NONFICTION - Sept. 20, 1992

THE PUZZLE PEOPLE: Memoirs of a Transplant Surgeon by Thomas E. Starzl (University of Pittsburgh Press: $24.95; 364 pp.). The “puzzle people,” writes Dr. Thomas E. Starzl in this engaging memoir, are not just the recipients of transplanted organs but those who perform the operations as well--the surgeons, some “corroded or destroyed by the experience,” others “sublimated,” but all inexorably changed. Starzl, a pioneer in liver transplantation, indicates that the change is a result of obsession, for the specialty requires nothing less: With the many ethical, medical, financial and political question marks surrounding transplantation--not to mention the enormous needs of the patients--obsession alone permits transplant surgeons to endure the pressure cooker in which they work. Although Starzl mentions many colleagues in these pages, he remains center stage, describing his progression from perpetual graduate student, to young MD with “an intense fear of failing the patients,” to a respected, sometimes controversial specialist. Starzl speaks frequently but not very effectively of his personal life, making the best parts of “The Puzzle People” Starzl’s professional war stories, whether in the operating room, the lab, on campus or during medical conferences. One in particular is unforgettable--the emergency call Starzl received during an operation from a colleague also in the midst of surgery in another state, which led to Starzl’s packing up a score of unwashed instruments, catching a helicopter and arriving at the other hospital to find his colleague’s finger still stuck in a vein in his patient’s ruptured liver “like the Dutch boy at the dike.” The patient, with Starzl’s help, survived.