About halfway through "Letters to a Young Doctor," Richard Selzer describes a nurse who "flings herself upon" the body of a dying patient. "One knee on the bed, and she is aboard, her skirt hiked. Now she straddles the man and bends to clamp his mouth with her own. As though her tongue were a key that would unlock the secret that lay in his body if only she could find the right way to insert it."

The nurse is performing mouth-to-mouth resuscitation. The writing is vigorous. The details -- the skirt hiked, how she straddles the man -- are vivid. But, as though he didn't trust the description of what happened to be sufficient, Selzer adds a simile that is unnecessary, inexact, and misleading. Any attempt to French kiss the patient would surely inhibit mouth-to-mouth resuscitation. The image is too forced, the scene collapses.

Throughout the book, a collection of essays and stories about the practice of surgery, Selzer does the stylistic equivalent of forcing the nurse's tongue into the patient's mouth. And by doing so he continually betrays his own narrative gifts. In "Imelda," an extraordinary story of a surgeon's attempt to redeem the promise of a cure made to a girl with a cleft lip and cleft palate, he almost loses the narrative in all the flourishes. He indulges in idiosyncratic word order -- "hoping only to avoid the hemorrhage and perforation of disgrace" instead of "hoping only to avoid the disgrace of hemorrhage and perforation." He strains for images that end up as cartoons: "our own words did not carry through the air, but hung limply at our lips and chins." And he is wordy: he describes a dress as being "at some risk of slipping down her arms" instead of simply saying it was too big.

In other chapters, Selzer is pretentious, sprinkling the prose with foreign phrases that have perfectly suitable American equivalents: in medias res, ensemble. He is tasteless (in "Brute" he describes a black in the most stereotypical racist terms) and stuffy (he uses "forebears" instead of ancestors, "myrmidons" instead of followers).

Too often he lapses into egotism: "Soon we surgeons will be turned out to pasture, to graze out our days dreaming of old wars and trying to remember what exactly they were all about . . . Grace a Dieu, I shall be safe in my tomb like an ancient king in moldered ermine, unmindful that the kingdom I once ruled had vanished long ago." Not only are surgeons warriors and kings, but Selzer himself claims sovereignty over all surgery!

An occasional descent into egotism, an infrequent stuffy, tasteless, or pretentious phrase, are forgivable. But Selzer mistakes such bad style for fine writing. He insists on dressing up his prose with feather boas. The book has the stilted, artificial tone of someone who is compulsively literary, or rather Literary. Selzer seems to believe the simple is insufficient.

Selzer lets himself be too tempted by the sound of phrases: the orotund epigram, the suspect assertion. "As one can love a beggar about whom one knows nothing, so can one love a dying patient who has openly declared the bankruptcy of his flesh." Or: "reverence for the teacher is essential to the accumulation of knowledge" -- or, as we non-surgeons would say, essential to learning.

Some of the phrases tremble on the edge of nonsense -- as when he writes that doctors who make love to their patients (or as he says "who indulge their lusts among the patients") "shall feed upon the dry cobs of repentance." I assume Selzer means they'll be sorry -- but he is embarrassed by the plain thought, and so he pulls out the dry cobs.

Normally, such faults would damn a book. But, when he forgets to be fancy, Selzer becomes a writer of great force. When he is colloquial, his prose is superior. And his anecdotes tend to be -- with a few dull exceptions -- dramatic. There are sections of "Imelda" and "Brute" (a tale of how Selzer sews an uncooperative patient's earlobes to the bed) that are shocking in their excellence. And one story, "Toenails," about how Selzer cares for some vagrants who gather in a library reading room, is almost a model of simplicity.

The stories are better than the essays because Selzer is better at describing something than he is at ruminating. As his writing strays from specific actions, it tends to get gassy; but as long as there is something real -- something that happened -- which he is trying to put into words, he stays simple.

Unquestionably, Selzer loves reading and writing. And at his best he is good enough to command respect for what appears to be a natural talent. Unfortunately, he often fails to apply the precision necessary in surgery to writing. When he starts to wield a red pencil as rigorously as he wields a scalpel, he could become not merely a doctor with the hobby of publishing, but an artist.