If Atul Gawande is as gifted a physician as he is a writer, readers will be tempted to fly right to the hospital in Boston where the eighth-year surgical resident works the next time they have a medical emergency. Gawande, a staff writer on medicine and science for The New Yorker, displays a perfect pitch for prose -- and a disarmingly candid manner about both the weaknesses and triumphs of modern doctoring -- in this debut collection of essays. Complications is by turns critique, confessional, medical mystery, apologia, and examination of self, society, and an admittedly
imperfect science. Gawande's emotional range, from compassion to outrage to unabashed curiosity, singles him out as just the one to have written this book. Accessible, even irresistible, to lay readers, the list of people who ought to read these profound pieces encompasses those already in the medical profession, those contemplating a career in medicine, those who have needed or will at some point require medical attention. In other words, pretty much everyone.
Gawande celebrates the moments of intuition that can truly alter someone's life for the better, as when a pretty 23-year-old woman with what looked to be a straightforward skin rash on one leg came into the ER where Gawande was on duty. Dogged by a nagging suspicion that the problem might be far greater, the author and several colleagues convinced the woman and her father to let them biopsy some of the affected tissue. Gawande's hunch turned out to have been right on the money -- the woman's leg was being quickly consumed by necrotizing fasciitis, brought on by the "flesh-eating bacteria" strain of A Streptococcus. The team of doctors was able to save not only the girl's life, but her leg and foot from amputation as well, by the quick diagnosis.
But the good doctor also opens up the usually closed doors to an academic hospital's regular Morbidity & Mortality Conference, where the all-too human fallibility of physicians is scrutinized dispassionately but completely. Gawande doesn't flinch from the M&M that revealed the errors he made in a case where he almost lost someone in the emergency room. When a patient dies or becomes ill as a result of questionable -- even bad -- decisions by the attending doctor, the incident is laid out (if anonymously, in the case of residents) for all his or her colleagues to examine and learn from. Indeed, it is that learning curve that accounts for much of the uncertainty in Western medicine. Doctors need to practice on living patients to learn how to doctor, but making mistakes is an unquestionable aspect of education. Do you want a doctor-in-training working on your case? No, you want the experienced mind and hands of someone who's been doing this for years. But how did the veteran physician come by his knowledge?
Enlightening, frightening, and entertaining, Complications gives ordinary readers an empathetic glimpse behind the operating curtain, behind the scrubs, behind the eyes of a contemporary surgeon. It lets everyone on both sides of the medical divide take full stock of medicine today -- as too many, even in today's atmosphere of informed consent, do not.