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By Sherwin B. Nuland
Knopf 395pp $26.95

Combine extraordinary life experience with an intriguing conceit, and you have a recipe for a great book. That's what New Haven surgeon Sherwin B. Nuland did in 1994, when his How We Die offered an intimate look at life and death, and the principal ways in which people pass from one state to another. After years of treating ill or injured patients, Nuland brilliantly mixed firsthand testimony with artful writing to convey what goes awry with the human machine when battered by cancer or AIDS, or betrayed by a failing heart. For his effort, he snagged a National Book Award.

Nuland is back with his new, intriguingly titled book The Wisdom of the Body. Once again, he has unpacked decades of hospital war stories, and his fascination with our marvelous mechanisms is infectious. The book's opening rivals any episode of ER or Chicago Hope: A panicky hospital operator pages, ''Any general surgeon!...Go immediately to the operating room,'' and Nuland is off and running. Soon, he's literally elbow deep in New Haven housewife Margaret Hansen, whose seemingly unstoppable bleeding has brought her near death. Nuland provides a breathtaking detective chase through her organs, probing for what's wrong--a ruptured aorta feeding the spleen, it turns out. He saves her. We're elated. And then we even get to ride home with him and see him wake his sleeping wife and tell her the tale.

It's just crackerjack storytelling. Unfortunately, Nuland promises us at the denouement of this scene that he'll spend the rest of the book explaining his main theme--a discussion of the human spirit, that ''yet-unexplored factor in human biology that accounts for a patient's will to live and doctor's ability to save her.'' But what is it? Almost 400 pages later, I haven't a clue. It has to do with the ''wisdom of the body,'' something that Nuland repeatedly struggles to define but, aside from assuring us that we are more than the sum of our parts, never seems to figure out for himself.

Without a manageable conceit, he goes astray in a series of boring lectures on all kinds of biological topics, from the nature of cells to the formation of a fetus to neurological impulses.

Nuland throws us some life preservers in the form of personal anecdotes--one involving the birth of his son. But his effort to tie them together becomes a parade of highfalutin prose posing as insight. He defines ''spirit'' as being ''in its very essence the product of the organization and integration of the multiplicity of physical and chemical phenomena that is us.'' He tries again later. To understand the human spirit, he says, ''we need only invoke what is in our human cells--the highest power and the greatest magic that has ever awed a wonder-struck observer of its magnificence.'' Mm-hm. Forgive me, but these passages don't hold a candle to the following, about screwing up a polyp removal: ''My trousers soaked in stool-flecked blood, a stinking pool of it on the floor around me, I drearily waited out the 20 minutes until the scenery could be prepared for the next act in this execrable rectal epic.'' Now that's spirited writing.



PHOTO: Cover, "The Wisdom of the Body"

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Updated June 15, 1997 by bwwebmaster
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