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Complications: A Surgeon's Notes on an Imperfect Science (2002)

Atul Gawande, who is currently finishing a medical residency in Boston, has some pretty big shoes to fill. As a surgeon writing essays about his profession for the general public, he follows in the footsteps of Richard Selzer, who has been writing wonderfully about the complexities and oddities of surgery for several decades. And writing in the pages of The New Yorker, he follows in the tradition of the great Berton Roueche, whose "Narratives of Medical Detection" are among the best pieces ever to appear in the magazine. Perhaps wisely, Dr. Gawande neither tries to be as lyrical as Dr. Selzer nor to plumb the mysteries and the adventure of medical investigation as did Roueche. Instead he offers us an entree to the world of the physician in training and tries to be scrupulously fair in his treatment of the various and often competing concerns of doctors, patients, ethicists, insurers, etc. He's generous in sharing his own experiences and discussing his mistakes and the essays are often interesting, but they are somehow antiseptic and less engaging than they might be if he took firmer positions on the issues or at least revealed more of his own opinions and prejudices.

Dr. Gawande writes that :

    Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. 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.
    We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however-close enough to see
    the furrowed brows, the doubts and missteps, the failures as well as the successes -- is how messy, uncertain, and also surprising medicine turns
    out to be.

He's at his best when he's leading the reader through the mess. From doctors with psychological problems to the vagaries of diagnosis to the strange, but surely coincidental, occurrences of a Friday the 13th with a full moon, he shows us that for all the advances in medicine in recent years, there is still much we don't understand and a stubborn persistence of quite alarming human error. He's less good in essays like the one on the decline of autopsies (which happens to be on-line) when he strives so hard to take a balanced and empathetic approach that he borders on abandoning medical judgment.

The book is definitely worth reading and I'll be keeping an eye out for his essays. I suspect, and hope, that his best work lies in front of him and that as he gains experience and confidence he'll be willing to give his writing a little harder edge. Hopefully he can do that without losing his welcome humility, rare enough in doctors in general but almost unheard of in a surgeon.

(Reviewed:26-Mar-02)

Grade: (B)

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Complications: A Surgeon's Notes on an Imperfect Science (2002)

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