Bernard Lown.The lost art of healing: practising compassion in medicine. New York:Ballantine Books, 1999. US$ 14, pp 332. ISBN 0-345425979

Bernard Lown is a pioneer in research on sudden cardiac death. He invented the defibrillator and introduced the technique of cardioversion. He discovered the use of lidocaine in treating ventricular arrhythmias. Very early in the course of his career Dr Lown shed light on the relationship between potassium and digitalis. For his exceptional work in raising public awareness of the catastrophic consequences of nuclear war, he was awarded the Nobel Peace Prize in 1985. This distinguished cardiologist, whose research and wisdom have shaped modern cardiology, writes his memoirs and also pinpoints the ills plaguing modern medicine and suggests a cure.

The first section of the book, entitled ‘Hearing the patient: the art of diagnosis’, uses anecdotes and human interest stories to illustrate how arriving at a clinical diagnosis is a creative and satisfying experience. He states that the science of history taking, the art of listening and the insights obtained by touching are interwoven to produce truth. At a time when medicine is becoming increasingly entangled in a love affair with technology, this is a bold and courageous statement in favour of clinical acumen and bedside skills.

The chapter on ‘Mind and heart’ makes for fascinating reading while ‘Killed by the imagination’ is a chilling account of the power of mind over matter. Dr Lown’s preoccupation with psychology and his concerns regarding the role of psychological factors and stress in causing sudden cardiac death are evident. He devotes an entire chapter to Munchausen syndrome, an entity that is consistently chastening and disconcerting to physicians and shows how little the medical profession understands the human mind.

A section devoted to the disappearing art of doctoring explores the doctor-patient relationship. His views regarding the power of words are thought-provoking. Wrong words can maim as easily as a physical assault; yet words also have a far greater potential for healing. He writes about scientific discoveries and inventions that have changed the face of modern cardiology. The chapters on digitalis, the discovery of the defibrillator and the genesis of coronary care units transport us into the past. We experience the thrill of reading the history of modern cardiology being made, with Dr Lown as the chief protagonist. These stories leave one in awe of this brilliant scientist who by the sheer magnitude of his contributions seems to have single-handedly elevated the field of cardiology to its current position.

Yet, he remains remarkably down-to-earth, self-critical and insightful, as his concluding lines on coronary care units proves. He writes:

‘Of course every silver lining has its cloud. Every advance exacts a cost. Medicine grew even more depersonalised. Technology took precedent and patients became secondary (with the advent of CCU). A paradox of my life and its ultimate irony is that my research work facilitated that which I utterly deplore.’

Dr Lown writes compassionately about the challenges in caring for the elderly. No pills, just sensitivity, innovation and imagination are his mantras in dealing with the problems faced by the elderly. His essay on death and dying reveals a deep understanding of the uncertainties and frailties of life. He is disturbed by the schizophrenic mix of denial and morbid preoccupation that humans have regarding death. Dr Lown calls for the ‘deinsti-tutionalisation’ of death. He believes that lending ‘dignity to death’ will remain just a distant dream unless hospitals are decoupled from the act of dying.

The book is peppered with fond memories of his mentor, Dr Samuel A Levine. Their mutual respect, their disagreements and skirmishes add an element of drama to the narrative. It is an immensely readable and thought-provoking book which is a treasure trove of wisdom, advice and knowledge for all those aspiring to be doctors in the true sense.