BOOK REVIEW : Fiction Dissects Doctor’s ‘Moral Morass’ : DOC-IN-A-BOX <i> by Robert A. Burton</i> ; Soho Press $18.95, 225 pages

Some of our most able witnesses of the human condition in the history of literature have been doctors: Rabelais, Chekhov, William Carlos Williams, Montaigne, Oliver Wendell HolmesJ. Cronin, Somerset Maugham. Even a partial list is impressive and suggests the variety within the ranks of doctor-writers.

Robert A. Burton, a neurologist practicing in San Francisco and author of “Doc-in-a-Box,” claims to have been lured to medicine by the experience of working in his father’s pharmacy as a child; then he found his calling as a writer after reading the short stories of William Carlos Williams.

In truth, he owes more to Raymond Chandler than he does to Williams. A modern tone pervades this novel, one of ennui and alienation. The deep family connections, the delicate moral sensibility and the sense of communal life found in the works of both Chekhov and Williams are missing.

This isn’t to say the clumsily titled “Doc-in-a-Box” is a failure. There’s a good deal to admire in this terse, hard-edged first novel, not least its pace and the clarity with which modern medical dilemmas are presented.

The story is set in Los Angeles. In the course of the first few pages, Dr. Webb Smith, “a plastic surgeon in Tinseltown” specializing in facial reconstructions, treats a street kid with a gunshot wound in the emergency room of a hospital. Webb makes two mistakes: he doesn’t report the gunshot wound, and he rather haphazardly accepts a vial of cocaine from the victim.

Webb’s mistakes are discovered. In short time, the eight physicians who sit on the Board of Medical Quality Assurance pass judgment on him. His license is suspended for a year. When next seen, Dr. Webb Smith is picking up garbage along the L.A. River as part of a gang working off jail sentences in community service. Once Webb had “dreamed of being special; now he couldn’t be more ordinary.”

But his “ordinariness” is, in fact, more complex. Webb isn’t exactly a tragic figure or a martyr; he may be a good doctor, but he’s the product of his own weaknesses. There’s his compulsive womanizing, especially with nurses (“He used to love the sight of a nursing uniform tossed alongside his bed” and found they “smelled of optimism and a sense of duty”), which has caused his wife, Elizabeth, to leave him. He has an affection for alcohol and, occasionally, drugs. He suffers from fatalism, an inability to “enjoy what he had earned”--like a man who saves his good suit for the right occasion, only to watch his life slide by without the occasion arriving.

Unable to envision himself as anything but a doctor, Webb decides to flout the rules; when he finishes up his community service, he applies for a job in a walk-in medical clinic called Instantcare, located in a former dress shop in a seedy Venice neighborhood. He doesn’t mention his suspended medical license to Williams, the man who hires him. Williams isn’t too concerned with certification anyway. At Instantcare, Williams explains, medicine is a business, health care is a product and generating word-of-mouth business matters much more than good, or even valid, credentials.

The elderly, the sick and the poor--rather than wealthy women seeking face lifts--become Webb’s new patients. Also the abused children of junkie-whores like Mrs. DeJonette, who brings in her 4-year-old son, Booker, with a steak knife stuck through his cheek. Webb is back at the bottom of the heap. Like the washed-up detective--drummed out of the force for some infraction--he’s returned to duty, but in a fallen state, unrecognized in an environment so humble and real.

Webb takes in his old buddy Joe, who is dying of cancer of the pancreas and has nowhere to go. Everybody in this book is single and as emotionally choked as Phillip Marlowe. Joe, a vet with a small pension, is divorced. Webb is separated. Even Jessica, who plays be-bop at a seaside bar, seems largely divorced from everything.

There’s a “moral morass” lurking in the practice of medicine, says the author, and Dr. Webb Smith is drawn right into the center of it. Do you take a child away from a junkie-mother, condemning him to float though the foster system, or do you try to save the mother and the child? Can you ethically spare your friend a few tortured last days, or weeks, and quietly assist his death?

There’s a conciseness to Burton’s writing that fits the story he’s telling. And yet, one can’t help feeling there’s more he can learn from William Carlos Williams. “We need too often a burst of air in at the window of our prose,” Williams wrote in an essay on Pound and Gertrude Stein. Next time, one wishes Burton would throw the windows open even wider. Let the air ruffle the language a little and stir characters locked in torpor to more bounteous life.

Next: Carolyn See reviews “Cottonwood” by Raymond Strother (Dutton).