It’s worth taking a look at Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science even if you’ve read the New Yorker essays from which the chapters of the book were drawn. Gawande, a surgical resident at a Boston hospital, writes about the rarely discussed moments in medicine when doctors come face-to-face with the limits of their own knowledge.
The titles of the three sections of the book–Fallibility, Mystery, and Uncertainty–are not words that we usually associate with surgeons. And yet, as Gawande explains in spare, well-written prose, those kinds of moments show doctors at their best and their worst. For even in the face of mystery, in the knowledge of their own fallibility, and in times of uncertainty, doctors must make split-second decisions that could harm their patients just as easily as they could save them.
As he examines various aspects of the decision-making process that doctors go through when they see patients, Gawande reminds us that doctors are fallible human beings:
Gawande does a great job of exposing that human side: he treats his subjects–gastric bypass patients, good doctors gone bad, and even autopsied bodies–with respect, care, and tenderness. But he never stops asking questions: how could this operation have been performed better? How could that decision have been made more responsibly? How can the hundreds of small decisions a doctor makes on a given day be abstracted and analyzed on a larger scale? In that last sense, Gawande’s work shares similarities with that of his friend and fellow New Yorker essayist Malcolm Gladwell, who has recently become something of a guru in the business community.
Despite the value of Gawande’s more theoretical musings on “the imperfect science,” it was his presentation of stories from the operating room that kept me most riveted. In the last, and best chapter of the book, “The Case of the Red Leg,” Gawande describes his treatment of a patient who arrives at the emergency room with a swollen leg. Gawande resists making the most probable diagnosis–that the patient suffers from a relatively benign condition of cellulitus, a basic skin infection–because he had recently seen a patient with an extremely rare condition called necrotizing fasciitis. That disease, sometimes called the “flesh-eating bacteria,” kills seventy percent of the people afflicted with it. The only way to tell the difference between cellulitus and necrotizing fasciitis is to perform a surgical biopsy, something that both the patient and the doctor are reluctant to do. But catching the disease early–and removing the bacteria, which can sometimes involve amputation–is the only way to prevent death.
After anguished conversations and second opinions, the patient decides to have the biopsy. The moment when the surgical team opens up her leg is almost painfully tense:
The drama rises when the surgical team confronts the patient’s father with their findings:
Although it may be these pulse-pounding stories that keep the reader of Gawande’s book turning the pages, it is the process of decision-making itself that haunts the author–how, he wonders, would that patient have been treated differently if she had not happened to see a doctor who himself had happened to see a patient with necrotizing fasciitis a few weeks earlier? How would her experience had been different if she had visited a hospital in the Bronx instead of Boston? What can medical facilities do to make sure that patients receive the same standard of care wherever they go? And how should doctors know when to trust their gut intuition, and when to ignore it?
As Gawande’s wonderful book shows, these are complicated questions. But by dealing openly with mistakes when they make them, and by admitting that mystery, fallability, and uncertainty are part of their jobs, doctors can do a better job of finding the right answers.
Want to find out more? Check out Complications: A Surgeon’s Notes on an Imperfect Science on Amazon.com.
Comments