Much in this autobiography of a Russian Ã‰migrÃ‰ surgeon seems to exemplify the stereotypical Russian tendency toward extremes: ebullience and depression; a love of the land but a frustration st living; st critical points, an optimism snatched from despair. Golyakhovsky finally chose exile in preference to endless hounding and accusations by Party-member colleagues. He had steadfastly refused to join the Party. He was open in denouncing the incompetence of the Party hacks st his medical institution. And he was half Jewish. (The name he uses is that of his Christian mother, adopted after his first anti-Semitic mortification on the first day of school.) Growing up under Stalin, Golyakhovsky was in medical school at the rime of the ""Jewish Doctors' Plot."" He served a stint in the army and in remote outposts--the fate of Jewish MDs. But through persistence, ability, and connections (Iris father was also a surgeon), he rose to eminent positions in Moscow clinics. A specialist in orthopedic surgery, he devised innovative surgical procedures and invented a number of joint prostheses. He also became well known as a writer of poetry for children--which led to friendships with Party and dissident writers. His patients included Khrushchev, Pasternak, and the ballet dancer Plisetskaya. The sharply drawn vignettes of classmates, professors, colleagues, and patients are reminiscent, at times, of Richard Selzer's surgical fictions. There are also accounts of treating Russian leaders, of staying at a palatial dacha, of the death from burns of Yuri Gagarin's best friend, who would have been the first cosmonaut; there is even some kiss-and-tell. Golyakhovsky's experience confirms what Medvedev and other scientist-reporters have described: the widespread bribery, the privileges that accrue to Party members, the endemic alcoholism, the low position of women doctors, the shortage of the most ordinary hospital supplies. But the personal story dominates, with its constant theme of moral dilemma--the fear of reprisal, the guilt of remaining silent or, worse, denouncing an unjustly accused colleague. The final passages recount what follows the decision to leave: the artful managing of exit visas, the suspenseful wait. Golyakhovsky is now completing a residency at Brooklyn Jewish Hospital. Interesting if not unusual material, readable if not always sympathetic.