Life and Death Pair in a Mortal Tango : DANCING WITH MR. D: Notes on Life and Death by Bert Keizer; Nan A. Talese / Doubleday $23.95, 324 pages

Much noise is heard in courtrooms nowadays about the legal and moral niceties of death and dying. Much breath is expended from the pulpit, and much ink is spread on op-ed pages: Do we enjoy the “right to die,” with or without the assistance of a physician? Or is the physician under a moral duty to use heroic measures to save every human life, no matter how blighted and afflicted?

But the spirited public debate often ignores the intimate truth that we find in the pages of “Dancing With Mr. D,” the harrowing memoir of a physician who knows what really happens when the human body reaches the end of life. Often enough, writes Bert Keizer, “the patient will just keep on dying, whatever we do.”

Keizer’s remarkable book was first published in Holland, where some 1,000 physician-assisted deaths are said to take place each year. He describes in heart-rending detail his experiences in the Dutch nursing home where he attends to dying men and women day after day, and his random musings add up to something elegant and even exalted, a confession by a troubled healer whose work is literally a matter of life and death.

Significantly, Keizer is trained in both philosophy and medicine, and so “Dancing With Mr. D” can be approached as a work of applied philosophy and practical theology as well as a kind of medical autobiography. When Keizer ponders the Bible verses in a painting that hangs over the head of a dying man--”In God I have put my trust; I will not fear what flesh can do unto me”--the words of the Psalmist strike us as cruelly ironic precisely because he knows all too well the many ways in which the flesh may be afflicted before a man or woman finally gives up the ghost.

Keizer allows us to hear the voices of his fellow physicians in unguarded moments of conversation on the wards. He shows us the men and women under their care as they are carried by their illnesses toward death. And he reveals that the question of whether to “assist” in the death of a patient is sometimes more painful for the physician than for the loved ones of the patient.

“Don’t scoff at cortisones; Jesus always used them,” cracks one doctor who is being urged by the relatives of his patient to inject a fatal dose of barbiturates into an old man who may or may not be dying of lung cancer. “With that stuff, you can even get a corpse singing again, if only for a short while.”

No clinical detail is left out, and the book is full of shocks, some slight and some soul-shaking, as we confront what really happens when life comes to an end. But Keizer is too much the realist, too mundane and matter-of-fact, to dress up his book in melodrama. The bedside conversations are often muted and understated; the medical interventions are almost casual and improvised. The final moments of life are presented without a word of hype.

“A dying person doesn’t wrestle with Death as Proust says,” Keizer explains, “but with a crease in the sheets that makes him uncomfortable or with the bothersome light in the corridor. You can die without realizing it.”

Keizer is ever the rationalist, the truth-teller, the goad. He refuses to exalt what medicine can do, and he insists on pointing out what it cannot do. “Let us at least keep an eye on the dry land of rational analysis while floating around in the sea of magical gestures,” Keizer implores. “Otherwise, our profession will sink back to cupping, purging, emetics, mustard plasters, and rubbing our warts in moonlight, and wouldn’t that be an awful way in which to ignore 24 centuries of trying to straighten our backs?”

“Dancing With Mr. D” is not the book you will want to take along for beach reading on your summer vacation. Indeed, it is a book that may bring on a dark night of the soul even on a sunny day. But if you are curious about what really happens when we die--and if you are brave enough to hear the plain truth about what medicine can and cannot do to postpone the end of life--then Bert Keizer is the rare healer who is willing to speak the truth out loud.