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Complications

Atul Gawande

A Surgeon's Note on An Imperfect Science

(Henry Holt & Company)

Uncomplicated Reading

It should be the function of medicine to help people die young as late in life as possible.
— Ernst Wynder


In his book Complications, Atul Gawande makes fascinating nonfiction writing appear effortless. Maybe it is true ? all you need is an interesting topic and a good grasp of writing.


In Gawande’s case, surgical residency and a spot as a medicine and science staff writer for the New Yorker adds to the equation. Complications undertakes the challenge of examining the fallibility of doctors, the mysteries of medicine and the unknowns of the field with enough emotion, blood, guts and freakish incidents to keep us in the paper gowns interested. Gawande’s simple and congenial tone makes Complications, well, uncomplicated. It is a fast, light-feeling read that is definitely patient-friendly.


He begins his book in trauma duty, attending to a young man shot in the buttocks, thus throwing us headfirst into the action side of medicine. The success of television shows like ER and Rescue 911 reveals much we love a good medical story—who cares about broken fingers or indigestion when you can have bone marrow transplants and babies delivered in the backs of cars? Gawande knows his audience and delivers the goods. He makes each case unique and interesting, even reserving a special section for medical oddities, such as a pregnant woman with threatening and uncontrollable nausea and a newscaster who must quit her job because of uncontrollable blushing.


As an author, however, Gawande wisely opts for compassion and sensitivity rather than focusing on the sensational. In describing a small patient he treated, a child with a tumor, he remarks, “He remained sweetly brave, as children do more often than you’d expect.” He never stoops to treat patients as victims or freaks to satiate our curiosity. Each “case”—even those mentioned briefly or anonymously—is accorded an identity and a personality, not approached as a specimen or piece of meat or cliché (“the gang violence victim,” “the pregnant teen,” “the Alzheimers patient”) He draws upon his own experiences as a father taking his children to the hospital—and as a patient himself, as all doctors must inevitably be at some point—to explain the conundrum of patients’ rights vs. doctor’s authority. The bottom line is that doctors are neither autonomous nor perfect. 


Gawande fearlessly presents the members of his honorable profession as almost frightening fallible and human creatures. He writes:


“It’s not science you call upon, but a doctor. A doctor with good days and bad days, a doctor with a weird laugh and a bad haircut. A doctor with three other patients to see and, inevitably, gaps in what he knows and skills he’s still trying to learn.”


He talks about doctors making mistakes and losing their license, not as villains but as sad inevitabilities, reminding us that the practice of medicine and the job of modern-day healer are in no way easy. He tells us, matter-of-factly, that “all doctors make terrible mistakes,” and that in our litigious world, “Most surgeons are sued at least once in the course of their careers.”


Gawande’s writing style lends itself well to his compassionate voice. He explains everything clearly, without either confusing medical jargon or condescension to the reader. His humor is refreshing and often self-deprecating, such as when he encounters a woman in the emergency room with a board attached to her foot through an embedded screw. “‘Wow, that must hurt,’ I blurted out idiotically.”


Above all, Gawande clearly relishes his field. From now on, this reviewer will never be able to read the word ‘fat’ without thinking of the adjectives ‘glistening’ and ‘yellow.’ His unabashed love of medicine is encouraging in a world where the image of physician as shrewd businessman rather than sacred healer is so widespread. “When something goes perfectly,” he explains, ?at such moments, it is more than easy, it is beautiful.” The author is never blasé about the power of medicine with its state-of-the-art techniques. He marvels about the Roux-en-Y gastric bypass operation is “The strangest operation I have ever participated in in surgery . . . it is an operation that is intended to control a person’s will.”


If one can cite a weakness in Gawande’s book, it is perhaps that he waxes too rhetorical. He methodically presents us with the various aspects of medicine, then throws us a series of questions and problems with its practice. So constantly does he bring up the uncertainty of being a doctor that it casts an aura of uncertainty and hesitation to the book itself. With a style as gentle as his, Gawande might have dared to go out on a limb a bit further and offer us his prescription for exactly what needs changing in the medical field, without fear of seeming too forceful or opinionated.


Overall, Complications is a fine example of literary nonfiction. Gawande handles a subject that often appears in a host of unappealing forms—dry, disgusting or didactic, to name just a few—and finesses it in his own way so it can be served up tastefully to any audience. A fast and friendly read, Gawande offers a rare combination of a good subject with good writing, with the slight opportunity that the reader may learn something as well.

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