Diagnoses

By Peter Stoler

HEARTSOUNDS by Martha Weinman Lear

Simon & Schuster; 413 pages; $12.95

Anyone who has been seriously ill often develops mixed feelings about general practitioners and practitioners in general. Those sentiments have produced a burgeoning nonfiction genre: the antimedical medical book. Last season's outstanding instance was Norman Cousins' Anatomy of an Illness (Norton; $9.95). More in elation than in anger, the former editor of the Saturday Review recounted his battle against a disease of the spinal tissue that physicians had pronounced irreversible. Cousins ignored them. If stress and other negative emotions could trigger illness, he reasoned, positive emotions might restore health. The patient treated himself medically with ascorbic acid and emotionally with laughter-inducing joke books and reruns of Marx brothers movies. Not exactly what the doctor ordered, but it worked.

The story of Cousins' recovery became a surprise bestseller--a surprise, that is, to the medical establishment. It should have known better. As bills increase and treatments grow impersonal, the sales of antimedical books have risen faster than fevers. Case in point: Martha Weinman Lear's Heartsounds, now in its third week on TIME'S bestseller list. Unlike Cousins' account, it has no upbeat conclusion about the body's ability to heal itself. Sorrow unfolds from the book's opening line: "He awoke at 7 a.m. with pain in his chest."

He is Hal Lear, Martha's husband, a physician and a man of intelligence and sensitivity. The pain that woke him was the onset of his first heart attack. Before Dr. Lear's death four years later, he was to suffer every indignity open to victims of cardiac disease. Worse, as a doctor he understood exactly what was happening to him, so that he was not even granted the anesthesia of ignorance.

With unblinking candor, Martha Lear records every agony, every tantrum, every embarrassment experienced by a man whose body has begun the process of betrayal. No one is spared, least of all the author. She recalls her resentment of the illness that disables both her husband and her marriage: "I ache for him but I resent him as well, this sick, sunken man ... The intensity of the anger that hovers here, beneath what I take to be love, is frightening. I understand the wretched banality of such an anger as this . . . yet it shames and appalls me."

That anger is not directed solely at Hal and his illness. The author's finest fury is saved for medical institutions. Norman Cousins was ironic: "A hospital is no place for a person who is seriously ill." Martha Lear is splenetic: "The social atrocities committed by the staff!" she recalls of Hal's initial hospital admission. "It was as though, by the simple act of signing in, patients forfeited the right to be treated with respect." Her husband reinforces her feelings.

"Where else," he asks, "would you tolerate such rotten service for $185.80 a day?"

The physician cannot heal himself. Helplessly he witnesses the indiscriminate dispensing of sleeping pills in order to give the house staff an easier night, the neglect of infections, the imperious commands made by the vertical to the horizontal. His exhausted wish is for "a rule that every doctor must spend one week a year in a hospital bed. That would change things in a hurry."

Recuperation is slow and recovery elusive. Further heart problems bring Lear back to the hospital, this time for bypass surgery. After the operation, he suffers the most dreadful euphemism in the doctors' lexicon: "Complications." Rudeness and evasion become the order of the day, and a fatal demoralization sets in. "The patient," Martha Lear notes, "had been blamed for his illness, had been handed back his questions, unopened, and had been left feeling rejected, abandoned ... This is classic in long chronic disease; this is what the failures of the body do unerringly to the soul."

Any account of a good man's death is bound to be moving. But Heartsounds is far more than case history. Martha Weinman Lear is a born writer, and the resonances in her prose go back to Greek tragedy with its catalogue of grief and noble despair. By the cathartic ending, when there are no more tears to shed and no more afflictions to remember, Martha Lear is finally able to forgive. She realizes that the professionals could not per form a miracle: "The doctor does not exist who could treat such a gravely ill patient for such a long time without making mistakes . . . given their mortal limitations, they were more than good."

Still, forgiving is not forgetting, and her profoundly affecting chronicle is seeded with ideas and warnings. The antimedical book was born out of a moral demand: as long as patients feel the lack of care, as long as doctors act with an omniscience that is only an act, volumes like Cousins' and Lear's will continue to resound with cries from the heart. And the stethoscope will not be the best way to hear them. --Peter Stoler

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