It took guts to write this book. Specifically a stomach, liver, heart and spleen. And uterus, too. National Book Award-winning author Sherwin Nuland explores the vast mythology resonating in these five organs, presenting his information as both a historian and a practicing surgeon. (Nuland has been a clinical professor of surgery at Yale School of Medicine since 1962.)
In his book Nuland tells how, in the Western world, it wasn't until A.D. 131 that a Greek named Galen figured out the obvious: The stomach digests food (because of the body's "divine architecture"). In 1609, Belgian physician Jan Baptista van Helmont declared that a man's soul was located in his belly. This went against centuries of assumptions -- beginning with the ancient Egyptians -- that the soul was located in the heart. (Nuland doesn't mention this, but the American adage that "the way to a man's heart is through his stomach" is perhaps a joining of those two ancient beliefs.)
For all that modern medicine now knows, Nyland confesses that at least one anatomical mysery remains: Doctors are still puzzled by the spleen. Nuland also interlaces his historical anecdotes with operating room experiences to show how medicine has benefited from centuries of imaginative speculation about how the human body -- especially the above-mentioned pieces -- works.
When I phone Nuland at what I think is the hour of our appointed interview, it sounds as if he is in the middle of something. My call is a surprise.
"I'm sorry," he explains. "It's so strange. I've been reading my book and I've gotten so absorbed in it that I'm not even thinking about what I'm doing or where I am. This is the most peculiar egotistical thing." As he speaks I realize I made a mistake and phoned 15 minutes sooner than I was supposed to.
"I read the reviews of my book," he continues. "And one of the reviewers said 'so and so and so and so.' I said, 'I've got to read that!' So I read five or six pages. What I just started reading was the final chapter, as a matter of fact. The so-called epilogue. I read it about three times since the book came out. Once I start reading it, I become completely absorbed in it because even though I've gone over it so much, it always seems so ..." Then he whispers, "I know it's so strange."
"Do you like your writing?" I ask.
"I love my writing!" he says enthusiastically. "You know why? Because I write out loud. I essentially talk my way through a book. And the kindest comments that I've ever had about my writing come from my friends, who say, 'You know, we know you. This is the way you talk.'"
"You're a very good writer," I tell him.
"Thank you," he answers. "You're so kind."
Now, would I want you to operate on me?
[Nuland is not amused.] Well. I didn't get to be a professor at Yale without being a pretty good surgeon.
As a surgeon, do you have a favorite organ?
My favorite organs are the heart and the spleen. I go into ecstasies about the heart.
I'm not sure I understand what the spleen does.
Welcome to the group, my man. That's why it's called the organ of mystery. No one has ever been able to figure out why it is tucked up there under the diaphragm, why it's that peculiar color [it's red when it's in your body but turns green when it's plucked out!] or what it does -- although it has been increasingly discovered that it not only acts as a filter to get little particles out of the blood that don't belong there, it destroys blood cells that are old and need to be destroyed so they can be re-created in the bone marrow. It's very effective as part of the immune processes.
I have to make an intellectual confession. I refuse to believe that the four humors don't exist. [In his book, Nuland writes, "The notion of the four humors is related to a doctrine developed in the 5th century by the Sicilian natural philosopher Empedocles. Empedocles taught that all matter is composed of one or more of four elements: fire, air, earth, and water." Nuland further explains that the four elements were represented in the human body by the four humors: fire = blood (heart), air = yellow bile (liver), earth = black bile (spleen, stomach) and water = phlegm (brain).] This is the most sensible thing I've read.
It means that I'm not one thing.
You have any proof that the humors exist?
A lot of time I believe I'm filled with black bile.
You have to admire something like this that flies in the face of proof to the contrary. I think it would be terrible if we lived in such a mechanistic universe that people weren't free to believe in the four humors. I really feel that way. I hope something in this book liberates some of the readers to liberate themselves and think about the humors and believe in them. We wouldn't have magic. We wouldn't have poetry. We wouldn't have romance if something in us couldn't believe in the humors or some similar notion.
