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Under the knife
Atul Gawande dissects his profession
BY JULIA HANNA

Complications: A Surgeon’s Notes on an Imperfect Science
By Atul Gawande. Metropolitan Books, 271 pages, $24.


On some level, we know that doctors are people like you and me. It’s part of our culture. ER thrives on the drama of doctors who screw around, bicker, and make mistakes. I haven’t watched the new comedy Scrubs, but I imagine it makes your average surgeon seem more, not less, approachable. Before picking up Atul Gawande’s Complications, however, prepare for a different understanding of doctors’ humanity. Prepare, in fact, to have any and all preconceived notions about the state of medical science completely rearranged.

Gawande is a surgical resident at an unnamed hospital in Boston and a staff writer for the New Yorker — a formidable combination that results in riveting, on-the-ground descriptions of what it’s like to treat patients in today’s byzantine health-care system. The book’s three sections — " Fallibility, " " Mystery, " and " Uncertainty " — are the first indication that his perspective goes beyond awestruck reverence for the miracles of modern medicine. " There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing, " he writes. " The gap between what we know and what we aim for persists. And this gap complicates everything we do. "

Which isn’t to say Complications plays down the wonderful, everyday successes that occur at the intersection of cutting-edge technology and a surgeon’s skill. Gawande describes in fascinating detail how a gall bladder ( " a deflated olive-green balloon tucked under the liver " ) is removed with the aid of a miniature camera and instruments that are manipulated through several tiny incisions. He also makes it clear how quickly this routine procedure can go wrong — and he isn’t afraid to use himself as an example as he anatomizes the web of decisions that can lead to a less-than-ideal outcome.

He turns his attention from honest mistakes to baffling negligence in telling the frightening story of Hank Goodman, the alias for an orthopedist who slid from brilliant surgeon to robotic hack over the course of a few years. Burnout among doctors is surprisingly common, Gawande writes. " In private practice, there are no sabbaticals to offer, no leaves of absence, only disciplinary proceedings and public reports of misdeeds. As a consequence, when people try to help, they do it quietly, privately. Their intentions are good; the result usually isn’t. "

The eloquence of Gawande’s prose isn’t limited to big-picture meditations on the state of medicine today. He combines a surgeon’s precision with a poet’s ear for language when describing what we look like inside, and he breaks down the physiological progression of physical acts (such as vomiting) in fascinating detail. " A Queasy Feeling " follows the case of Amy Fitzpatrick, a woman who experiences constant nausea throughout her pregnancy with twins. The simultaneous depiction of what’s happening in Fitzpatrick’s body and her frantic efforts to pull over in rush-hour traffic creates almost unbearable suspense; it all culminates with this graphic gem: " In the expulsive phase, the diaphragm and the abdomen undergo a massive, prolonged contraction, generating intense pressure on the stomach; when the esophagus relaxes, it’s as if someone had taken the plug off a fire hydrant. "

Gawande also underlines a patient’s humanity through close observation and a sense of compassion that’s demonstrated in brief, skillful character sketches. We meet Rowland Scott Quinlan, a " Boston architect and avid sailor with a shock of white hair and a predilection for bow ties and Dutch cigarillos " who suffers from crippling back pain with no discernible cause. There’s Vincent Caselli, a good-natured 428-pound contractor who simply can’t stop eating, and Christine Drury, an aspiring Indianapolis news anchor with blue eyes, blond hair, and a serious problem with blushing.

Whether he’s tracing the medical history of pain or recalling his first, fumbling efforts to master a routine procedure, Gawande keeps returning to a simple paradox: the human body is both highly predictable and completely unfathomable. " From what I’ve learned looking inside of people, I’ve decided human beings are somewhere between a hurricane and an ice cube: in some respects, permanently mysterious, but in others — with enough science and careful probing — entirely scrutable, " he writes. Complications is both an eye-opening page turner and a carefully crafted examination of medicine that probes the expanses and limits of our understanding with the swift, steely edge of a scalpel’s blade.

Atul Gawande reads at Brookline Booksmith, 279 Harvard Street in Brookline, on Wednesday, May 22, at 7 p.m. Call (617) 566-6660.

Issue Date: May 16-23, 2002
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