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A Surgeon's Notes on an Imperfect Science
By Atul Gawande
Metropolitan Books
288 pgs. US$24/C$34.95
ISBN: 0-8050-6319-6

Notes from a healer

By Steven Martinovich
web posted April 1, 2002

ComplicationsAs Atul Gawande points out, although medicine is a science it is also a discipline practiced by human beings on other human beings. The pronouncements of doctors have long-been given God-like status by their patients but behind that stoic mask is a person who often relies on "habit, intuition, and sometimes plain old guessing."

It is with that in mind that Gawande explores the surgeon's profession in Complications: A Surgeon's Notes on an Imperfect Science, a series of interconnected essays that touch on the performance of doctors, treatments and new technologies. It can be a disconcerting glimpse at times, as Gawande admits at several points. It is a world where surgeons learn much of their craft on the job and where a diagnosis delivered with authority may be completely wrong.

Gawande is well placed to know these things. After earning degrees in politics, philosophy, and economics from Oxford University, and a medical degree from Harvard Medical School, he began a surgical residency at Brigham and Women's Hospital in Boston. It is his experiences that form the basis for the essays in Complications. Writing in a breezy yet authoritative manner, Gawande gives the reader insight into why someone would willingly take what is essentially a sharp knife and cross the line that many of us would refuse to approach: to carve open another human being.

"When you are in the operating room for the first time and see the surgeon press his scalpel to someone's body, you either shudder in horror or gape in awe. I gaped. It wasn't the blood and guts that enthralled me. It was the idea that a mere person would ever have the confidence to wield that scalpel ... Later, I was allowed to make an incision myself. The surgeon drew a six-inch dotted line across the patient's abdomen and then, to my surprise, had the nurse hand me the knife. It was, I remember, still warm. I put the blade to the skin and cut. The experience was odd and addictive, mixing exhilaration, anxiety, a righteous faith that operating was somehow beneficial, and the slightly nauseating discovery that it took more force than I realized. The moment made me want to be a surgeon -- someone with the assurance to proceed as if cutting were routine," Gawande writes in explanation.

Along with his exploration into the mindset of a surgeon, Gawande also details several of his cases and their treatments including morbid obesity, uncontrollable blushing, the terrifying necrotizing fasciitis - more popularly known as flesh eating disease, and he explores why few autopsies are being performed these days and why that's not positive trend. Utilizing these essays, Gawande delves into the difficult world of the diagnosis - essentially a balancing act involving the body of knowledge available to a doctor and their gut instinct.

So what makes a good surgeon? As Gawande says, you have to be "conscientious, industrious, and boneheaded enough to stick at practicing this one difficult thing day and night for years on end." It's someone who works past his or her early mistakes and applies the same will to practice that a professional athlete or musician does. A good surgeon isn't usually born, but they are created after years of practicing on you. It's a discomforting thought sometimes, as Gawande admits, but a necessary process.

Given that Gawande wrote several speeches for former U.S. President Bill Clinton, it's surprising and not to mention welcoming that - aside from mentioning the stress that doctors feel working within HMOs - that he avoids politicizing his effort. Rather Gawande has crafted several exceptional and elegant essays that explore a world that we only have access to when something catastrophic happens in our lives. Gawande welds his pen as he does his scalpel: delicately and skillfully.

Steven Martinovich is a freelance writer in Sudbury, Ontario and the editor of Enter Stage Right.

Buy Complications: A Surgeon's Notes on an Imperfect Science at Amazon.com for only $16.80 (30% off)

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