Sherwin B. Nuland is a clinical professor of surgery at Yale University, where he also teaches medical history and bioethics. He is also the author of the acclaimed How We Die (1994). Nuland is writing for a general audience, although he does not skirt complex explanations of human biology. (Consulting the glossary at the back of the book provides help with his scientific explanations.) Wisely, he begins his book with a riveting incident in an operating room before launching into more difficult passages about how the body works and about his philosophy of life. Nuland writes well, although he has a tendency to indulge in purple prose. He needs the discipline of describing the operating room and biological processes, it seems, because when he lets go of this material, his prose can be sophomoric—especially when he engages in silly puns. As he admits, surgeons are a rather arrogant and self-regarding group. He usually manages to keep his own ego in check, though, as he submits himself to considering the wonder and mystery of the body, acknowledging that for all of his skill and learning, there are many diseases that simply defy explanation or treatment.
Nuland suggests that in most cases bodies take care of themselves. There are innumerable self-correcting mechanisms in the body. It is constantly fighting off and killing cancer cells, renewing itself, and compensating when some part of its system is hurt. Nuland suggests that this “wisdom of the body” is not merely a material phenomenon. It has developed over centuries into automatic functions of which people remain unaware. Moreover, cells, tissues, organs—indeed all parts of the body—have become not merely machines but living organisms that are driven not by themselves but by some spirit that is greater than the sum total of the body’s parts. Nuland does not claim to know what this spirit is. But he does insist that the body cannot be explained entirely in terms of its biology. There is another organizing principle at work, which can be explored if it cannot be entirely explained.
Nuland is no mystic. He has little tolerance for simplistic beliefs in mind over matter. For every patient with a will to live who has triumphed over a seemingly fatal illness, there have been just as many—even more—with the same fighting spirit who have succumbed to dreadful diseases. Neither a materialist nor a spiritualist, Nuland sets himself the difficult problem of fathoming the interaction between self and soul, so to speak. Nuland bases his quest for a realm beyond the material on the observation that much of the body has developed to a point well beyond what is needed for mere survival.
Even if Nuland’s search for the transcendent principle is discounted, his absorbing accounts of surgery suggest a bond between doctor and patient that cannot be understood in pure material terms. A case in point is Marge Hansen, a vigorous woman in her forties who thought that she was suffering from no more than muscle strain. When her problem persists, and when she is suddenly rushed to an emergency room because her midsection is swelling with blood so rapidly that she looks like a pregnant woman, Nuland is called in to deal with a situation that has the attending obstetrician perplexed to the point of panic. Hansen is not pregnant, and the origin of her rapid blood loss eludes detection. With only a few minutes to save her, Nuland plunges into her body, holding up her spleen, examining its vessels, searching for the site of the bleeding. He finds the source of the blood flow in an aneurysm of the splenetic artery—a weakened area that had ballooned into a blood bubble that had burst and caused her internal hemorrhage. Hansen’s case was so rare that even a veteran surgeon like Nuland had never seen it before.
What impresses Nuland about this operation is the bond he felt between himself and Hansen. He did not know her name at the time of the operation, and he points out that the draping of a patient’s body during surgery is not merely for antiseptic reasons but to shield the surgeon from too personal an involvement with the patient. Yet there is something about the energy he derives from the operation, from his later account to his wife about how he had saved the woman’s life, that provokes him to contemplate what he means by the wisdom of the body. He suggests that human life has organized itself around not merely its own survival but around a will to triumph over such...
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