Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande
Atul Gawande’s latest (and fourth) book, Being Mortal: Medicine and What Matters in the End, has been on countless 2014 ‘best-of’ lists. His three previous titles have all been bestsellers, he’s a 1987 Rhodes Scholar, a 2006 MacArthur “Genius” Fellow, and a TED favorite. He’s also a surgeon and professor at the country’s top venues, plus a staff writer at the venerable New Yorker. [Clearly the man never sleeps.]
And so, reader, I finally started to read the good doctor’s books. [Yes, I can be blindingly, inexplicably slow on the uptake at times.] I’ve begun at the beginning, with this, his first, which was (no surprise) a 2002 National Book Award finalist in nonfiction. That I’ve already loaded my iPod with the remaining three titles should be an indisputable thumbs-up verdict here. [If, you, too, decide to go aural, William David Griffith is laudable in creating and resolving medical drama and trauma.]
As the son of two Indian immigrant doctors, Gawande was born into a medical-savvy household. “We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world,” he writes. “What you find when you get in close … is how messy, uncertain, and also surprising medicine turns out to be.”
As if in reaction to medicine’s unpredictability, Gawande is especially methodical in presenting Complications, dividing the book into three succinct sections: the “fallibility of doctors,” medical mysteries and unknowns, and finally, dealing with uncertainty itself. Before sharing others’ stories, he’s quick to lay bare his personal nervous challenges, for example, when he was first asked to insert on his own a “central line” (which involves needles, coils, dilating, sutures, flushing, x-rays, oh my) into a patient’s chest just before surgery; his initial misses (ouch!) included.
Regularly in search of knowing more, Gwande goes to Shouldice Hospital in Toronto where the hernia operation has been perfected. He travels to a medical convention with 9000 other surgeons and spends the most time at an overlooked booth without any techno-bells and whistles, where he discovers a “trove of jewels,” including Joseph Lister’s 1867 articles on antiseptic method of surgery, the 1955 original proceedings of the first-ever world conference on organ transplantation, the 1863 Civil War surgeon’s diary, and more. He recounts the spectacular trajectory upward, then crashing downward, of a fellow surgeon. He reveals an emergency involving his then one-year-old daughter – and his reactions as a parent first. He examines the perplexing mystery of pain. He investigates morbid obesity and the extreme options people choose or bypass to save their lives. In spite of resistance, he insists on risky testing to rule out the minuscule possibility of a fatal outcome.
Beyond his medical expertise, his compassion and humanity are even more resonating, as he monitors the well-being of his patients well beyond the hospital and office, even at a Boston Bruins game. [I wonder if he’s taking new patients …!] “The stories here are true,” Gawande reminds from his opening “Author’s Note.” He’s changed a few names and minor details – which he indicates throughout – for the sake of confidentiality; otherwise, Gawande is unflinchingly forthcoming about doubts, mistakes, and … well, all those complications he’s directly witnessed and experienced as a surgical resident. Blood, guts, and real-life gore are all here for the reading … and learning and marveling.