Sherwin B. Nuland - How We Live

This book made available by the Internet Archive.

TO YOU, MY CHILDREN

TORIA

DREW

WILL

MOLLY

Whether one at a time or all together, you show me worlds I never knew

Men go forth to wonder at the heights of mountains, the huge waves of the sea, the broad flow of the rivers, the vast compass of the ocean, the courses of the stars; and they pass by themselves without wondering.

St. Augustine, Confessions, Book X, chapter 8

ACKNOWLEDGMENTS

N.

o author writes alone. Whatever his degree of solitude, the silent influence of seemingly long-forgotten words is always at his elbow, and so are the men and women who spoke them; the reading and the talk of a lifetime converge on his pages. Filtered through the individuality of a writer's mind, the distant echoes of experience become ever more insistent until they make themselves known, and find form at his fingertips though they may never rise into full, unveiled consciousness.

And so it has been with the writing of this book. I have allowed the submerged to reveal itself and it has come forth, telling me what portion of it must be expressedoften without doing the telling in any overtly recognizable pattern. And this too is one of those miracles of the human spirit of which these chapters treat: that we somehow know and act with the shrouded knowledge of countless past moments thought and unthought,

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conscious and unconscious; that something within us comprehends the muffled messages brought upward out of that pool of hidden memory from which the present is formed, never having lost its power to /'form as well. In such amazements is the brain of humankind distinct from that of any of our fellow animals. In such amazements is every human mind a singularity, distinct from any other that has ever been or will ever be. In such amazements are to be found the elements from which the writing of a book is shaped.

Still, though each of the long-unthought thoughts may become as perceptible as a clearly heard phrase, they are never in themselves sufficient to accomplish a writer's entire design. What is required in addition is yet another processa different variety of retrievalwhich must take place in the very forefront of consciousness. That process is the planned, purposeful search for overt information, and it calls for such elements as deliberate preparation, research, and review. There is much in this book that demanded study and analysis; that demanded, in fact, new learning on my part, or at least new understandings. And there is also much that demanded the conscious exchange of ideas with others, and the seeking of advice. Like all authors, I have sought out the best advisers I could find, and in this I have been advantaged by the freely given gifts of immensely talented colleagues. Great swaths of this book are the outcome of conversation, not infrequently over prolonged meals of a wide variety of digestibility. But what was always deliciously digestible was the nourishing content of these successive communions by which my understanding was gradually broadened, not only about the wholeness of the human body but as well of the tiniest constituents of which it is composed and the manner in which the entirety becomes the functioning fabric of the human organism.

Though my professional life has been spent in constant enlargement of my acquaintance with that organism, there is no replacement for the discerning eyes of others, especially those who have become expert on one or another specific aspect of it. I am honored to thank the friends at Yale and elsewhere who have so carefully reviewed the sections of this book dealing with areas of their expertise, and done their best to keep me from error. It is hardly necessary to add that if I am found anywhere to have strayed from the straight and narrow of factual accuracy, it is only because I have eluded their meticulous screening and wandered off on my own. The

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names of the following men and women will be far from unfamiliar to readers who work in their respective fields: Sidney Altman, Lawrence Cohen, Edmund Crelin, Alan DeCherney, Thomas Duffy, Rosemarie Fisher, Gilbert Glaser, Bernard Lytton, Margretta Seashore, and William Stewart. I cannot emphasize too strongly that my request of every expert was to verify the facts of biology and medicine insofar as there is general agreement about the current state of knowledge. Wherever interpretations appear, or speculation, or what some might even call daydreamingit is mine alone.

I have not hesitated to contact other knowledgeable colleagues when help of a highly specific nature was needed, as in verifying some obscure datum, tracking down a bibliographical reference, rendering an opinion when some piece of evidence was in dispute, or soliciting a fresh point of view. At such times of need, I have at least once and sometimes much more than once turned to Toby Appel, Sharon Baca, Saul Benison, Jerome Bylebyl, Joseph Fruton, Paul Fry, Rafaella Elaine Grimaldi, Gail Harris, Majlen Helenius, John Hollander, Elena Rose Kagan, Katherine Landau, Robert J. Levine, Regina Kenny Marone, Peter McPhedran, Emanuel Papper, James Ponet, Gordon Shepherd, Stephen Waxman, and my consistently dependable source of new insights, Ferenc Gyorgyey. Not to be forgotten is Wendolyn Hill, to whom I am indebted for focusing the full force of her medical artistic skill on my illustrations.

As the major themes of this book were taking shape, I twice presented them at seminars of my fellow Fellows of the Whitney Humanities Center at Yale. A more formal presentation occurred as the 1995 John P. McGovern Award Lecture of the American Osier Society, a group of academic physicians committed to medical education and the humanities, taking place at the society's annual meeting in Pittsburgh. I am grateful to the membership of both these groups for the lively discussions that ensued on each occasion, the echoes of which will be discernible to the participants in the text that follows.

Several of my friends and neighbors, none of them a doctor or scientist, have graciously read the entire manuscript from the viewpoint of the general reader. The comments of each of them have sharpened my thinking and helped me to clarify issues. They are Judith Cuthbertson, Alexander Sommers, and Sarah Tyler.

To reckon him who taught me this Art equally dear to me as my parents,

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to share my substance with him, and relieve his necessities if required. These are the first words of the Hippocratic Oath, following immediately after the invocation of the gods Apollo, Aesculapius, Hygeia, and Panacea. No matter the dedication and skill of professors and colleagues, every doctor knows that his best teachers are his patients. It is through them that he comes to appreciate the fullness of the body's splendor, and the dangers of its frailties; it is through them that so much of his understanding of the human spirit arises. Thousands of men and women have entrusted their health and often their lives to my hands. This now seems the proper place, and at last the proper time, to thank them for showing me the way toward my philosophy, and theirs.