operating table to try and save a life each day.
And what it ends up being is an exploratory surgery on the medical profession. And creditably, Gawande, a young Boston surgeon, not just takes the reader into the operation theatre, but even inside that immensely complex and frightening piece of machinery - the human body. “I cut down the middle of our patient’s belly, through skin and then dense inches of glistening yellow fat… We put metal retractors in place to hold the wound open and keep the liver and the slithering loops of bowel out of the way.” No attempt to shy away!
While medicine is still regarded by most as a profession with almost magical powers, the author points out the limits of the profession too.And rarely does a practitioner of any profession manage to take such an unblinkered yet engaging look at his own profession.
The book is full of cases, some that the author has been associated with, others that he has heard of.What makes his writing a pleasure to read is the way he has confronted the unanswered questions that hang over the profession, and yet which have to be confronted by doctors and patients every day.Medicine here is not a perfect, idealised science but one with many complications, with no simple, formulaic solutions.
Creditably, Gawande manages to take a human, and humane look at the awe-inspiring field of medicine, and the mysteries that are yet to be unravelled. The tone is set right from the name of the book and the chapters within. The book is divided into sections called ‘Fallibility’, ‘Mystery’ and ‘Uncertainty’.
Of course this book is on American medical practices. So even when one is reading about the shortcomings of the profession there, the mind boggles at imagining the distance Third World nations like India have to cover to even reach the current US standards.
Many cases are illuminating. For example, though one has heard of the wrong arm, leg or other body parts being operated upon, it was only in 1988 that it became a standard practice in the US to mark the part of the body on which the operation would be done. Many cases seem to have to medical solutions, eg, a television newsreader who blushed so severely that she nearly lost her job. Or a young woman who suffered from nausea for no visible reason.
An excellent practice that Gawande has referred to is the mandatory meeting that US academic hospitals have to have every week.At the meeting, called Morbidity and Mortality Conference, doctors discuss their mistakes of the week, to prepare better for next time. As these meetings do not come under legal jurisdiction, doctors can be self-critical.
‘Good’ doctors going ‘bad’. Gawande points to the greater danger of ‘good’ doctors making mistakes, which are less easily detectable than those of the ‘bad’ ones. He cites cases of doctors, too, facing factors like work pressure, tensions at home, overcrowded schedule, even sheer laziness that may cause a doctor to make the wrong decision. And Gawande is honest enough to admit the several wrong decisions that he has made.
The book is a rich collage of a science interacting with humans with no set answers, only clues. It shows no tendency to cover up embarrassing facts. It points to medicine being a complex, perplexing and a very fallibly human profession. The self-critically analytical tone combined with excellent readability makes Complications a must read. Definitely among the best writings on the subject.Suman Tarafdar