An Interview with Sherwin B. Nuland, M.D. by Christopher Mahon copyright 2003 All Rights Reserved Sherwin B. Nuland, M.D., was awarded the National Book Award in 1994 for his book, How We Die: Reflections on Life’s Final Chapter. He is a clinical professor of surgery at Yale, and also teaches bioethics and medical history. Dr. Nuland has written books on the medical arts and the meaning of the human body, has published a biography of Leonardo da Vinci in the Penguin Lives series, and is a regular contributor to The American Scholar. His memoir, Lost in America: A Journey with My Father, was discussed in this column in the April issue of WritersMonthly.

Dr. Sherwin B. Nuland’s quietly resonant ’ if not mellifluous ’ and elegantly reasoned voice came across the telephone line, from Connecticut, and into my world. I was happy to have reached him. I wanted to follow up on my review of ’ I prefer to say "literary dialogue with" ’ his eloquent memoir, Lost in America: A Journey with My Father, by asking him a few questions.

Specifically, I wanted to ask him about the art of the memoir, about his literary style, and about his notions of spirituality or, perhaps, more to the point, skepticism, because I was intrigued with some words he wrote, which are printed on pages 65 and 66 of his memoir: "As agnostic as my philosophy is, the synagogue has been a place of refuge and a home for me, and the congregation a family. With my wife and my children, I go there more than occasionally, a skeptic faithful to his memories."

(Although the meaning of that quotation is not completely lost by removing it from its context in the memoir, I advise all who are interested to read the complete book to understand the fullness of its meaning.)

I had begun the interview with my own thoughts on why I felt memoirs were important ’ because they could be honest and real, I said ’ and I asked Dr. Nuland for his thoughts on the value of the memoir as a distinct literary genre. He agreed that truth and reality were important in his own memoir, and he indicated he found reading memoirs valuable because they allowed him to "empathize" with other human beings. He also discussed another kind of memoir, one which, at times, may use truth as a starting point.

"There are memoirs that are written specifically as literary projects," he told me. "And what the writer is attempting is to use the story of his or her life to deliberately create a piece of literature. And when the writer does that, he or she is tempted to take liberties with the truth and with accuracy because they are looking for the literary flourish. They are looking for a certain kind of symmetry. They are looking for, they are attempting to use, your own experiences to tell a well-rounded story. Of course, real life is not well-rounded. Real life always leaves mysteries and confusions and uncertainties."

In the course of our talk, Dr. Nuland mentioned some books that had particularly impressed him, in terms of how they relate to the art of the memoir.

When he began to think about writing his own memoir, he wanted to read some books that might be similar in nature to his own. He read Bronx Primitive, by Kate Simon. He also mentioned having read, at some point, The Liar’s Club, by Mary Karr. In regards to this book, he indicated that the "emotional truth" can often be more important than "the literal truth." He also mentioned that Philip Roth’s book, Patrimony, was important to him.

After we finished speaking about these books, I asked him a question about his literary style. I wanted to know who might have influenced his literary style or, at least, which writers he might particularly admire, for their writing style. And I was interested in learning, too, if his writing style was a tribute to his father, an immigrant from Russia, who spoke Yiddish, and never completely mastered the English language.

"If there’s a single book that has influenced me more than any other," he said, "and there is a single book, and it has influenced me more than any other, and it has influenced me far more than any other, … it is the King James version of the English Bible. And we don’t know who wrote what. We only know that the committee got together and took the works of a group of people who had not gotten together but had somehow accumulated all this material and they created a masterpiece of sound. I grew up studying not the King James version of the Bible but the Bible that is read in Jewish liturgy and literature. But in college I became very close to the English Bible, took a year’s course in it, first the Old Testament, second the New Testament. I became so fascinated with the sounds and the rhythms and the beauty of the language that I realized years later when I began writing that the cadences and rhythms in which I not only wrote but spoke were very much those of Ecclesiastes and of Psalms, specifically, even a little bit of the Song of Solomon. But, I think, probably Eccliasestes ’ its reality, sometimes even its pessimism. But pessimism only when pessimism is the only realistic place to look. So that is an influence in my style of writing.

"What is also an influence is what the English language has meant to me. You recall, of course, since you read the book so recently, that English was not my first language [note: Dr. Nuland grew up in a household where Yiddish was spoken], that English, to me, was the key to America. English, to me, was the escape that I wanted so much from that little apartment in which I grew up. English was the high road to achievement and happiness in this world and so I was fascinated by the language right from the moment that I began to know how to write it and to read it. So that has stuck with me forever.

"And my inveterate reading has had more to do with my fascination with the language than it does with the stories ’ as much as I love the stories and what different writers can do with language. Interestingly, in the last thirty years or so, I’ve read far far far more nonfiction than fiction, and there is a kind of nonfiction which is not literally designed but ends up as being what we now call literary nonfiction. In other words, people who write nonfiction so beautifully that it stands as literature. One of the classic exemplars of that, of course, is Oliver Sacks. There are, you know, there are others. Lewis Thomas, who was dean of our school, was another one of those who wrote about science … and he wrote magnificently. … Because I knew him personally I realized he wrote exactly as he spoke. Which has always been my own end because I am essentially speaking onto the paper … .

"The greatest compliment I’ve ever had is from friends who say to me, ’As I read your books, or your essays, I feel like you’re talking to me because that’s the way you talk.’"

