Complications: A Surgeon's Notes on an Imperfect Science

Atul Gawande

Henry Holt and Company, Apr 1, 2003 - Medical - 288 pages

A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine.

Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is -- complicated, perplexing, and profoundly human.

Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won't go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.

At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.

Complications is a 2002 National Book Award Finalist for Nonfiction.

Contents

• Authors Note: 1
• The Computer and the Hernia Factory: 35
• Nine Thousand Surgeons: 75
• When Good Doctors Go Bad: 88
• Full Moon Friday the Thirteenth: 109
• A Queasy Feeling: 130
• Crimson Tide: 146
• The Man Who Couldnt Stop Eating: 162
• Final Cut: 187
• The Dead Baby Mystery: 202
• The Case of the Red Leg: 228
• Notes on Sources: 253

Popular passages

Page 24 - And this is the uncomfortable truth about teaching. By traditional ethics and public insistence (not to mention court rulings), a patient's right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden, behind drapes and anesthesia and the elisions of language.‎

Page 19 - ... steady. You do not even need all ten fingers to be accepted. To be sure, talent helps. Professors say that every two or three years they'll see someone truly gifted come through a program — someone who picks up complex manual skills unusually quickly, sees tissue planes before others do, anticipates trouble before it happens.‎

Page 19 - ... three sticks to find the vein himself, and that made me feel better. Maybe she was an unusually tough case. When I failed with a third patient a few days later, though, the doubts really set in. Again, it was stick, stick, stick, and nothing. I stepped aside. The resident watching me got it on the next try. Surgeons, as a group, adhere to a curious egalitarianism. They believe in practice, not talent. People often assume that you have to have great hands to become a surgeon, but it's not true....‎

Page 263 - Factors Associated with the Transition to Non-Prone Sleep Positions of Infants in the United States — The National Infant Sleep Position Study.‎

Page 259 - Nausea and vomiting remain a significant clinical problem: trends over time in controlling chemotherapy-induced nausea and vomiting in 1413 patients treated in community clinical practices.‎

Page 57 - M— and it takes place, usually once a week, at nearly even' academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges. Surgeons, in particular, take the M & M seriously. Here they can gather behind closed doors to review the mistakes, untoward events, and deaths that occurred on their watch, determine responsibility, and figure out what to do differently next time.‎

Page 61 - There are surgeons who will see faults everywhere except in themselves. They have no questions and no fears about their abilities. As a result, they learn nothing from their mistakes and know nothing of their limitations. As one surgeon told me, it is a rare but alarming thing to meet a surgeon without fear. 'If you're not a little afraid when you operate,' he said, 'you're bound to do a patient a grave disservice' ‎

Page 24 - Turn your wrist more," he told me. "Like this?" I asked. "Uh, sort of," he said. In medicine, there has long been a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think that patients actually benefit from teaching. Studies commonly find that teaching hospitals have better outcomes than nonteaching hospitals....‎

Page 259 - ... March 12, 2000. 33. Muth ER, Lawson B. Using flight simulators aboard ships: human side effects of an optimal scenario with smooth seas. Aviat Space Environ Med 74:497, 2003. 34. Kolasinski EM, Gilson RD. Ataxia following exposure to a virtual environment. Aviat Space Environ Med 70:264, 1999. 35. Oman CM. Motion sickness: a synthesis and evaluation of the sensory conflict theory.‎

About the author

Atul Gawande is the author of four bestselling books: Complications, a finalist for the National Book Award; Better; The Checklist Manifesto; and Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Founder and Chair of Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He is also chair of Haven, where he was CEO from 2018–2020. He and his wife have three children and live in Newton, Massachusetts.

Bibliographic information

• Title: Complications: A Surgeon's Notes on an Imperfect Science
• Author: Atul Gawande
• Publisher: Henry Holt and Company, 2003
• ISBN: 1429972106, 9781429972109
• Length: 288 pages
• Subjects: Medical / Essays; Medical / Surgery / General