Complications – A Surgeon’s Notes on an Imperfect Science by Atul Gawande

Genre: Non-fiction, Medicine
Length: 269 pages

Reviewed by: Caliana von Lichtenstein

“Medicine is, I have found, a strange and in many ways disturbing business. 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.”

The pages of Complications are riddled with narrative accounts of daring surgical procedures, miraculous saves in the emergency room, mysterious diseases and their often misdiagnosed symptoms, as well as descriptions of the challenges health-care workers face on a daily basis. Throughout these narratives, Atul Gawande, a surgical resident, deals with some of the issues that surround the modern medical field. When is it appropriate to let students practice? Whom do they practice on? Shouldn’t every person receive the best medical care possible, and thus be only in the care of the most experienced surgeons, physicians, and nurses? How do we justify the use of human intellect and decision-making when sometimes machines make more accurate diagnoses? What actions should be taken against doctors who make mistakes? To quote Gawande: “As patients, we want both expertise and progress. What nobody wants to face is that these are contradictory desires. In the words of one British public report, ‘There should be no learning curve as far as patient safety is concerned.’ But that is entirely wishful thinking.”

Gawande’s writing style, far from being the brisk choppy method usually employed for surgical notes or doctor’s orders, is flowing and easy to read. He combines the riveting accounts of his years of experience in the medical field with his reflections on current issues – giving the book a fast-paced yet thoughtful tone.

Though he never claims Christianity, Gawande certainly appears to respect the sanctity of human life. Throughout the book, he wrestles with the idea that every life is precious and should receive medical care by the most experienced health-care workers – but that because of the way modern medicine functions, expertise is truly not possible in every case. To again quote Gawande: “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…The gap between what we know and what we aim for persists. And this gap complicates everything we do.”

This book is written by a surgeon, and thus its fairly vivid descriptions of botched hip replacements, gastric bypass operations, gunshot wounds, and heart surgeries are not for the squeamish. However, for those searching for an exciting, informative, and often thought-provoking read on the complexities of modern medicine, this is certainly an excellent option.