His circle of friends

In 1999, Jay Neugeboren got very sick but didn’t know it. His coronary arteries were almost completely blocked, but, nearing 60, he swam a mile a day and played tennis and basketball with men half his age. When he complained of shortness of breath, his doctors in Massachusetts failed to diagnose the problem. Only a long-distance phone call from a Southern California cardiologist -- a friend since high school who picked up subtle clues in what Neugeboren was saying -- got him into a hospital in time for quintuple-bypass surgery. It worked. Neugeboren recovered fully but was all too aware that he might have died if, as another friend put it, he “hadn’t gone to high school with the right guys.”

Neugeboren’s medical support group included not just Dr. Rich Helfant, former chief of cardiology at Cedars-Sinai Medical Center in Los Angeles, but also Dr. Phil Yarnell, a neurologist in Denver, Colo.; Dr. Jerry Friedland, director of AIDS programs at the Yale School of Medicine and at Yale-New Haven Hospital, where he made sure Neugeboren got a top surgeon and the best possible care; and New York psychotherapist Arthur Rudy. All were close friends who had grown up together in Brooklyn in a Jewish atmosphere of intellectual striving, social activism and “rooting for the Dodgers.” To Neugeboren, their virtues as friends and as human beings had a lot to do with their success as doctors -- at least as much as their technical expertise.

Every patient should be so lucky, Neugeboren thought, but of course not every patient is. Experienced in writing about aspects of medicine -- his nonfiction books “Imagining Robert” and “Transforming Madness” concerned his schizophrenic brother and America’s treatment of the mentally ill -- Neugeboren reflected on his brush with death and its wider implications. How had his regular doctors failed to spot those blocked arteries? How had Helfant, 3,000 miles away, succeeded? Why did the support of his friends and family prove so vital to healing? Why, in an age of medical miracles such as his open-heart surgery, is the other kind of “open heart,” the willingness to listen to the patient and treat him or her as a unique individual, so often lacking?

The result of Neugeboren’s questioning is this book, which opens with his own case and spirals outward to consider the last 100 years of disease fighting -- years in which U.S. life expectancy soared but life span, the upper limit of aging, remained the same; in which chronic ailments such as heart disease and cancer replaced acute infectious diseases as the main causes of death; in which low-tech public health measures such as inoculations and clean water accounted for most of the gains in longevity by 1940, before high-tech medicine really got going.

Neugeboren’s M.D. friends, who still call him “Neugie” and “the Noog,” point out that radical, expensive interventions such as open-heart surgery are necessary only because we don’t really know what causes heart disease. (And neurology, Yarnell says, is 40 years behind cardiology. We don’t know how to get the injured brain to heal itself.) We can’t prevent or cure atherosclerosis -- just patch patients up. Diagnosis is easier when the doctor knows the patient well and the patient has enough trust in the doctor to activate the placebo effect, which gives even primitive shamans a fair percentage of cures. But the trend to managed care by near strangers has eroded trust. “Without trust,” Neugeboren says, “the quality of medical care, and of our well-being, is dangerously compromised.”

His friends say the humanistic side of medicine should be valued as highly as the science. The book’s best parts are taped interviews in which they describe their lives and philosophies in pungent language. Particularly moving are Friedland’s experiences in Africa (where he has returned to fight AIDS) and Rudy’s as an Army psychologist during the Vietnam War: “On one side there are American boys who’ve lost limbs and on the other side there are Vietnamese prisoners who’ve lost limbs. And they look at each other across the [psychiatric] unit and it’s okay. Now that they’ve been mutilated for the rest of their lives, no one’s killing anyone.”But the agreement is so total, and Neugeboren’s friends are so admirable, that we almost wish he would bring in a devil’s advocate to argue against the change of heart he urges so persuasively -- some technology worshiper or insurance company executive or hard-nosed budget cutter to tell us it’s all idealistic pie in the sky. Muscles are built from resistance, and “Open Heart” seems a little flabby. Neugeboren’s writing style doesn’t help. Oddly for a novelist (“Listen Ruben Fontanez,” “An Orphan’s Tale,” “Don’t Worry About the Kids”), he has a weakness for extraneous detail and for 200-word periodic sentences packed with parenthetical asides. A few can be exhilarating, but a whole book of them amounts to a stress test -- a literary treadmill.