Books: The Philosopher’s Stone

MORTAL LESSONS: NOTES ON THE ART OF SURGERY by RICHARD SELZER

219 pages. Simon & Schuster. $8.95.

Would-be surgeons are required to study Gray’s Anatomy before walking into the operating room. They ought to study Mortal Lessons as assiduously. Medical texts can only teach the location of the internal organsand explain the techniques of surgery. Richard Selzer forces physicians to think about the morality of medicine — and to search for meaning in the rituals of an art “at once murderous, painful, healing and full of love.”

Selzer is hardly the first M.D. to ruminate about the scalpel. Rabelais, Chekhov, William Carlos Williams, Celine, and more recently William Nolen have written moving accounts of their medical careers. But few have examined the surgical art with such fervor and concern. Some doctors deplore the body’s limitations; Selzer celebrates them. “It is the flesh alone that counts,” he begins. “In the recesses of the body I search for the philosopher’s stone.”

The author’s prose style is some times clouded by a purple hue, but his in sights are as clear as those in Lewis Thomas’ Lives of a Cell. In one chapter Selzer defines the heart as “purest theatre . . . throbbing in its cage palpably as any nightingale. It quickens in response to our emotions. And all the while we feel it, hear it, even — we, its stage and its audience.” The liver is that “great maroon snail,” of whose existence one is hardly aware until it malfunctions. “No wave of emotion sweeps it. Neither music nor mathematics gives it pause in its appointed tasks.” The author is as wry and bemused when he describes bones, the digestive tract or a kidney stone, “this small piece of gravel” in Pascal’s phrase, that could bring down Oliver Cromwell and alter the course of history.

Selzer, a faculty member at the Yale University Medical School, can be entertaining, even whimsical, when he discusses baldness or Homo sapiens’ his toric love affair with alcohol. But there is no drollery in his discussions of life’s end. Like a man describing an old colleague, Selzer watches death at work. “You do not die all at once,” observes the surgeon. “Some tissues live on for minutes, even hours, giving still their little cellular shrieks, molecular echoes of the agony of the whole corpus . . . There are outposts where clusters of cells yet shine, besieged, little lights blinking in the advancing darkness. Doomed soldiers, they battle on. Until Death has secured the premises all to itself.”

Like the cells about which he writes, the essayist battles on, searching not only for the sources of the body’s ills, but for the far more elusive thing that theologians call the soul. He recognizes, ultimately, that the Grail he seeks is less likely to be found in floodlit operating rooms than in the darkness of the mind. “It is not the surgeon who is God’s darling,” concludes Selzer. “It is the poet who heals with his words, stanches the flow of blood, stills the rattling breath, applies poultice to the scalded flesh.”

This poet-surgeon writes, he says, because he wishes to be a doctor. His colleagues should take heed. Mortal Lessons will not make any surgeon a better technician; but it just might make him a healer. Peter Stoler