Edited by BLAS FALCONER | BARRY KITTERMAN | AMY WRIGHT
Going to God
An Interview with Thomas Gibbs
Amy Wright for Zone 3: Your essay, “The Two-Headed Calf,” in addition to making a political argument, recalls an archetypal metaphor for decision-making, only instead of Janus with the two faces, I now see this pitiable creature who cannot lift its two ponderous heads. The tremendous gesture, it seems to me, is that the physician opts toward responsibility in the natural world. It is not a move everyone makes—to become an agent of circumstance, and more than one head has been split against it. Have you ever known or seen anyone act in a way that signified ownership of character?
Thomas Gibbs: Regarding choices directed by circumstance, this narrative crosses my mind often: “Imelda” is an essay by retired surgeon writer Richard Selzer. Selzer was a medical student when asked by Dr. Hugh Franciscus, the Chief of Plastic Surgery at the Albany Medical College, to be a translator on a medical mission to Comayagua, in the highlands of Honduras.
Selzer assisted with before and after photography of the patients needing plastic surgery for horrendous facial cancers and hideous congenital malformations of the face and mouth. Imelda was a fourteen-year-old girl who held a pink rag to her face covering her enormous defect. Her resistance to revealing her defect intensified her disfigurement. Selzer took photographs; Franciscus marked her for the surgery.
As the surgery begins Imelda suffers malignant hyperthermia. There is no ice, no means of reversing her temperature; she dies. The two doctors go out to the mother. The chief, Dr. Franciscus, tells the mother her child is dead. The mother holds his hand and tells him at least Imelda is going to God as a beautiful young girl. She does not understand the surgery was not done. The mother says she needs to find someone to help her with the body and promises to return the next day.
When she comes back the following morning, she opens the mat covering the girl and weeps at her beauty. Selzer looks down and sees the surgery has been done. Fine sutures correct her features. The medical student then realizes the surgeon had gone down to the morgue in the night and operated on the dead body, correcting the anomaly.
I am guessing that Selzer went to medical school in the late fifties. I saw the calf during the same decade. Culturally at this time normalcy was the standard. If one observation was not normal then there was a likelihood that more deviance was to be encountered. Fixing outliers was the mission.
Imelda shocked me because I don’t know that I would have operated on a deceased patient. But the complex character of the plastic surgeon makes the narrative. The surgeon, an authoritative, arrogant, brilliant, too superior to have friends, reader of medical books only, is broken by this case. It may seem the surgery was done to support the mother but in fact the surgeon could not deal with this patient dying and his not being able to fix the defect. He never goes on another mission, his surgery schedule is reduced and he retires. So in fact he is not honored by this circumstance-directed response, he is decimated by it.
She had suffered fulminate hepatitis after a blood transfusion at time of hysterectomy. Her abdomen filled with ascetic fluid and her vaginal cuff prolapsed, then distended with increased pressure. Other doctors, many of whom that I knew and respected, said no they would not operate to correct the defect. The risk was too high that she would die on the table. Even a good result would give her little time. She could not travel in her condition and she dispassionately asked for my help.
When I examined her it looked like a huge pink wasp nest was hanging between her legs. I did the surgery. She survived and left the hospital the next day. She didn’t need to walk with a towel between her legs, or get in the bathtub to go to evacuate. Several days later my office receptionist received a call. She called my intercom and told me a woman wanted to speak to me. She explained, “She says she is standing in the waters of Massachusetts Bay.”
I thought about choices, what my father, a small town general practitioner, would have done. I thought about whether I was really doing what was best for her or if I was clearing my conscience, my pre-guilt for thinking no. Was I doing what I was raised to think I needed to do? Was I fixing her? Was I operating because I thought I was a better surgeon than the others? Some editors have talked to me about the “savior” complex of some physicians. Was my ego in the way. You are correct that the result for the patient is not dependent on what directs my actions. Still I think about these choices in the middle of the night as I attend my patients.
AW: I appreciate your portrait for complicating my reading of initiative—and compassion. The movement in my mind of Dr. Franciscus to a compassionable figure rather than a compassionate one is just that—a field of grasses shifting direction in the wind. Perhaps for this reason I am drawn to the constants in the story. The results for the mother, whatever the doctor’s reasons for operating are the same—and Imelda, whether the surgery is performed after her death or not, is fundamentally untouched.
TG: You are correct. The result is not altered by the reasoning. The transition of becoming aware of why and how a choice is directed leads one to wonder if we in fact have free choice. I wrote an essay about a woman who came to my office as she was dying. She wanted to return to Cape Cod, to go/come home for the last time.
AW: Your wasp nest image is horrifically gorgeous. It gives me shivers. I think what strikes me most about Franciscus’s story is that I want to read it as if it could be different. And maybe that’s what feels empowering about reading. Isn’t the reason we decide any of these things based on empathy? Even Franciscus has empathy for mortality, fear for life he can not perfect...
TG: Yes, at some point we act. I knew I was going to operate on the wasp nest as soon as I heard her story. Before I had seen it with my own eyes, examined it with hands that knew what to do, my mind was developing an operative plan. I remembered a similar surgery I had read in an old out of print operative text. Art begins in the narrative, the story, and our interpretation.
AW: Your natural compassion must have been either exercised or strained over the years. I hope you will speak to how empathy develops. Can it be trained like the trunk of a fruit tree—or does it just arise?
TG: I am writing you as I wait to take a woman to the OR for a D&C after fetal demise. It will probably be midnight before the surgery and one or two before she goes home.
The staff here calls me a dinosaur, still in solo practice, hanging around late at night. But I have not given you a direct answer.... I was twelve when my mother went down to my father’s office for a pregnancy test. She was pregnant but when the lab tech, (my Uncle George) looked at the blood smear he called my father to check. They saw the leukemia but could not tell her. The next day my father drove her up to the University Medical Center in Syracuse. It was fall and they stopped along the back roads of the Finger Lakes and took pictures of mother standing in front of the autumn leaves.
I am not sure what the doctors told her about pregnancy and cancer. I remember her coming home. The family prayed for a miracle. My mother lived to deliver my sister Mary, the last of her ten children. At some point as the family fervently asked God to save her, I came to the realization that there would be no heavenly intervention. I got my driver’s license the summer before she died. I put a mattress in the back of the station wagon, carried her down to the car and drove her around the lake. She loved the shore birds and herons. We would look for them in her favorite coves. By fall we listened to the Canadian geese as they flew to a warmer place. When she fell asleep on the way home I would sing to her.
Patients ask, “what would you do if I was your mother or your wife?” I usually answer, “Are you kidding, my wife doesn’t listen to me.” But I know what they are thinking, what they want—to be thought of as more than a patient, a bar code on a hospital ID band. I tell them what I think is best but that I will support whatever choice they make.
My sister, Mary, suffers now from breast cancer. She says when she looks down her shirt she sees a horror show. I say no matter, I will be there. Sometimes that is all we can do, be present and accounted for.