Death's door opens to reveal two perspectives on the end

February 13, 1994|By Gerri Kobren

Title: "Raising the Dead: A Doctor's Encounter with His Own Mortality"

Author: Richard Selzer

Publisher: Whittle/Viking Penguin

Length, price: 118 pages, $17.50

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Title: "How We Die: Reflections on Life's Final Chapter"

Author: Sherwin B. Nuland

Publisher: Knopf

Length, price: 278 pages, $24

In 1811, Dr. Richard Selzer tells us, Fanny d'Arblay, a 59-year-old novelist of no permanent distinction, underwent an unanesthetized mastectomy in the bedroom of her Paris home, as treatment for an invasive, painful, fist-sized tumor. It was an agony almost beyond belief. Fanny, recovered and writing to her sister nine months later, made the most of it; she was, after all, an imaginative writer.

That's something to keep in mind while reading Dr. Selzer's new book, as is his praise for the scalpel-sharp writing style of Fanny's doctor, Dominique-Jean Larrey, a French army surgeon

known for his high-speed amputations. Quoting from Larrey's instruction for treating frostbite the way Russians thaw a fish -- with snow, ice or cold water -- Dr. Selzer's delight is unqualified: "Now show me the writer who wouldn't die to have written that," he challenges.

It's a dare he takes to heart: Scalpel-sharp and metaphorically loaded, "Raising the Dead" is a tale of his own lunge through the doorway of death and his hallucination-ridden return to the world of the living.

This is a take-no-prisoners account of what happens to a body in and after an intensive care unit, as seen, for the most part, by the author's witty, disembodied self. It's told in a poetic rush that makes no apology for its anatomically correct language.

So here he is, author, surgeon, teacher, lecturer, felled by Legionnaire's disease and sliding into unconsciousness. Here's the emergency-room staff, like "a flock of white birds -- stooping to peck at my arms, groins, beaking my mouth, rectum, everywhere."

There. Now the tube is in his trachea, the cuff inflated to keep it from slipping out. Still not fully narcotized, the man shakes his frantic head from side to side, refusing what has been thrust in. He coughs, strains, his neck is a contraption of taut tendons and engorged veins. . . . In the meantime, a catheter has been slid into his bladder, another plastic tube into one of his nostrils to gain access to his stomach. Already long strings of blackish bile are staining the sheet on which he lies.

. . . [For] the next twenty-three days the man in the bed is to be ventilated, dosed, defibrillated, probed, suctioned, and infused. Most of his bodily functions will be taken over. No longer need he swallow, chew, inhale or exhale, cough, urinate, defecate, clear his throat, maintain acid-base balance, cogitate, remember, sigh, weep, laugh, desire.

Six days into his coma, he is bloated with fluid, "swollen like a toad." Four days after that, diuretic has made his kidneys pump out the water; he is skeletal. Four more days, and the author-observer sees his body as an abandoned house, "the eaves of his ribs overhanging the scaphoid belly. His umbilicus, that mute evidence of his ancestry, seems set directly upon the vertebral column."

Not a pretty picture -- and not surprising when, on the 23rd day, the EKG goes flat and responds not a whit to the frantic ministrations of his nurse. Minutes tick by; a doctor arrives and pronounces him dead. More minutes pass. Then -- he breathes. He reaches up and yanks out his endotracheal tube.

The hospital's own Lazarus, he continues his recovery, terrorized by the carnivorous swallowing of his inflatable mattress, distressed by the "hydrocephalic" heads of the tulips some ill-advised friend has brought, and caught up in hallucinatory adventures along the Nile, in the waters off Molokai and a monastery in Ireland.

What fun it's all made to seem, especially so since we know Dr. Selzer survives -- how else could he have written the book? But there's a final joke in this, a punch line that Fanny D'Arblay would probably have appreciated.

As eloquent as Dr. Selzer, Sherwin B. Nuland takes a different tack in "How We Die." Here, no one gets out alive or comes back after. Death, he tells us, is nature's way of making room for the future; life depends on it. Far from being dignified, it's "a messy business," he warns. "We rarely go gentle into that good night."

In fact, it's generally a ghastly process, the way he describes it, in sections on heart disease, cancer, AIDS, violence, Alzheimer's disease and old age.

Oddly, however, this is not a depressing book, due primarily to the sensibility behind it. Surgeon, teacher and writer, Dr. Nuland, in his 60s now, has fought the good fight often enough to know what he's been fighting for. In spite of everything, this is more about life than about death, and about the only triumph that's left to us at the end -- the final empowerment of the person.

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