The Inside Story
By F. Gonzalez-Crussi
A Surgeon Reflects on Medical Myths
By Sherwin B. Nuland
Simon & Schuster. 286 pp. $24
Reviewed by F. Gonzalez-Crussi
Our internal organs work best in the dark. To perform their quasi-miraculous functions they would have shade, or at least twilight, and shun the glare of consciousness. Who ever thought of riveting attention upon breathing or digesting? Intellectual attentiveness appears to have been designed for foreign affairs only; what goes on in the interior provinces is a tightly guarded state secret.
Sherwin Nuland's latest book, The Mysteries Within, is aptly named. To the ordinary person, the unsuspected wheels and springs of the body's inner mechanism become manifest only in disease; the pain and suffering they cause are sufficient reminders. But to the surgeon the body's insides are the focus of ever-vigilant attention -- not a detached sort of contemplation or a speculative, abstract canvassing, but the down-to-earth attentiveness demanded in the operating room. The kind of awareness that, admixed with reasoned boldness, allows the surgeon to pass from possibility to concrete act in a flash, irrevocably, and under all manner of pressures.
Nuland, a surgeon, writes narratives of a uniquely direct, spirited style, marked by a sense of immediacy, undaunted, never languid, always sensible, and proceeding to their appointed end on a generally straight course. Trust a surgeon to tell you a pithy story that will touch you and impress you and compel your attention. Nuland does just that in The Mysteries Within.
He tells us of a strange, inert object found inside the stomach of a baby, a concretion made of wax from improperly heated milk cartons; of a liver torn in an accident, wherein the slash providentially followed the line that modern surgical technique recommends to excise a segment of this organ; of a young student whose severe and protracted shoulder pain, appearing after an injury he sustained during a football game, led everyone to believe he had dislocated his shoulder, only to realize later that a torn spleen was the cause of the pain. Many other stories are included, all enlivened by a refreshingly lucid style and a touch of humor that makes the book an unalloyed pleasure to read.
Nuland is at his best as a raconteur. The many vicissitudes and rich lore of hospital life come alive through his art. The high-tension dramas daily staged in the operating "theater," as it is sometimes called, would look in vain for a more eloquent actor or a better chronicler. He enlivens his portraits from nature with delightful brush strokes: Of a fastidiously cautious cardiac surgeon, he writes: "It was not enough to wear both belt and suspenders. I always suspected that he pinned his trousers to his shirt." His assistant, sempiternally unfazed, and a trusted source of reassurance in moments of crisis, was "a human gyroscope of stability."
One purpose of the book, Nuland says in the introduction, is to survey present medical concepts by the light of the early ideas, myths and superstitions from which they arose. But when he is not telling stories, the book is less appealing. A pedagogical tone, as in the chapters dealing chiefly with historical matters, is less attractive than his admirable flourishes of anecdote, experience and reminiscence.
Then, in a philosophical epilogue, Nuland tackles the conflict between science and religion, no less. One distillate from a surgeon's boldness, I suppose, is a chutzpah that will balk at nothing. But none of this detracts from the excellence of The Mysteries Within. Even at his most professional, the surgeon-author eschews pedantry, and generously drops pearls of reading enjoyment on each page.
Bertrand Russell, discoursing on "useless knowledge," affirmed that information that fails to increase our technical proficiency or to enhance our skills is nevertheless useful in an indirect way. It adds color and warmth to otherwise drab and uninspiring information. He said apricots tasted better to him since the day he found out the origin of the word "apricot." Likewise, an immunologist may not be a better specialist after reading The Mysteries Within, but I'll wager that such a reader will not think of the spleen in quite the same way after learning that its removal was once thought to make a runner speedier. I recommend Nuland's book to both the laity and the medical public.
F. Gonzalez-Crussi is head of laboratories at Children's Memorial Hospital of Chicago. His latest book is "There is a World Elsewhere."
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