That called up a thousand other questions on the artistic nature of language, but I decided to steer away from those. I wanted to move to my next topic, which had to do with spirituality. The topic naturally connected to Dr. Nuland’s words about the King James Bible. I was interested in his thoughts on spirituality and, particularly, the sources of his skeptical approach to a belief in supernatural forces.

I explained to Dr. Nuland some of my own spiritual preoccupations, especially those having to do with the dialogues among different spiritual histories and practices and, especially, between Christianity and Buddhism. And then I mentioned that I had been particularly struck by his words on pages 65 and 66 of his memoir, where he had written that even though he has an agnostic philosophy, he still finds that the synagogue is "a refuge and a home" and that he is "a skeptic faithful to your memories."

"Do you think," I finally asked him, "that the human body operates under spiritual principles as well as biological ones?"

At this point, Dr. Nuland informed me that he had dedicated practically a whole book ’ The Wisdom of the Body ’ to this question. (The book was later issued in paperback by Vintage in 1998 under the title How We Live.) And then he continued … .

"In essence," he said, "the book now called How We Live was meant to be a description of the way the body works. [It was meant] for ordinary people, for the general reader [to inform them about] the anatomy and the physiology and, in other words, the functioning of the body. There are sections, of course, on the nervous system and the heart and the spleen and the endocrine system and all of those nice things in the G.I. [gastrointestinal] system.

"And as I wrote this book, because I write by free association, because I never plan anything and I don’t have any outline and don’t know from one paragraph to another what I’m going to be saying, amazing things happen, for me, when I write.

"I learn what I’m really thinking. I learn what’s been buried in my unconscious and it comes out on the page. And I realized chapter by chapter that much of what I was talking about was really what I call the human spirit. And so, toward the end, when I finished writing about the nervous system, I began hypothesizing and musing and conjecturing about what the human spirit is, and, to me, the spiritual quality of human kind arises out of the biology of the body. I think it is an absolute necessity.

"There is a sense of absolute wonderment that anybody who has ever had any acquaintance with the functioning of the human body must have about himself or herself as a being. And it is so different from the being that is our closest animal contact, or equivalent, I should say, like the chimpanzee, for example.

"There is something uniquely spiritual about the human mind and the human body and the interplay between the body and the mind. I am going to predict that within the next twenty-five years ’ this being the century of the mind, the century of the brain, as the scientists call it ’ that we are going to discover that the unique nature of human striving, of love, of the thing I call the spirit, which is that feeling of being enriched, that feeling of being better, somehow, than we are, the feeling of being somehow greater than our individual parts, that will be studied and that will be understood by looking into the way neurological stimuli move around from one part of the brain to the other."

"From a biologic point of view, you mean?" I asked.

"From a biological point of view," he answered. "We will understand why we are more than our biology. Interestingly, almost like a paradox, that by studying the biology very carefully, we will know how we transcend our biology."

Yet I remained interested in the source of his skepticism, mostly because faith is a topic of increasing interest to me. I realize now, of course, since our conversation, and since returning to his memoir for an even closer inspection, that he dealt with some of this topic in his book, even right there on p. 65. He wrote of the "lingering fear of the seductive power of theology like that expressed in the Untaneh Tokef [a particularly searing Jewish prayer]," and of the manner in which formalized religion and superstitious beliefs can be related to "the destructive reefs of obsessional thinking, guilt, and depression." Even so, I asked how he would define the source of his skepticism and how he would characterize a divinity, if, in fact, there was a divine power we were biologically tapped into.

"I actually use the word ’divine,’" he said, "and I define it and I trace its etymology in that book. The etymology of ’divine’ comes from an Indo-European root which has to do with nature. To me, the key to everything we are obviously arises from nature and evolution. We have evolved this way because we needed to evolve this way. We have developed the human spirit because we have needed to develop the human spirit. And when you say, when you asked me to defend skepticism, I should turn that question on its head. … I seem to recall [he was talking now about distant days, when he was a member of a high school debating team] that those on the positive side of the debate must defend their position. Those on the negative side can then attack their defense. So it’s necessary for the religious, for the people of faith, to tell me why they have faith in the absence of evidence. And I deal with that in the book, in the last chapter. I know it’s tempting when you look at that book to just read the last chapter because everything kind of comes together there. But I think you can’t completely understand the argument unless you read the book."

Our conversation continued. I became more interested in reading his book, How We Live, and I realized how much Dr. Nuland respects the religious faith of others, and the reality of faith itself ’ in matters both religious and nonreligious.

It is all complicated issue, of course, revolving around the depth of human needs, as Dr. Nuland pointed out, and the origin of the cosmos. Yet the roots of religion in history, Dr. Nuland told me, were based on a "loyalty to one’s father" and a loyalty to practices that, perhaps, are not linked to the real.

Yet he spoke, finally, of a panel discussion he once attended. On the panel there was a person of religious faith, a Catholic nun, who taught at a nearby college. She looked upon the Creator with wonder and awe. Dr. Nuland looks upon the human body ’ upon nature itself, one might say ’ with wonder and awe. And so, even though Dr. Nuland and the person of religious faith might not share the same belief system, they certainly share common ground. Again, he reminded me of the wonder anyone feels when they consider the workings of the human body and of nature itself.

"Wonder unites us all," he said.

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