NONFICTION - April 25, 1993

FIRST, DO NO HARM by Lisa Belkin (Simon & Schuster: $23; 271 pp.) In 1988, when Armando Dimas arrived in the emergency room of Hermann Hospital in Houston, Texas, one of the first things the attending surgeon told a colleague was that Dimas--aside from the bullet that had passed through his spinal cord and lodged in his head--was “basically healthy. He’ll make a good donor.” The hospital had only one problem: Dimas not only lived through surgery but insisted--through eye blinks, as he was permanently paralyzed from the neck down--that the hospital do everything it could to keep him alive. Armando’s story is one of four told by New York Times medical correspondent Lisa Belkin in “First, Do No Harm,” and the author has chosen each gut-wrenching account to address two central questions: Are some lives not worth saving, and if so, who should make that determination? Besides Dimas, there’s Patrick, a boy with a digestive tract disease who has spent most of his 15 years at Hermann, slowly dying; premature twins, each weighing less than two pounds and with extremely poor prognoses; and a third premature baby, born to a couple whose seven-year attempt to conceive was fruitless, suffering with a severe case of spina bifida. “First, Do No Harm” sounds terribly depressing but turns out to be a mesmerizing page-turner, filled not with hope--there are no happy endings here--but with the deep commitment shown by numerous doctors, nurses, parents and patients. Focusing on cases that have come before Hermann’s ethics committee and are consequently freighted with conflict, Belkin has written a book of enormous sensitivity and intelligence. Hillary Clinton should read it . . . as should anyone concerned by the costs, emotional as well as economic, of playing God.