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Stitch in time

Inside the world of those who delve inside us

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Close your eyes and imagine: You discover a lump on your breast or a strange oozing rash traveling at light speed from your ankle to your neck. You try to remain calm, but you can’t. You picture cancerous cells splitting and metastasizing to other parts of your body with the ferocious celerity of the broomsticks gone amok in Fantasia. You lightly scratch the rash that started as one red speck and feel viruses and infections of unknown name and origin flooding your organs and blood, eating at you from the inside out. You try to breathe, talk yourself down; it’s difficult. You want it fixed. You want the lump cut out of your body and the infection extinguished. Right Now. You run to the doctor.

Going to a physician or surgeon is a different business than it once was. We used to look upon doctors as the final decision makers. Now, despite the God-like power we often attribute to them, the ultimate choice still belongs to the patient. Once, doctors made decisions based on need. Now many are based in large part on cost, the stringent guidelines of insurance companies and very real fears about malpractice suits. The fact is, there are not always solutions to our medical problems, or ideal circumstances to go along with trying to do the best thing. Sometimes they fix us. Other times, we’re not so lucky.

“Medicine is, I have found, a strange and in many ways disturbing business,” writes Atul Gawande, a surgical resident in a Boston hospital, in his new book, Complications: A Surgeon’s Notes on an Imperfect Science. “The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however—close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes—is how messy, uncertain, and also surprising medicine turns out to be.”

Gawande offers us a well-balanced look at the state of medicine today. He readily admits the shortcomings of doctors, that they are, above all else, fallible human beings just like the rest of us. He also reveals the miracles that do happen, the “magic” that saves a bodily function, a limb, a life. He guides us through this tangle of intentions and realities with a kind heart, an experienced mind, and a surprising wit. The reader finishes the book not with any new answers about how to navigate the maze of medicine and doctor-speak nor how to survive as a patient, but rather with deeper insights into the whole industry, its modern miracles and its timeless unknowns.

Complications is divided into three sections: the fallibility of doctors and how medical mistakes happen; the mysteries of medicine and the struggles over what to do about them; and the fundamental uncertainty of medicine itself…the ocean of unknowns that leave even the most experienced specialist dumbfounded.

We learn about the mistakes doctors have made—from a general surgeon leaving a large metal instrument in a patient’s abdomen, to a cardiac surgeon who skipped a small but crucial step during a heart valve operation, killing the patient. We read the statistics of doctors who abuse alcohol and prescription drugs, and about the good doctors who go bad, taking on too many patients and driven to suicide.

On the flip side, we learn about the power of a physician’s intuition, about bedside manner that makes what could have been a horrifying hospital experience for one patient and his loved one far more bearable. We see inside the stomach of a 438-lb. man as it is stapled to a fraction of its original size to help him physically and emotionally become a man half his weight. We sympathize with a healthy young woman who experiences intense nausea during all nine months of her pregnancy, so debilitating and untreatable that she can barely shift in bed or eat more than a morsel of food at a time. We read about a girl who comes into the hospital with a skin rash only to learn as it turns black and gangrenous that she has a rare infection, one which may take her entire leg. Saves and successes, losses and second guesses. All in a day’s work.

“Western medicine is dominated by a single imperative—the quest for machinelike perfection in the delivery of care,” writes Gawande. “From the first day of medical training, it is clear that errors are unacceptable…When I am in the operating room, the highest praise I can receive from my fellow surgeons is, ‘You’re a machine, Gawande.’ And the use of ‘machine’ is more than casual: Human beings, under some circumstances, really can act like machines.” Clearly, Gawande—who is in his eighth and final year of surgical residency, as well as a regular contributor to The New Yorker—can be a state-of-the-art machine. He is the first to admit, however, that on some days neither machine nor human can “fix” an ailing patient, and all that’s left are the old-fashioned, big-hearted reactions of a human being at his most compassionate.

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