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Peter A. Selwyn - Surviving the Fall: The Personal Journey of an AIDS Doctor

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This is a memoir of the first decade of the AIDS epidemic in the Bronx, a physicians firsthand account of the emergence of an epidemic and the lives that it touched. It is also an exploration of how the physician was himself transformed by his experience with these patients. Dr Peter Selwyn, now a well-known researcher and clinician in the area of HIV and drug abuse, came to Montefiore Medical Center in the Bronx as a medical intern in June 1981. He remained there for ten years, caring for patients with AIDS. During that same span he married and became a father. Absorbed in the pain and losses of his patients and their families, Dr Selwyn finally acknowledged the grief he had carried for decades following the sudden death (and apparent suicide) of his father when the author was an infant. He realized that, like AIDS, suicide stigmatizes both those who die and those who survive. Surrounded by young patients who were dying, he understood what it meant to have a father and to be one. For him, it was a process of healing in the midst of the epidemic. His story can help us see AIDS (and any life-threatening illness) as an opportunity to go through our own fear, pain and darkness and to come out on the other side. Recognizing the darkness and passing through it, observes Dr Selwyn, is a prerequisite for anyone seeking to be an effective caregiver, whether professional or personal. It is a process that can teach us how to accompany patients or loved ones through illness and to witness and relive their suffering as they approach death. This is a story of loss, discovery and coming to terms with the past, a story with a message for anyone dealing with the challenges of living, dying and being human.

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title Surviving the Fall The Personal Journey of an AIDS Doctor - photo 1

title:Surviving the Fall : The Personal Journey of an AIDS Doctor
author:Selwyn, Peter A.
publisher:Yale University Press
isbn10 | asin:
print isbn13:9780300082760
ebook isbn13:9780585351971
language:English
subjectSelwyn, Peter A, AIDS (Disease)--New York (State)--Bronx County (N.Y.) , Physicians--New York (State)--Bronx County (N.Y.)--Biography.
publication date:1998
lcc:RC607.A26S429 1998eb
ddc:616.97/92/0092
subject:Selwyn, Peter A, AIDS (Disease)--New York (State)--Bronx County (N.Y.) , Physicians--New York (State)--Bronx County (N.Y.)--Biography.
Page iii
Surviving the Fall
The Personal Journey of an AIDS Doctor
Peter A. Selwyn, M.D.
Surviving the Fall The Personal Journey of an AIDS Doctor - image 2
Page iv
Copyright 1998 by Peter A. Selwyn.
All rights reserved.
Parts of this book appeared in substantially different form in "HIV Therapy in the Real
World," AIDS 10 (1996): 159193; "Caring for HIV-Infected Drug Users: A Provider's
Perspective," Bulletin of the New York Academy of Medicine 72 (1995): 21116; and "Before
Their Time: A Clinician's Reflections on Death and AIDS," in Facing Death: Where
Culture, Religion, and Medicine Meet,
ed. Howard M. Spiro, Mary G. McCrea Curnen, and
Lee Palmer Wandel, 3337 (New Haven: Yale University Press, 1996).
This book may not be reproduced, in whole or in part, including illustrations, in any form
(beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and
except by reviewers for the public press), without written permission from the publishers.
Designed by Rebecca Gibb.
Set in Fournier type by The Composing Room of Michigan, Inc.
Printed in the United States of America by Vail-Ballou Press, Binghamton, New York.
Library of Congress Cataloging-in-Publication Data
Selwyn, Peter A.
Surviving the fall : the personal journey of an AIDS doctor / Peter A. Selwyn.
p. cm.
ISBN 0-300-07126-4 (cloth : alk. paper)
ISBN 0-300-08276-2 (pbk. : alk. paper)
1. Selwyn, Peter A. 2. AIDS (Disease)New York (State)Bronx County
(N.Y.) 3. PhysiciansNew York (State)Bronx County (N.Y.)Biography.
I. Title.
RC607.A26S429 1998
616.97'92'0092dc21
[B]
97-15292
A catalogue record for this book is available from the British Library.
The paper in this book meets the guidelines for permanence and durability of the
Committee on Production Guidelines for Book Longevity of the Council on Library
Resources.
10 9 8 7 6 5 4 3 2
Page v
To my father, who left
To my mother, who stayed
To my wife, who saw inside me
To my daughters, who taught me unconditional love
Page vi
Picture 3
Men make their own history, but they do not make it just as they please; they do not make it under circumstances chosen by themselves, but under circumstances directly encountered, given and transmitted from the past.
Karl Marx, The 18th Brumaire of Louis Bonaparte, 1869
Picture 4
We all grow up with the weight of history on us. Our ancestors dwell in the attics of our brains as they do in the spiraling chains of knowledge hidden in every cell of our bodies.
Shirley Abbott, Womenfolk, Growing Up Down South, 1983
Picture 5
AIDS is kind of like life, just speeded up.
Javon P., heroin addict with AIDS, Bronx, New York, 1988
Page vii
Contents
Foreword
Sherwin B. Nuland, M.D.
ix
Acknowledgments
xiii
Introduction
xvii
1
Immersion
1
2
Connection
59
3
Excavation
105
4
Reconstruction
131

Page ix
Foreword
At the end of a long surgical career, I deliberately look back on the particular personal failing for which I feel the most regret. My conscience is not relieved by the near-universality of the shortcoming that is the source of my self-reproach, nor am I forgiven by an awareness that the failing is the virtually inevitable outcome of the biotechnological culture of medicine's past three decades. I know better than to have succumbed, and the existence of mitigating circumstances does not by one whit decrease my culpability.
The fault I so lament is the product of the single greatest problem facing a profession in which compassion, empathy and dedication to a pastoral calling have long been idealized as the traditional hallmarks of com-
Page x
mitment to the relief of human suffering, even though they have for the most part been incompletely attained. Medicine's and my great problem and great fault consist of what might be called the intellectualizationthe enrapturement with science and technologyby which that legion of men and women who are today's doctors have allowed themselves to become besotted. To be fair, it must be pointed out that this phenomenon has not occurred to the absolute exclusion of our instincts of humanity toward our patients. Still, it has nevertheless indubitably displaced them as the primary motive of care.
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