By Sidney M. Schwab ’66, M.D. Berkeley, Calif.: Frog Ltd., 2006. 240 pp. $15.95 paperback.
Reviewed by Alan W. Powers ’66
Cutting Remarks reads a bit like travel literature—travel to a premier surgical training hospital and to that undiscovered country, the body. Dr. Sid Schwab (who was my roommate for a time at Amherst) writes of anatomy with ease, and often with delight: “You wouldn’t expect to see beautiful robin’s-egg blue inside your belly, but that’s how the normal gallbladder looks. Gorgeous. It stands out from the earth tones of everything else in there, like an agate amongst the river rocks.”
In the book, Schwab combines a paean to and exposé of his education as a general surgeon. We’re at his elbow, beginning with his apprenticeship, progressing through his relations with supervisors and teachers (some, famous surgeons) and engaging the complete spectrum of patients, from the happily misdiagnosed to those who summon great courage in dire straits. The character sketches he writes of patients and surgeons are not to be missed, nor are his ironic asides on, say, addicts in distress: “Trauma survival is inversely related to societal value.” Sometimes, the doctor admits to losing professional distance, as when he meets a “speed-talking, pig-tailed 10-year-old, freckled like a crumpet.” He writes with affection as he describes the girl, who needs a kidney transplant, and her father, the donor, “who had already donated a bunch of his freckles.”
The author’s voice is a moral compass, carrying the reader through the crises and the losses into the rare moments of elation, and onward. Cutting Remarks is memoir, bildungsroman, travelogue and surgical text. It also offers a trenchant critique of past and present medical practices. Schwab emphasizes how much surgical training has changed, as students focus on narrow sub-specialties rather than on general surgery. The book should be required reading for applicants to surgical programs, and for patients, particularly those desiring laparoscopy. It would be a good book to pack—on CD—for a voyage to Mars, in case the need for surgery arises. After reading it, I feel ready to undertake simple thoracic procedures if I can find the right lighting. Or maybe not.
If many physicians become writers, is it because both doctors and writers fight mortality? In the long view, only a few, and only writers, win. Chekhov and Rabelais live. The speaker we meet in Cutting Remarks is like a Dante-esque guide through the regions bordering life. He regards “an artfully made bowel anastomosis” as “a thing of beauty.”
Schwab has now semi-retired, and what surgery has lost—a brother in the art—American autobiography has gained.
Powers has spent his career teaching English at community colleges in Massachusetts.