Is the human body perfect?
No. The human body is the result of evolution. If the human body were perfect, we wouldn't have to wear clothes. We wouldn't have to live in houses. The whole aim of evolution is to make the animal independent of the environment, if you can say evolution has an aim. We will never be perfect because what we've done with our culture has overcome our environment. We don't have to be perfect. We're not going to evolve anymore.
Could the human body be more efficient than it is?
Oh sure. We could digest far more efficiently. It could respond to certain dangers far more efficiently. It could control mutations in the cells more efficiently so we wouldn't develop cancers. It could handle some of the food we eat in such a way that cholesterol wouldn't get deposited in our blood vessels. It could have a brain of such nature that we could immediately recall every experience we've ever had. Those are plenty of ways in which it could be better.
You don't talk about the brain in your book. I have these arguments with my wife about the brain. I believe that I am my brain. My wife believes the brain is just another organ.
I think you're both right. It's just another organ, but you're in your brain. The brain, after all, is what the biologists would call the head ganglion. Everything proceeds from there; it's the control center for everything we do. The mind couldn't exist without the brain. The mind is a function of the brain.
Is Sherwin Nuland in his brain or his heart?
He's in his brain. That's one of the purposes of writing a book. He is thought to be in his heart in certain times. He is thought to be in his stomach. There are those who even thought he was in his diaphragm. Now we know conclusively that he is in his brain.
How do we know that?
Ha ha ha. Because we know that none of those other organs have any possibility of consciousness. We know based on CT scans, MRIs, that thoughts arise in the brain -- that every stimulus that one responds consciously to is the result of activity on the brain. Parts of our brains are lighting up as you and I are talking.
You outline all the mythology surrounding the heart, but in the end the heart is just a muscle?
The heart is only a muscle with certain electric conduction systems in it that enable it to pump without needing to be stimulated with every beat. That's all it is. But, of course, metaphorically the heart is the center of emotions. We've inherited it from several thousand years of civilization because they can feel the heart beating. They can feel the heart getting excited and beating harder. When we're depressed we feel heavy weights on our heart.
You wrote that mysticism, superstition, philosophy, religion and deceit are in opposition to the science of medicine. What about faith? Is faith just faith, or can it become as concrete as science?
We wouldn't call it faith if it were anything other than faith. We choose the word "faith" because we accept things on faith and don't seek proof. Why do scientists reject those who have faith because there is no proof that anything they believe in is true? Those who have faith don't want evidence. The great strength of their belief is faith. In fact, I have jokingly said if God were to appear on Earth, I wouldn't be surprised if a lot of people stopped believing in him.
Here's a real elementary question: I was interviewing a woman about the flu and realized no one can answer whether a virus is alive.
Oh, the question of the age. Oh, if I could prove that one way or the other, I could go off to Oslo and pick up my prize. A virus is alive in the sense that it can reproduce, but the criteria for life include things like spontaneous movement, digestion, respiration. A virus can't do those things. So, strictly speaking, it does not fulfill all the criteria that a good biologist would expect of life. But the fact is, they can reproduce from each other because they have the DNA.
But what drives a virus to do what it does?
It is not driven to do what it does. It's like any chemical; it's a hunk of DNA. It's a chemical compound, and when it gets near certain other kinds of chemical compounds it automatically, by the forces of physics and chemistry, functions a certain way.
Is there some different life impulse that transcends faith and virus? What did you call it in the book, vitalism?
Yes. The old belief that there's a life impulse in there beyond the physics and chemistry. Vitalism has been dying a very slow death. In fact, it's quite dead because everything that we ascribe to some special vital phenomenon can now be understood in terms of ordinary physics and chemistry.
So life is just chemistry and physics?
I wrote a whole book about this, "The Wisdom of the Body," which is now called "How We Live" in paperback. We are creatures of physics and chemistry, but Bowman lives in your mind. We have created an entire culture of emotions and spirituality of poetry, music. And that's what life really is. The mere fact that something is living by biological criteria doesn't mean it contains life as most sentient, thinking human beings would define it. I write a column every three months for the American Scholar, and I talk about the fact that scientists during the next couple of decades will develop what is called the minimal genome, the number of genes to reproduce another living thing. You can call that life, but life is a philosophical concept. It's a theological concept. It has all sorts of implications, so there's no way to answer your question.
