THE BODY ECLECTIC

By John Elson

What happens during life's final moments was the subject of Sherwin B. Nuland's award-winning How We Die (1994). Now, in The Wisdom of the Body (Knopf; 395 pages; $26.95), Yale's distinguished surgeon and bioethicist presents a kind of prequel: an anatomy of human life, vividly illustrated by case histories from his wide operating-room experience. The result is a book--part basic textbook, part memoir and meditation--that is wholly secular yet sublimely uplifting. Although not religious in a formal sense, Nuland is overwhelmed with awe at how the human body works. As he writes, "We are, of necessity, miracles with flaws."

The basic miracle, as Nuland describes it, is that the body's different systems--cardiovascular, reproductive and so on--work together in a seemingly chaotic but balanced harmony. The flaws of the human miracle are the diseases that attack these systems. As Nuland sees it, the surgeon's role is to assist the body in mounting a concerted defense against the intruders, be they cancerous cells or traumatic injuries. Nuland generally writes with a clarity that any journalist can envy. Still, the eyelids of the scientifically challenged may droop a bit amid the book's vital but unlyrical nuts-and-bolts background passages. For example, one sentence on cell division begins, "Meiosis is somewhat more complicated because its purpose is to result in a spermatogonium or oogonium with half the original chromosome number..." Yes, "complicated" is indeed the mot juste.

The Wisdom of the Body perks up considerably in its accounts of medical case histories. Some of them have the adrenaline-charged force of a Grisham page turner. In his opening chapter, Nuland writes of Margaret Hansen, 42, who was rushed to the emergency room of St. Raphael's hospital in New Haven, Conn., for treatment of what the resident gynecologist thought was a ruptured tubal pregnancy. An abdominal incision that spattered the operating room with Hansen's blood proved him wrong. By chance, Nuland was checking on two patients at St. Raphael's when the loudspeaker crackled an urgent plea--"part outcry for help and part call to arms"--for any general surgeon to go to the operating room. With Hansen on the verge of death, Nuland took charge and located the trouble: an aneurysm of the splenetic artery. In chilling but mesmerizing detail, he explains how he slowed, then stopped, the bleeding and excised the damaged artery. Afterward, this veteran of hundreds of operations found himself in a state of near euphoria: "Something within me wanted to sing and shout, to dance carefree and make love, to acclaim my triumph to the heavens and the ages--a woman's life had been saved, and I would always remember the wonder of this night."

But something more was involved than Nuland's experience and surgical skill. The patient survived, he believes, because of her will to live. This instinct, the product of eons of evolution, is evidence to the author that humans are greater than the sum of their 75 trillion constituent parts, their cells. Some readers will see the miracle of mankind as proof that a Creator exists. Nuland does not. His surrogate for spiritual piety is awe and wonder at the mystery of the human spirit and the marvelous economy of the physiology that embodies it.

--By John Elson