The Puzzle People: Memoirs of a Transplant Surgeon By Thomas E. Starzl (review)

appear to be drawn to those areas of medicine that limit their involvement with individual suffering, preferring instead fields focused on organ-based technical procedures. If economic reward is any measure of what our society values, it appears that human relationships and knowledge of the person are considered less important than technical expertise. If Cassell doesn't try to address all these troubling questions, he has thought long and hard and has advanced the discussion in a difficult area. Although I am afraid that the book's length and dry style may put off some potential readers, particularly the busy front-line clinicians who might be most appreciative of his moral and philosophic support, the book should be rewarding to anyone involved with medical education. It might also be profitably assigned to medical students or residents as part of a medical ethics or humanities course. Individual chapters stand on their own and may be read separately. While Cassell's erudite work tells us what everyone already believes, that we need to "treat the whole person," Cassell correctly points out the sharp split between what everyone believes and what we do and teach. He provides a cogent intellectual framework for how and why this split came about. His explanation may not be the whole story, and he may be short of remedies, but if what we need first in medicine is a fundamental change of heart, Cassell's book is a good place to start. Alan B. Astrow Department of Medicine St. Vincent's Hospital and Medical Center of New York The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl. Pittsburgh : Univ. of Pittsburgh Press, 1992. Pp. 364. $24.95. The ancient Spartan warrior asked only one question about an enemy force: where is it?, its size or power being irrelevant. Dr. Thomas E. Starzl is spiritually of that lineage. Superbly honed by a long, five-year Johns Hopkins surgical residency under the legendary Dr. Alfred Blalock, he quickly took the field against an old adversary: When I began work in transplantation in 1958, the landscape was almost bare. There were no human organ recipients except for the few who had received kidneys in Boston from their identical twin donors, (p. 4) The Puzzle People is an engrossing story of how one man deliberately set out to change that landscape. It is a journey worthy of any Spartan soldier's in its personal indifference to discomfort, pain, and danger. Now the doubters and scorners must pay him and his colleagues the ultimate compliment, the honor of astonishment. Starzl's mission has been accomplished: today in operating rooms throughout the world, surgeons are able to give the gift of a new life to patients who would be doomed without a transplant. One may ask: might another have done what Starzl did? Would any other 152 Book Reviews surgeon have defied conventional medical wisdom about transplantation's genetic-matching "absolute"; voluntarily signed on for a thirty-year journey at hard labor, low pay, and minimum domestic privileges; endured the pain of many patient deaths; and surmounted stomach ulcers, bouts of hepatitis, laser beam eye injury, and coronary disease to complete the mission? Perhaps. Perhaps someone else might have done what Starzl did; might, like a Spartan soldier, have plunged into the "icy stream of divergence and innovation ," while encumbered with a heavy "baggage of caveats and criticism," then advanced to meet a cunning, omnicompetent "foe." But, as Aristotle observed, would-be athletes don't win the Olympic prize; it only goes to those who enter the race. Starzl knew the terror of the true Spartan. He writes of his terror during each of the thousands of operations he performed since the 1950s and of his intense revulsion at surgery's brutal assault on the body. Starzl's bravery is the sort that Aristotle had in mind when he described the nature of courage: The brave man is not the rash man, who is soon dead, but one who fears the right thing in the right way at the right time. In battle he holds his position even against superior forces, fearing dishonor more than death. A work of courage and...