In the case of the upstate New York novelist Paul West, who in A Stroke of Genius recounts the various illnesses that have besieged him in recent years—heart disease, diabetes, debilitating migraines—"the sheer majesty of salt" was among the active agents in his physical decline. "Nothing tasted right unless it had been fried," West writes about his restless appetite, but it wasn't until quite late in life, after suffering a serious stroke, that he found that he'd been a "slow suicide whose corroded emblem was the frying pan."

Told that he was likely to die quickly without a pacemaker implant to regulate his faltering heartbeat, West reluctantly agreed. "It was not just a patch applied, a decal, but an incubus," he writes, that would "send me stumbling back out into the world as a well-wired freak at the mercy of microwave ovens and thunderstorms, insect-repelling wave-emitter boxes and airport security barriers."

While A Stroke of Genius brims with exacting accounts of West's post-implant life ("I have been mortified into becoming some Homo adaptus, a modified man") and of what he calls the "panjandrum hubris" of arrogant doctors, this memoir is more diffuse and philosophical than either [Reynolds Price's A Whole New Life or Wilfrid Sheed's In Love with Daylight]. Like his contemporaries, West is fascinated by the links between illness and creativity, and goes so far as to call disease "the supreme art form." But one of the rewards of this brave and lovely book is that it quickly moves well beyond being a survivor's celebration.

West writes convincingly about his generation's ingrained existentialism, a world view that has "argued against passivity, telling us to push, to take the blame, to be—above all—energetic in designing ourselves." That "puritanical message" has carried over, he notes, into his generation's contemplation of not only the good life, but the good death. And happily, one of the signal messages that A Stroke of Genius imparts … is that there does indeed seem to be, as West perceives, a simple dignity in being a "critic, fighter, and perfectionist to the end."