The Uncertain Art: Thoughts on a Life in Medicine (Hardcover)

~ (Author)
Key Phrases: first aphorism, hippocrates redux, uncertain art, The Gross Clinic, New York, United States (more...)

Editorial Reviews

From Publishers Weekly

In these essays reprinted, for the most part, from the American Scholar, Yale clinical surgery professor Nuland ponders various aspects of the practice of medicine and patient care. Opening the collection by urging his colleagues toward introspection and self-awareness, Nuland stresses that doctors make life-and-death decisions based on their own emotions, strengths, insecurities and very human needs. In another essay concerning human cloning and manipulating DNA to achieve human immortality, the author suggests we put the brakes on radical technologies whose uncertain consequences we have only begun to contemplate. On a trip to China, Nuland is intrigued by a thyroid operation performed under acupuncture where the patient was wide awake and smiling and suffered no anesthetic aftereffects after a two-and-a-half-hour excavation of her neck. Elsewhere, in an essay on grief written shortly after 9/11, Nuland calls Islamic fundamentalism a sickness of the soul, and in the book's final entry, he himself grieves over a cardiac patient who died while waiting for a new heart. Although solid and perceptive, these essays are also occasionally flowery and verbose, and do not offer the rich insights of the author's bestselling How We Die. (May)
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From Booklist

These essays, which Nuland wrote from 1998 through 2004 for the American Scholar, make up a less-unified book than his gripping and powerful How We Die (1994) and The Mysteries Within (2000), each chapter of which proceeds from a particular incident in his surgical career. But then, these pieces’ range of topics is greater, their expositional mainsprings less intimate. Two chapters impressively ponder the first sentence of the first aphorism of Hippocrates, which begins, “Life is short, and the Art i.e., medicine is long.” Others engrossingly discuss the placebo effect, acupuncture during surgery, “Grave Robbing,” electroconvulsive therapy, three classic medical texts, and Thomas Eakins’ two great paintings of surgical teaching. Personal experience powers amusing as well as informative pieces on weight training by the elderly (this could be an outtake from The Art of Aging, 2007), writing, and actually responding to the call for “a doctor in the house.” Oddly, the most personal chapter, first published herein, is the least successful; about a heart-transplant candidate Nuland befriended, it is, atypically for Nuland, insufficiently emotionally distanced. --Ray Olson

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Product Details

• Hardcover: 224 pages
• Publisher: Random House; 1 Reprint edition (May 20, 2008)
• Language: English
• ISBN-10: 1400064783
• ISBN-13: 978-1400064786
• Product Dimensions: 9.4 x 6.3 x 1.2 inches
• Shipping Weight: 1 pounds
• Average Customer Review: 3.7 out of 5 stars  See all reviews (7 customer reviews)
• Amazon.com Sales Rank: #524,086 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

10 of 11 people found the following review helpful:

3.0 out of 5 stars not up to Nuland's standard, July 18, 2008

By	mikemac9 "mikemac9" (Los Angeles, CA USA) - See all my reviews

This book is a collection of recycled pieces written for the magazine of the Phi Beta Kappa society. Nothing is inherently wrong with a compilation, although the pieces didn't flow all that smoothly together. More important is the subject matter addressed; many of the chapters just didn't capture my interest the way his previous books have. And the writing seems a bit pretentious; never use a short word when a longer one can found. Its almost like the articles were written to impress those who are thought to fancy themselves to be of a certain refined intellectual and critical level (eg PBK members), as if to say "sure, I'm a doctor and not a college professor but I have a big vocabulary too!"

4 of 4 people found the following review helpful:

3.0 out of 5 stars A book that highlight's a venerated surgeon's writing skills, September 26, 2008

By	Stephen Pletko "Uncle Stevie" (London, Ontario, Canada) - See all my reviews (TOP 500 REVIEWER)

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"All of this is prologue [the preceding pages of the book's introduction] to introducing the substance of my book and explaining the title I having chosen for it. By now it is doubtless clear that [the book's title] "The Uncertain Art" refers to medicine and that I have been attempting in the foregoing paragraphs [of this book] to stake out a territory whose boundaries are sufficiently vague that I feel free to roam wherever inclination leads me. Roam, that is, so long as I stay within sight of the assignment I have given myself, which is to write as a doctor, about issues associated with doctoring."

The above is found near the end of the introduction to this book authored by Sherwin Nuland, a clinical professor of surgery at Yale University and the author of numerous books.

Each of the chapters (except for the last one) in this book is a "slight modification" of the "sequence of [stand-alone] essays" the author wrote between 1998 and 2004 for the publication "The American Scholar." Thus, the new writing in this book actually consists of a brief "Author's Note" (found at the beginning), the Introduction, and the last essay or chapter.

It seems to me what Nuland has attempted to do was to take a series of stand-alone essays that he had written previously and tried to connect them so they would have a common theme. The theme being how a doctor has to make decisions and judgements in the face of uncertainty.

However, I had a difficult time extracting this theme from his essays or chapters (except for the two chapters that dealt with Hippocrates). Don't get me wrong. All the essays are well-written and show considerable thought in composition but taken as a whole, they don't seem to have any cohesive theme.

If you reread the quotation that begins this review, you'll see that Nuland tells us in the last sentence that he wrote about "issues associated with doctoring." However, there are several essays (such as the joy of writing and reflections on 9/11) that seem out of place.

The subtitle of this book is "Thoughts on a Life in Medicine." However, there is much research (especially historical research) that actually makes up the bulk of this book, not just the author's thoughts.

There are no references in this book. Most of the essays are well-researched and show considerable attention to detail (such as essays on the hidden meaning of medical words, grave robbing, the medical school & the university, and electroconvulsive therapy). Where did the author get all this information?

Finally, scholarly publications such as "The American Scholar" demand references. It's my guess that the original essays had references but for some reason it was decided not to include them with this book. Why?

In conclusion, the essays that make up this book are well-written but don't clearly accentuate either the book's title or subtitle.

(first published 2008; author's note; introduction; 21 essays or chapters; main narrative 185 pages; acknowledgements; index)

<<Stephen Pletko, London, Ontario, Canada>>

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3 of 3 people found the following review helpful:

4.0 out of 5 stars More, please, June 17, 2008

By	N. King (Washington, DC) - See all my reviews (REAL NAME)

I enjoyed this book, as I do all of Nuland's offerings, but it wasn't riveting - it was more like meandering through a park. Most of these pieces were previously published in periodicals, and like many compilations, the necessary brevity normally demanded by magazine editors left me, in several cases, wishing for more fleshing out of the various subjects introduced. I especially missed that which Nuland has done so well in his previous books - brought the subject matter literally to life based on specific stories of his patients. This was done only in the final chapter, and not coincidentally, this chapter was by far the most interesting, compassionate, and illustrative of his central thesis. Nevertheless, considering the nonsense that passes for literature today, well worth having and reading more than once.