How do you repress being a philosopher when you cut someone open?
It's necessary to get into a completely detached head space when you're cutting someone open. If you attempt to think about that person's life -- whom they love and who loves them, who depends on them, what will happen to an entire life stream of people if things don't go well -- you'll lose your objectivity. You'll lose -- how can I put this? -- the coldbloodedness that is necessary to make decisions. It's easier to raise a cup of tea to my lips if the person on the other side of the table is neutral in my life. If the person on the other side of the table is someone whom I'm falling in love with, my hands will shake.
There's all kinds of symbolism in what we do in an operating room. We wash ourselves; we purge ourselves of any outside influences; we drape the patient so thoroughly so we don't see this patient. The patient is asleep; he's inarticulate; he's unresponsive. He becomes a subject detached from his humanity. And all this comes out in the symbolism of the drapes and the gloves and the anesthesia. When we operate we're a team. The patient is not one of us -- he's not part of that team. We work on him, we work for him, but we don't work with him.
Do doctors ever question that procedure?
The one you just described. I can imagine a group of New Age doctors saying, "Let's all put our foreheads on the patient's body and heal her with our third eyes."
There's no such thing as a New Age surgeon. Surgery is an artistic kind of craft. It is real. Surgeons function essentially the way a craftsman functions: "I love the way this dissection is going. This feels so right to me. It's beautiful to look at it. It feels just right. It's coming together. Oh, I love this job." Yet at the same time that surgery is the most direct thing you can do -- because you're holding it in your hand -- it's also the most abstract because you must abstract yourself from the reality of what the hell you're doing here. You've got your hands inside a body of another human being.
Every once in a very, very great while, one gets into dreadful trouble operating. It might be once a year; it might be every couple years. One becomes panic-stricken at what one has done. I'm talking about the trouble you get into because you made a dumb move. What you've got to do is get out of your mind and remain absolutely ice cold.
This is a personal question: Are you an organ donor?
I'm 69 years old. The only organs of mine that are worth anything are the cornea and the skin.
Any thoughts about organ donation?
Different perspectives. A lot of people are dying because we don't have enough organs. I've known several people dying waiting for hearts. One must encourage organ donations. There will come a time when we won't need organ transplantation -- in the meantime, one must do everything they can.
The reason I asked about organ donation is because of the cultural mysticism of the heart. Your heart really is you. Maybe it should be buried or burned with the rest of you. Maybe it screws up the transmutation of your soul if your heart is in another's body.
[Laughs.] There's a whole literature of interviews with people who have had others' hearts transplanted into them and how it affected their psychological functioning. I once wrote a story in the New Yorker about a heart transplant. The patient is really obsessed with thoughts about "Who's heart is this inside of me?" You don't often hear people saying this about transplanted kidneys or livers, but the heart has a different symbolism.
Is it just symbolism? Couldn't there be something really uniquely David Bowman about my heart?
You're a good mystic -- we need more like you. I'm scientifically trained. I refuse to believe in anything supernatural. I believe it's straight symbolism.
I wouldn't want to donate my brain to someone else. How do we know that there isn't something individual that resonates in our hearts?
Let's put it this way: The only neurological tissue in the heart is tissue that carries electrical impulse to make the heart beat. There is no tissue in the heart that is capable of thought or the transmission of information.
I hope I sound more like Dr. Frankenstein than some New Age guy.
No. You sound like the kind of guy who could write fiction and poetry and music, because the essence of the culture is this kind of metaphor. What I'm trying to get across in my book is that we've inherited this from thousands of years of mystical and magical thinking. What we have to do is accept this mystical and magical thinking for what it is and use it -- use it to enrich our lives. [Pause.] But I wouldn't rely on it to cure my pneumonia.