THE WISDOM OF THE BODY by Sherwin B Nuland, MD, Alfred A Knopf, 1997. $27; Random House Audio Books, 2 cassettes read by the author, three hours, $18. ISBN: 0-679-44407-6

Review by Del Meyer, MD

Sherwin B Nuland, MD, Clinical Professor of Surgery at Yale University, received a National Book award for his previous volume, How We Die. The Wisdom of the Body is his sixth book. Touted as an inspiring search into the interior life of our bodies for the biologically elusive quality of life that defines us, this book actually tells much about Dr Nuland's surgical skills and prowess. The author accompanies readers on a tour of the circulatory, lymphatic, cardiac, reproductive, nervous and digestive systems. In many cases the experiences of patients--a breast cancer patient, heart transplant recipient and Down syndrome individual--enhance the lessons of the body. Though the book bounces from textbook discussion to testimonial, there is a clear unifying theme: The body survives by continually and elegantly seeking homeostasis through gross or fine biological regulation, sometimes in spite of our human intervention. Dr. Nuland tells us about one surgical hurdle after another and how he skillfully accomplishes an extraordinary feat deep in the interior of the human abdomen. He weaves us through the entire cerebration of what transpires when a patient bleeds to death, taking us through every second--how he doubles the size of the surgical field, searches in vain for the source of bleeding, and then in desperation does what every surgeon is trained to do, he clamps the aorta to save the patient's life. This extreme measure gives him time to think at a slower pace and prepare his team for his next move. Nuland courageously admits to one serious judgement error he made when he removed a polyp in his office. The patient had a bleeding disorder and the routine procedure required emergency action to staunch the blood flow. Prior to the current HMO cost containment out patient emphasis, such an incident could have met with serious Peer Review consequences. In a case of bowel gangrene, he does not spare his reader the graphic details. His clothes become soiled with blood and feces, which he considerately removes before telling the patient's family, how he miraculously saved the patient's life. By interweaving detailed physiology lessons and case histories, Nuland develops the thesis that the human spirit, "the very essence of human life" is the result of adaptive biological mechanisms. He sees the human spirit as being derived from our genetically determined structure and function, and, while he believes it originates from this mechanistic basis, he still finds it awe-inspiring. Nuland's tendency to foist medical terminology on lay readers is distracting. Even with assistance from diagrams, the text becomes both ponderous and tedious. Nuland also explains some of his own struggles as a physicians when he felt uneasy with other fathers-to-be at his childbirth preparation class.

The ultimate alienation took place at the second Lamaze meeting when the young nurse who directed the course asked each of us to tell what we did out there in the real world. She called this "sharing yourself with your peer group," and its purpose was to cement our fellowship. It was not to be. From then on, I was kept at a respectful and slightly uncomfortable distance.

Nevertheless, at its loftier moments, The Wisdom of the Body is alive with compelling stories about patients overcoming the odds--or not--depending on the strength of their optimism or resolve. Nuland considers intriguing philosophical questions about the human spirit and whether physiology rules in or rules out the existence of God. Ultimately, he does not believe in the Kierkegaardian leap of faith, but in scientific explanation. While Nuland is to be congratulated for his ever-widening appreciation of the biological miracle which is life, the book is tarnished by his seeming unwillingness to step outside the circle of congratulations. While The Wisdom of the Body is not always easy reading, it may be useful reading. The cassette version, with its graphic details of the operating theater, will probably appeal to the lay person. He exposes much of his personal life, writing about his young second wife and family, and is sexually frank (for example, he comments after a particularly grueling operation that he feels like making love). Nuland seems to be trying to include something for everyone. I found it difficult to follow all the various scientific, spiritual, theological, and philosophical interactions. Obviously, these are immense fields to analyze and synthesize, even after a busy forty-year career in surgery. Maybe Dr. Nuland will further distill his wisdom for us in a seventh book.

Del Meyer, MD