Atul Gawande’s ‘Complications: A Surgeon's notes on imperfect science’ is a gem-like collection of short non-fictional essays based on the medical accounts and experiences of the eighth-year surgical resident. Atul is also a Harvard Med graduate, New Yorker staff and a Rhodes Scholar. He portrays the thrill of the day-to-day surgical and medical drama through his undeniable gift and power conjure up the reality of the ward. The book impresses for its authenticity, truth and virtues that paint Dr. Gawande as a forceful, uncompromising, reasonable, poetic and insightful writer. ‘Complications’ is highly recommended for those interested in the acquisition of firsthand knowledge on the ethical encounters of being a surgeon.
The title of the book says it all with a clear-cut thesis that is well and accurately defined. It promotes the idea that surgical procedures and diagnoses in the field of medical science are delicate processes requiring professionalism and a deep understanding of the cases. There are several reasons for the success of the book. First is the ease with which Gawande tells his medical stories with simple yet interesting beginnings paired with a heightened sense of drama. The stories featured are similarly personal encounters that inculcate in readers values from the characters and the medical procedures they undergo. Perhaps Atul’s most significant achievement and contribution to the book is his honesty that leads him to admit to his weaknesses. He views them as elements part of his being necessary for growth and experience. Most medical doctors often fail to achieve this no matter their level of accomplishments and accolades. The book is a candid work with a detailed cover of health issues and the medical profession.
Complications is divided into three sections, part one, two and three which are "Fallibility," "Mystery," and "Uncertainty" respectively. Part one has interesting topics like, ‘education of a knife’, ‘when doctors make mistakes’, ‘the computer and the hernia factory’ and ‘when good doctors go bad’ just to mention a few. It contains chilling stories of errors made in the medical profession especially by young doctors still learning the procedures on live patients. Some of these near-inevitable results are as a result of the stress, depression and burnout of seasoned specialists. It is here that Atul includes an account of his own case of poor judgment in an emergency that was fortunately controlled. He emphasizes in this first section the significance of constant practice in the profession from an example of hospitals that are specialized in hernia repair.
Part two has other interesting topics like, ‘the pain perplex’, ‘a queasy feeling’, ‘full moon Friday the thirteenth’ and ’mystery and crimson tide’. It chronicles several medical mysteries that empathize with different patients while engaging the readers as well. The author in the section recounts the pain and agony of the pregnant woman who had constant episodes of vomiting and nausea that could not be stopped regardless of the antiemetic drugs she was given. This continued on till the time of her delivery of twins. These are often some of the medical mysteries that doctors dismiss when they fail to pin-down the problems patients have. The story correlates with that of a young architect who had a severe case of back pain that completely incapacitated him and was at one point advised to seek help from outside the medical walls.
The third and last section of the book covers captions like, ‘the dead baby mystery’, ‘the case of the red leg’, ‘uncertainty’, ‘whose body is it anyway’ and ‘the final cut’. Here, Gawande addresses the significant issue of uncertainty, which is often an ever-daunting challenge in the field. This is due to the imperfect nature of some of the information on diagnosis and treatment of medical problems. Autopsies are as a result, usually performed to help clarify the cases. These are however, similarly performed with appalling infrequency particularly due to their revelation of misdiagnoses that are often in high rates.
The book addresses a number of other relevant issues in the current medical world in its broad array of topics. There is the new more democratic and free relationship between patients and physicians that is conceived. This however, has a downside when patients make wrong decisions. The last and final chapters report on cases of great suspense as a result of uncertainties. It is in such instances when doctors' intuitions are usually of critical value. Gawande attempts to put across the message that the society is fast paced that the medical society should adapt.
He also describes the treatments of challenging conditions like chronic pain, morbid obesity and necrotizing fasciitis which is the often-fatal condition that is caused by the dreaded "flesh-eating bacteria". He follows with a comprehensive analysis of the delicate processes physicians use to balance between knowledge and intuition enabling them to make seemingly impossible decisions. He concludes that the promise of “the alterable moment the fragile but crystalline opportunity for one's know-how, ability or just gut instinct to change the course of another's life for the better” is what draws practitioners to the challenging profession.
His approach and style of writing makes it easy to relate to the experiences in the book. He for instance gives examples of patients then explains the controversies surrounding the techniques and decisions that are made by the surgeons. His explanations are not only candid but detailed as well accounting for all the happenings in the field. He sheds light on the many issues in the medical field that most people are not probably too familiar with, that applies to those within the system together with those that interact with the system. This means that patients and doctors alike have a lot to learn from the book. The first section for instance is more applicable to patients with the last two relating more to doctors and surgeons when Gawande discusses the different medical phenomena’s in the field.
‘Complications’ is a model of ethical interrogations in ordinary medical encounters. Although many of the writings were published separately in Slate and The New Yorker and Slate, when read together, they create a comprehensive and unified vision of the complexities of practicing medicine. In "Education of a Knife," for example, Atul begins with a vivid description of him as a student who is anxious to learn from his chief resident. He is then taught how to insert a "central line." Here, readers are able to watch him, direct the three-inch needle under the patient’s clavicle and insert the needle inside the vena cava, widen the opening and finally thread the catheter into the blood vessel. The process is delicate since he has to make sure he does not puncture the heart that is beating nearby or the lungs. His personal life is also integrated in the book when he undergoes the painful realization that his newborn son has a cardiac emergency. He ironically does not allow his young colleague after discharge to practice on his child and hands the case over to the expert cardiologist in the hospital. He covers these inconsistencies skillfully by excusing himself and aligning his thoughts to the paradox of medicine that demands more practice for better care of patients.
There is no doubt that Gawande's book powerfully illuminates on clinical disguises to patients, medical practitioners and other interested parties. He draws the convincing conclusion that improvements in the training physicians are possible. This is because all accomplished practitioners fail before becoming experts. He hopes that doctors can learn to face their mistakes through confession, absolution and restitution a remedy believes concentrates on the ethical status of the physicians. His discussions on medical errors emphasize on the significance of critical looks at the medical system as a whole.
Atul invites the ethical reflection of both doctors and their patients. He advises patients to learn to willingly share their experiences with medical practitioners and consequently a fair structural remedy system. He concludes that choice should be allowed for everyone since it is important to support learning and justly distribute risk. Gawande’s program for the distribution of risk makes it an interesting read for families, policy makers, patients, medical practitioners, funding institutions and oversight agencies that are all responsible for their own ethical status in relation to medicine. No matter what measures are always taken, doctors are sometimes bound to falter, it is not reasonable to ask for perfection and Atul in his book attempts to ask practitioners never to cease to aim for the best results.
Reference
Gawande, Atul. (2007). Complications: A Surgeon's Notes on an Imperfect Science. Gardners
Books.
