Gawande: Complications

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Atul Gawande, Complications : Notes from the Life of a Young Surgeon. New Delhi ; New York, NY : Penguin Books, 2002. xx + 251 pages ; includes bibliographical references. "Several of these pieces have appeared in a slightly different form in the New Yorker and Slate"--T.p. verso.

I was delighted when I started reading Complications and realised it was an essay collection, since I’m horribly behind in the "My Year of Reading Dangerously Challenge", for which I promised to read more essays. And then I forgot all about that, and just became lost in Gawande’s wonderful prose, his thoughtful philosophies, and his compelling stories. Which is to say, I love this book and I think everyone should read it.

As implied by the title, the book is about medicine in the twenty-first century, with all of its ambiguities. Gawande doesn’t shy away from tough issues: topics include the morality of teaching doctors their craft on actual patients, whether autopsies should be performed, and the rate of mistakes in hospitals. As regular readers know, I have a chronic illness called fibromyalgia. It’s one of those things that can’t be magically treated with a pill or surgery, one of those that makes me, in Gawande’s words, "a spectral, ever-present reminder of failure--the kind of patient whose very existence is a reproach to [the doctors] and their expertise." It took them over a year to diagnose me, and during that time not only did I go through every test known to man, but I was regularly accused of being a hypochondriac or simply a liar (I was 15, and despite having friends and being a straight-A student, several doctors thought I just didn’t feel like going to school). Even upon diagnosis, there wasn’t much they could do to help me (other than an awesome biofeedback thing), and I came out of the whole experience with a deep distrust of the medical establishment.

All of that being said, there were two or three doctors who were simply wonderful (including the one who taught me biofeedback), who gave me hope and worked with me and who obviously cared. And in reading Complications, I felt like I had found another one of those doctors. Gawande’s willing to admit the flaws in his profession, but he’s not unrelentingly negative. After all, modern medicine can do some pretty miraculous things, and most doctors do want to help people.

I don’t think I’m reviewing this book very well! I suppose I wanted to provide background, so you know going in that I was more than a bit skeptical of anyone with an M.D. after their name. That way, when you hear me gush all about the book, you’ll realise just how big a gap Gawande bridged to affect me as a reader.

So let’s start the gushing! There’s a marvelous mix in here of Gawande’s personal stories as a surgical resident, individual patient stories, medical innovations and discoveries, and medical philosophy. The balance is perfect; I was constantly interested in and entertained by the essays, and I had to force myself to slow down so that book would last longer. I read a lot of nonfiction, but there aren’t too many nonfiction books I would describe as page-turning. Complications is one of them.

In addition to the fascinating subject matter, Gawande’s voice, his ability as an essayist, makes the book. He comes off as so human, with a deep care for his patients, worry about dilemmas, wonder at the latest technology. I think it’s impossible to not empathise with him, and the way he recreates events it feels like you’re there. I found myself holding my breath with him, as a patient crashed in the ER, as if I were watching a medical drama! He also talks with many of the patients long after their initial contact, so it’s obvious he invests in the patient-doctor relationship. And by getting to know them more, he can tell the reader more about their lives, which makes for stronger essays. The whole book works on both the intellectual and emotional levels!

I think the best way to convince you that you need to read this book is simply share some excerpts. From the introduction:

We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.

From "The Pain Perplex," an essay which discusses new discoveries that all pain is "in your head" and equally real regardless of how it originates (as a fibro sufferer, who has to endure a lot of skepticism, this essay made me cry simply because it validated me):

When doctors encounter a patient who has chronic pain without physical findings to account for it--and such patients are exceedingly common--we tend to be dismissive. We believe the world to be decipherable and logical, to come with problems we can see or feel or at least measure with some machine.

When you feel pain, it’s your brain running an neuromodule that produces the pain experience, as if someone pressed the PLAY button on a CD player. And a great many things can press the button…The way Melzack explains it, a pain neuromodule is not a discrete anatomical entity but a network, linking components from virtually every region of the brain. Input is gathered from sensory nerves, memory, mood, and other centers, like members of some committee in charge of whether the music will play. If the signals reach a certain threshold, they trigger the neuromodule. And then what plays is no one-note melody. Pain is a symphony-a complex response that includes not just a distinct sensations but also motor activity, a change in emotion, a focusing of attention, a brand-new memory.

That’s just a small flavour, but I think you can get a sense of Gawande’s marvelous writing ability from it. As for me, I’ve already put his second book, Better, on hold.

-- Notes by EVA