9780805063196

Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with ones own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually iscomplicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpels edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that wont go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.

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Atul Gawande is a surgical resident in Boston and a staff writer on medicine and science for The New Yorker. A former Rhodes scholar, he received his M.D. from Harvard Medical School and an M.P.H. from the Harvard School of Public Health. His writing has also appeared in The Best American Science and Nature Writing 2000, the New Yorker essay collection In Sickness and In Health, and Slate. Gawande lives with his wife and three children in Newton, Massachusetts. This is his first book.

Author's Note

1

(2)

Introduction

3

(8)

Part I---Fallibility

Education of a Knife

11

(24)

The Computer and the Hernia Factory

35

(12)

When Doctors Make Mistakes

47

(28)

Nine Thousand Surgeons

75

(13)

When Good Doctors Go Bad

88

(21)

Part II---Mystery

Full Moon Friday the Thirteenth

109

(6)

The Pain Perplex

115

(15)

A Queasy Feeling

130

(16)

Crimson Tide

146

(16)

The Man Who Couldn't Stop Eating

162

(25)

Part III---Uncertainty

Final Cut

187

(15)

The Dead Baby Mystery

202

(6)

Whose Body Is It, Anyway?

208

(20)

The Case of the Red Leg

228

(25)

Notes on Sources

253

(12)

Acknowledgments

265

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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. I wondered how the surgeon knew that all the steps would go as planned, that bleeding would be controlled and organs would not be injured. He didn't, but still he cut.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.

Excerpted from Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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Complications A Surgeon's Notes on an Imperfect Science

Complications A Surgeon's Notes on an Imperfect Science

0805063196

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