Transplant Surgeon Steeled Self Against Fear : Medicine: Physician’s autobiography also is a history of liver replacements over the last 29 years.

He blazed a stellar career in medicine, earning renown as the father of liver transplantation, but the thought of pulling on his surgical gloves made Dr. Thomas Starzl sick with fear.

In his new book, “The Puzzle People: Memoirs of a Transplant Surgeon,” Starzl, now 66, reveals his torment, a paralyzing anxiety that only went away when he actually began operating.

It started when the future world-famous physician was 32, and in his fifth and final year of residency. He realized then he lacked the toughness to hold a life in his hands.

“It was as if I had trained all of my life to become a violin virtuoso,” he writes, “only to discover that I loathed giving concerts or even playing privately.”

But Starzl was intent on becoming a doctor, and having already discarded careers in neurophysiology and heart physiology, he stayed with surgery.

“I was stuck with those anxieties,” Starzl said in an interview. As a result, he said, “I was striving for liberation my whole life.”

Liberation came last year. Anticipating the decline of his eyesight and dexterity, Starzl laid down his scalpel. He now devotes all his time to research, his lifelong love, as director of the Transplantation Institute at the University of Pittsburgh.

Despite his fears, Starzl performed the first successful liver transplant in 1963 at the University of Colorado. He also was the driving force behind the first animal-to-human liver transplant, when a baboon’s organ went into a 35-year-old man on June 28 this year.

Starzl’s research made both possible.

He relates this in his book, both autobiography and transplant history, published Aug. 15 by the University of Pittsburgh Press.

Starzl gave the interview seated on the couch in his cluttered office over a Pizza Hut at Pitt. Blown-up family photographs and a letter from former President Reagan adorn the walls. When his two mongrel dogs wandered through, Starzl fed them jerky with his long, thin surgeon’s fingers.

Longtime friend, Dr. Willard Goodwin, emeritus professor of surgery-urology at UCLA, said Starzl is stiff and tends to instruct others. But inside, Starzl is “soft, very soft,” Goodwin said.

This shows in his telling of the story of Bennie Solis, a 3-year-old who in 1963 underwent the first attempted liver transplant. Bennie bled to death on the operating table; his damaged liver no longer made blood-clotting substances.

“He was wrapped in a plain white sheet after being washed off by a weeping nurse,” Starzl writes. “The surgeons stayed in the operating room for a long time after . . . looking at the ground and saying nothing.”

Starzl solved the clotting problem before further operations. But 27 years later he hadn’t found a cure for painful attachment to his patients.

Stormie Jones was 7 years old in 1984 when she became the first heart-liver transplant recipient. She lived six more years, a record, before dying of heart rejection in 1990 at age 13.

Her short, difficult life touched millions of Americans, none more than Starzl.

In his book, the surgeon recalls how the laces of Stormie’s tennis shoes were always loose and that her smile “once seen was never forgotten.”

After she died, Starzl never operated again.

The book offers light moments, too. There’s the one about Dr. Loyal Davis, former first lady Nancy Reagan’s late stepfather.

Davis was chairman of surgery at Northwestern University Medical School in Chicago when Starzl studied there. Davis detested smoking.

One day, Starzl and a fellow student had just put out cigarettes in an elevator when the doors opened on Davis. He smelled smoke and made Starzl lift one shoe, then the other, where the offending butt lay.

Davis asked whose it was. The brash youngster replied, “You can have it, sir--I believe you saw it first.”

The chairman’s associates were shocked. But after a moment, Davis smiled, and Starzl heard him laugh as he walked down the hall.

Throughout the book, Starzl memorializes patients who submitted to the first transplants, and those who furthered the art of transplant surgery. The book’s title refers to the stitched-up recipients, though it could just as easily mean the researchers who piece together the large and small puzzles of transplantation.

The liver poses particular challenges.

It’s the largest organ and second only to the brain in complexity. Removing one liver, preparing another and transplanting it takes about 10 hours, longer than a body can survive with blood vessels clamped.

To keep open the window of time, Starzl devised a way to route blood around the liver during surgery.

Though no longer donning surgical gloves, Starzl still receives letters from the families of former patients.

“They always start by saying that they know I won’t remember Jimmie or whatever was the patient’s name,” the surgeon writes in his book. “Then they express thanks for the fact that we had made an effort instead of letting their children die, off in a back room without hope. . . .

“They were wrong about one thing. That I would not remember.”