Within Normal Limits <i> by Todd Grimson (Vintage Contemporaries: $5.95, paperback; 246 pp.) </i>

Darrell Patterson, an emergency room doctor in a Seattle hospital admits to an old friend that it’s not so much his work or marriage that despairs him but “myself.” It is one of the few character insights with which readers will agree in Todd Grimson’s first novel, “Within Normal Limits.” Patterson’s reverence for violence and drugs, and his addiction to them, his capricious indifference to medical trauma patients, a numbed affection for his family wearies the reader early on in this largely aimless first-person story.

“Tired of cutting, tired of feeling like a glorified TV repairman or plumber, tired of using my hands,” Dr. Patterson left surgery and switched to emergency medicine. Now mired in debilitating ennui and though still a young doctor in his mid-30s, he admits with great haughtiness that much of his “time is wasted trying to explain simple facts of life to naturally stupid and sometimes willfully ignorant people of all ages and persuasions.” Indeed, most of the book is an endless array of gory symptoms and wounds at the expense of characters. In an easy formula that leaves the reader ultimately resentful and bored, Patterson’s blunt indifference to the urban carnage is meant to shock the reader. With little passion, Patterson describes the face of a prostitute rubbed into concrete by her pimp or an attempted suicide victim who “simply blew off his face” and succeeded “I guess, in radically altering his life.”

When Darrell’s wife Anna, an ICU nurse and an aspiring photographer, suggests they have an “open marriage,” Darrell reacts with predictable profound indifference. For years, Anna has watched him pop pills “whenever you think you are starting to slip . . . getting too human or something.” To stay within normal limits, Darrell regulates himself with a variety of drugs.

Repeatedly, we see the dynamic where Patterson feels “really, fully alive” only in moments of terror and violence. On an especially busy night in his ward, he admits “that I might actually enjoy a war or some other big disaster, a nuclear accident or terrorist bomb.” Later he yearns for the ER to be “like in a war.” A knockdown fight he witnesses on the street between a black and a white woman is a “spectacle (that) pleases me.” His reverie for such violence is unpredictable, though a sense of sympathy in him is only aroused when the ingredients are right: The patient is under great pain, and there is something “sad” about them. A violent drug addict who years before had sustained brain damage in a car accident is someone for whom he “feel(s) a kind of perverse affection.” If Darrell was only happy amid such pain and trauma, why then does he seek to insulate himself from it with drugs? Conceivably, despite the numbers of “fakers and drunks” who visit his unit, he should relish every moment in R filled as it is with panic and pain. The reader wonders how long Patterson would sustain that envy of trauma were he a true victim. Would he feel really human to be bloodied, or is he content in his existential/cerebral largely domestic trauma?

“Prone as I sometimes am to instant assessments,” Patterson’s world is divided basically into likes and dislikes, but mostly the latter. His 7-year-old son “leaves me cold” and “whatever guilt I may feel about this only moves me to dislike him the more.” His mother is “one of those cliched bubble-headed blondes,” his working-class brother, jealous of Darrell’s wealth and success, is someone “I haven’t liked for years.” Many colleagues and nurses are disliked as well.

Patterson reduces people to stereotypes. An orderly “is the archetypal gay,” a nurse “the prototypical lesbian.” Even the questions he’s asked are stereotypical. Twice he hears, “Save anybody last night?”

Despite Patterson’s admission that many of his profundities about life and death are “banal and hardly brilliant,” he continued to offer them (“No one is immortal, and I thought that I might figure out, if not the why, the how”; “Life is so short, and our bodies and psyches are so fragile. . .”).

At certain instances, some of the philosophical exposition is disconcertingly similar to Theodore Roethke’s famous poem, “The Far Field.” Patterson’s “It is infinitude that I fear” is the flip of Roethke’s “I learned not to fear infinity.” “Through the Finite (the corpse) I would come to some apprehension of the Infinite (the living body)” is a curious, themonic echo of Roethke’s poem and his particular line that “all finite things reveal infinitude.” Patterson’s recounting of seeing a child “caught in a reaper-harvester or accidentally shot by its brother” mirrors the details in a stanza of Roethke’s about a part of the field where the poet finds a cat “blasted to death” and rabbits “caught in the mower.”

Because there is little sense of story, other than whether Darrell will come to life again and whether his marriage will survive, some of the patients who appear in Darrell’s ER have to pass as characters that we should care about--Teena Overstreet, for instance, a prostitute/porno model who gets beat up regularly by her friend, and who only sometimes seems to recognize Patterson.

Old friends and colleagues of Patterson’s appear--a young lover of Anna’s, her sister-in-law and other minor characters. It’s especially difficult though to understand what Darrell could possibly offer in a friendship or with a woman with whom he has a brief affair. For a man settled so often “into my typical, semi-bored-seeming-attentive mode” it’s not easy to imagine what would make him appealing to other people.

Author Grimson, the book jacket points out, has worked as an emergency room interviewer, intensive care unit clerk, musician, flogger and grinder. Fortunately, rich details from these disparate worlds wind up in the novel pointing to a genuine “writer’s eye.” Yet they don’t figure in any sort of plausible drama. Even when Patterson isn’t drugged, much of the prose seemed numbed by narcotics. The book could end seemingly at any place on any line. Patterson is needlessly confined to that place within normal limits, where drugs may make “the temporary lessening of pain or anxiety . . . a very blessed state.” But this is no place the reader wants to be for an extended period. Even though “everybody wants to feel good,” and that’s what drugs do, Patterson believes, there is little pleasure, excitement or caring inside these boundaries.