doctors have allowed themselves to become besotted." In contrast with this tragic and dehumanizing aspect of modern medicine, Dr. Selwyn shares with us an unusually revealing personal account of his own pain, fear, and grief as he is surrounded by dying young patients that he is powerless to help.

A young doctor in his first job, just out of training, the harder he works the more his patients' needs seemed to escalate. He admits that "to the overinvolved young medical director, every new obstacle was only an excuse to work harder." But he gradually realizes that he is witnessing the arrival of something akin to the Great Plague of 1665, as a never-ending stream of young patients became ill and then died despite every medical effort.

By the end of 1980's AIDS had become the leading cause of death for both men and women aged twenty-five to forty-four in the United States. Estimated HIV infection levels of up to five percent in the general, young adult population in some parts of the Bronx were on a par with parts of central Africa. The lack of effective AIDS treatments during the period of this memoir meant that for most of Selwyn's patients an AIDS diagnosis was a death sentence. How he and his patients come to terms with this finality is the core of the book's message:

The disease humbled us, it made much of our carefully accumulated medical knowledge seem irrelevant. Yet by humbling us, it deepened our solidarity with our patients. I had not experienced such a clear connection to my patients until I was faced with this illness that I could not treat. I learned then that this role -- that of an engaged witness, accompanying and helping patients through their illness -- fundamentally defined my greatest usefulness as a physician, not only with patients who were deemed incurable but with all my patients. (p. 57)
Selwyn strains to keep a dispassionate professional detachment from his feelings, but he has too much in common with these young people to completely avoid a sense of identification with them. Most of his dying patients were within five years of his own age. As a new father he thinks of his own family while witnessing other young families ripped apart by terminal illness. He experiences the acute terror of suffering a needle-stick accident and endures months of anxious waiting before antibody testing confirms that he was not infected. He shares many stories that bring individual patients into focus -- sadly many of these relationships conclude with a funeral.

The book also tells a parallel story of Selwyn's recovery from unresolved grief due to the sudden death of his father by suicide when the author was an infant. He sees that the shame associated with AIDS is in some ways similar to the shame associated with suicide. Both involve disenfranchised grief, making it harder to work through the feelings openly. Helped by bereavement workshops which he attended at the Elisabeth Kubler-Ross Center, he becomes more aware of the profound commonality of experience, needs, and hopes that he shares with so many other people. The book concludes with him finally visiting his father's ashes and achieving a measure of acceptance of his childhood loss.

Overall it's a good read, noteworthy both as a look at the human side of medicine and as a chronicle of the early years when AIDS was first being recognized.

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