Complications: A Surgeon's Notes on an Imperfect Science

By Bassel Ghaddar


Through a collection of skillfully crafted essays written during his surgical residency, Dr. Atul Gawande sheds light on the fine line doctors tread between success and failure in a rapidly accelerating technologized field, yet one clearly limited and fundamentally human. Complications: A Surgeon’s Notes on an Imperfect Science is a must read for aspiring medical students. It is a unique compilation of brutally honest and perceptive essays, which allows the reader to delve into the frontline of modern healthcare and to observe just how doctors handle limitations of their knowledge and abilities, strike a balance between the art and science of their trade, and succeed in such a messy, uncertain, and surprising field.

Dr. Gawande grew up as the son of two doctors, attended Harvard Medical School, and wrote this book during his surgical residency at Brigham and Women’s Hospital in Boston, MA. Though a highly accomplished individual (Dr. Gawande has been published in scientific literature, is a columnist for the New Yorker, has advised health policy for the Clinton Administration, and is a leader in several health initiatives), from his writings emerges a very humble, compassionate, and balanced personality sincerely intrigued by and appreciative of the delicacy of his work.

Throughout the book Dr. Gawande brings up several sensitive issues that many other experienced physicians and authority figures prefer to keep out of public contemplation. The book is divided into three parts. Part I, called Fallibility, deals with the issue of how mistakes happen in medicine, what makes a good doctor, and how medical professionals can begin to err. He takes the reader through the frightening yet exhilarating events of a case gone awry in the operating room that almost caused the death of a patient. Dr. Gawande analyzes what mistakes he and his team had made, how it was dealt with, and what it meant for the patient. In another chapter he explores “how a novice learns to wield a knife”, or how it is doctors learn and practice their skills, for their subjects are the human body and any mistake is costly. Finally, through a fascinating study of a “hernia factory”, Gawande explores whether or not further specialization in medicine would yield better results, and whether computers should aid in diagnostics.

Part II (Mystery) deals with cases in which the doctors’ knowledge was simply insufficient to solve a case. Gawande focuses on the mysteries and unknowns of medicine and how the healthcare field deals with them. These are the stories of an architect with a sudden incapacitating back pain that seemed to have no physical explanation, a young woman with awful nausea that would not cease, and a television newscaster whose blushing became so enigmatically conspicuous and severe that she could no longer continue her work. Gawande’s graceful writing strikes a healthy balance of fascinating medical information and case description, trully captivating and intriguing the reader.

Finally, in Part III, called Uncertainty, Gawande explores the decisions doctors need to make when there are not clear guidelines. In a field where doing things correctly 99.5% of the time can still result in the loss of a life, being able to hone one’s instincts and make split-second decisions is ever important. Nevertheless, mistakes still occur and someone is held accountable. Dr. Gawande recognizes the fine line he and other surgeons and physicians walk every day, and does a superb job giving credit to the miracles medical knowledge has achieved, while remaining acutely aware of the humanity of doctors. This book is highly recommended for anyone looking to view medicine from the eyes of an accomplished surgeon, and to really observe the twists and turn of healthcare and the ethical issues that consequently arise.

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