Book Review - "Complicated Medicine"

By Philip Weidig
May 8, 2010

Gawande, Atul. Complications: A Surgeonís Notes on an Imperfect Science. New York: Henry Holt and Company, 2002. 269 pp., paper, $24.00. ISBN 0-312-42170-2

You would be hard pressed to find someone who thought being a surgeon was easy work. You'll probably find quite a few who think it is lucrative work, and they may (or may not) be right about that, but easy is not so common an answer. In his book, Complications: A surgeon's notes on an imperfect science, author and surgeon Atul Gawande offers many stories about his work as a doctor, both from his personal experiences with patients as a medical resident and from the experiences of other doctors and patients. He covers his trial-by-fire training, his personal achievements and failings as a doctor. Gawande's descriptions of life as a surgical resident paint a picture of the difficulty of a career in medicine as shown in particulars, like working in the emergency room when someone who has endured a shooting is brought in, having to endure a patient dying whom he had hoped to save and who he discovers he had misdiagnosed, to someone whose severe blushing is losing her her job, as well as his first trip to a medical conference.

Each chapter is its own self-contained narrative which is then used to substantiate an argument, with Gawande frist describing a particular case history, then changing gears intermittently to describe further the particulars of a condition, procedure, its history, its problems, the current ways of coping. Many interesting general topics are then covered this way, from surgeries like the roux-en-y bypass to frank discussions about the risks involved with the practice of medicine.

One intriguing chapter tells of incidents when Gawande foolheartedly accepts being on-call on a Friday the thirteenth -- when it turns out to be a full moon too. Showing by argument that superstitions based on patterns imposed on events and himself seeing them as old-wives' tales, he quickly finds himself isolated in such a rejection. It seems the hospital -- according to everyone -- is unusually flooded with accidents, suicide attempts and women having more babies than usual. He offers lots of statistics in this chapter to refute the idea that there is really more of this happening than on other nights, but no one will listen. Further the accompanying story plays an almost comic foil to his argument.

At another point in the book Gawande tells the story of a time during his residency when his unsure hand and uncertainty about himself and grip on concise particulars during emergencies is not yet up to par by years of training. He almost killed the patient. The attending surgeon stepped in just too late, after a poor judgement call on Gawande's part necessitated them calling yet the chief on-call surgeon to mend the situation. Although the patient was saved, it was a close call. The chapter then tells of later resulting discussion in "morbidity and mortality" sessions where people are expected to discuss their mistakes, show what they did wrong and how they should have behaved, or if there were circumstances really beyond anyone's control. Nonetheless we see people are expected to take responsibility for their actions before their colleagues and try to learn from mistakes.

In a lighter story, Gawande discusses his first trip to a medicial convention when fellow surgeons gather yearly to share information, exchange techniques, and to purchase new equipment for their practice. Gawande describes all parts of his experience, from going to movies, to listening to world-class surgeons talk about performing ground-breaking maneuvers, to hearing as solutions of a single problem several precisely opposed points of view and procedures, to finding case histories of surgeries done in the past in a set of beautifully bound treasured books, to dodging row upon row of vendors attempting to sell every new surgical gadget under the sun. the unusual light-heartedness of this chapter in the book highlights the difficulty of daily life for the surgeon in other chapters. And it has an emotional grounding: the reason surgeons go is to be with other people of their "tribe" and share a sense of community on say a bus.

Gawande is an effective storyteller. He can convey much information lightly without seeming to overburden the reader. He tells stories of real people, sometimes with extraordinary problems, but often with common ones too. It's hard to come away from Complications, without a deeper understanding of the world of medicine from several different angles. If you plan to be a doctor, or want to know what is really happening all around you as a patient (and who does not?), this is the book for you.


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