Simultaneously an honest account of the vicissitudes of a career in surgery, and a thoughtful cogitation on the quandaries in Medicine and its inherent limitations.
Title: Complications: A Surgeon’s Notes on an Imperfect Science
Author: Atul Gawande
Genre: Nonfiction
Originally published: 1 January 2002
Finished reading: 19 December 2019
Links: Get this book on Amazon
Written during his years of surgical residency, this book is a riveting collection of Atul Gawande’s earliest essays. While Being Mortal focuses on the ‘big problems’ in healthcare, Complications brings us right into the operating theatre and hospital wards.
A lot of the topics I ended up writing about came from experiences that I didn’t understand or that bothered me. They were often things patients ask about and I don’t have answers for, and I wanted to get answers.
It doesn’t get more real than that. Not only are we right next to Gawande as he slices open a patient for the first time—feeling his halting uncertainty as if it were our own—we come to develop an uncanny familiarity with the nature of Medicine itself.
In the very first piece, The Education of a Knife, we see how surgery is fluid and complex; where the surgeon wields the scalpel, pure knowledge falters. Hard facts alone lose all functionality. Unnerving though this prospect may seem, we find solace in Gawande’s concession, “the most important talent may be the talent for practice itself”.
Throughout the rest of the book, we are taken on thrilling journeys into other patients’ and doctors’ lives. Gawande’s proclivity for introspection, coupled with his eloquent prose, culminates in compelling narratives that leave the reader deep in thought.
We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line.
Questions so commonly debated in medical ethics—patient autonomy, medical errors, professionalism—are not discussed in the abstract but manifest in real-life stories that give them new meaning. A prodigious surgeon gone bad; a man with chronic back pain that yielded no physical explanation; a woman with angry red swelling on her leg that would not go away. Intriguing medical cases and sometimes near-impossible saves make each piece a captivating read.
Gawande writes with frankness and immediacy. His prose, though lyrical, eschews verbosity. Overall, I found Complications to be a brilliantly insightful piece of work—simultaneously a raw and honest account of the vicissitudes of a career in surgery, and a thoughtful cogitation on the quandaries in Medicine and its inherent limitations.
My favourite quotes from this book
(All quotes are arranged in chronological order as they appear in the book, with the chapters indicated in parentheses.)
The thing that still startles me is how fundamentally human an endeavour it is.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Introduction)
We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Introduction)
As pervasive as medicine has become in modern life, it remains mostly hidden and often misunderstood. We have taken it to be both more perfect than it is and less extraordinary than it can be.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Introduction)
There is a saying about surgeons, meant as a reproof: “Sometimes wrong; never in doubt.” But this seemed to me their strength. Each day surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one’s knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off—or even alive. Standing at the table my first time, I wondered how the surgeon knew that he would do this patient good, that all the steps would go as planned, that the bleeding would be controlled and infection would not take hold and organs would not be injured. He didn’t, of course. But still he cut.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part I Fallibility: Education of a Knife)
Skill, surgeons believe, can be taught; tenacity cannot.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part I Fallibility: Education of a Knife)
[T]he most important talent may be the talent for practice itself.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part I Fallibility: Education of a Knife)
This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong. And yet I also knew that a surgeon can take such feelings too far. It is one thing to be aware of one’s limitations. It is another to be plagued by self-doubt.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part I Fallibility: When Doctors Make Mistakes)
No matter what measures are taken, doctors will sometimes falter, and it isn’t reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part I Fallibility: When Doctors Make Mistakes)
Every doctor has things he or she ought to know but has yet to learn, capacities of judgment that will fail, a strength of character that can break.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part I Fallibility: When Good Doctors Go Bad)
The core predicament of medicine—the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of a society that pays the bills they run up so vexing—is uncertainty.
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science (Part III Uncertainty: The Case of the Red Leg)