Complications: A Surgeon's Notes on an Imperfect Science

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Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is—complicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. He investigates such enduring mysteries as the nature of pain, the inability to cure nausea, even the little-understood biology of blushing. He explores how deadly mistakes happen, and why good doctors go bad. He also gives us privileged entry into the inspiring world of ambitious operations, remarkable experiments, and unexpected intuitions. And through it all, we find Gawande's deep concern with the actual experiences of patients and doctors as they negotiate the paradoxes and imperfections inherent in caring for human lives. At once unsentimental 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. From Complications: I had just finished examining someone in the ER when one of the physicians stopped me with yet another patient: twenty-three-year-old Eleanor Bratton had a red and swollen leg. "It's probably only a cellulitis" —a skin infection—"but it's bad," he said. He had prescribed intravenous antibiotics, but he wanted me to make sure there wasn't anything "surgical" going on. The patient looked fit and athletic. There did not seem anything seriously ill about her. I glanced at her chart—she had good vital signs, no fever, and no past medical problems. I asked Eleanor if she had had any pus or drainage from her leg. No. Any ulcers? No. A foul smell or blackening of her skin? No. I le

Finalist for the 2002 National Book Award, Nonfiction.

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Editorial Reviews

From Barnes & Noble
“No one writes about medicine as a human subject as well as Atul Gawande,” says Adam Gopnik of this Boston surgeon whose articles appear regularly in The New Yorker. Gawande’s descriptions of everything from clumsy surgical mishaps to new cutting-edge operating room techniques are rendered with grace and wonder. Reading his accounts of pain experiments (in which female dancers excel) and medical-convention huckstering, one gains a sense of his stately, sometimes surrealistic profession.
From the Publisher
"Complications is a book about medicine that reads like a thriller."

—Malcolm Gladwell, author of The Tipping Point

"Complications is a uniquely soulful book about the science of mending bodies."

—Adam Gopnik, author of From Paris to the Moon

Publishers Weekly
Medicine reveals itself as a fascinatingly complex and "fundamentally human endeavor" in this distinguished debut essay collection by a surgical resident and staff writer for the New Yorker. Gawande, a former Rhodes scholar and Harvard Medical School graduate, illuminates "the moments in which medicine actually happens," and describes his profession as an "enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line." Gawande's background in philosophy and ethics is evident throughout these pieces, which range from edgy accounts of medical traumas to sobering analyses of doctors' anxieties and burnout. With humor, sensitivity and critical intelligence, he explores the pros and cons of new technologies, including a controversial factory model for routine surgeries that delivers superior success rates while dramatically cutting costs. He also describes treatment of such challenging conditions as morbid obesity, chronic pain and necrotizing fasciitis the often-fatal condition caused by dreaded "flesh-eating bacteria" and probes the agonizing process by which physicians balance knowledge and intuition to make seemingly impossible decisions. What draws practitioners to this challenging profession, he concludes, is the promise of "the alterable moment the fragile but crystalline opportunity for one's know-how, ability or just gut instinct to change the course of another's life for the better." These exquisitely crafted essays, in which medical subjects segue into explorations of much larger themes, place Gawande among the best in the field. National author tour. (Apr. 4) Copyright 2001 Cahners Business Information.
Malcolm Gladwell
"Complications is a book about medicine that reads like a thriller."
—Malcolm Gladwell, author of The Tipping Point
Adam Gopnik
"Complications is a uniquely soulful book about the science of mending bodies."
—Adam Gopnik, author of From Paris to the Moon
Kirkus Reviews
A gem-like collection of essays on medicine by eighth-year surgical resident, Harvard Med graduate, Rhodes scholar, and New Yorker staff writer Gawande, himself the son of physicians. Part I contains chilling stories of medical errors, some the near-inevitable results of young docs learning their craft by practicing on live patients, some due to the burnout or depression of seasoned specialists. (To his credit, Gawande includes a tale of his own poor judgment in a medical emergency that fortunately ended happily.) Practice does make perfect, the author demonstrates; hospitals specializing in hernia repair, for example, maximize their efficiency for the greater benefit of patients. With profound empathy, Part II chronicles medical mysteries. Readers will feel for the pregnant woman whose nausea and vomiting could not be stopped no matter what antiemetic drug she was given-until her twins were born and that same night she was able to eat a hamburger with blue cheese and fries. Sadly, these anecdotes often serve as reminders that what doctors can't pin down they often dismiss, as when a man with incapacitating back pain was advised by specialists to see a shrink. In Part III, Gawande addresses the issue of uncertainty, an ever-daunting challenge in a profession where information is always imperfect. Autopsies, which would help clarify many cases, are performed with appalling infrequency, perhaps because they reveal a depressing rate of misdiagnosis. The new, more democratic relationship between physicians and patients may also have a downside when patients make the wrong decision. The final chapter reports on a case of heart-stopping suspense, lacking clear indications and plagued by greatuncertainty, in which the doctors' intuition was critical. If Gawande's hands in the operating room are as sure as his handling of words, his success in his chosen career is all but guaranteed. Author tour
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Product Details

  • ISBN-13: 9780805063196
  • Publisher: Holt, Henry & Company, Inc.
  • Publication date: 4/28/2002
  • Pages: 288
  • Sales rank: 262,542
  • Product dimensions: 5.73 (w) x 8.47 (h) x 0.99 (d)

Meet the Author

Atul Gawande is the author of The Checklist Manifesto and Better. Complications was a National Book Award finalist. He is also a MacArthur Fellow, a general surgeon at the Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and an assistant professor at Harvard Medical School and the Harvard School of Public Health. He served as a senior health policy advisor in the Clinton presidential campaign and White House from 1992 to 1993. He received his B.A.S. from Stanford University, M.A. in politics, philosophy and economics from Oxford University, M.D. from Harvard Medical School, and M.P.H. from the Harvard School of Public Health. He lives with his wife and three children in Newton, Massachusetts.

Good To Know

In his interview with Barnes &, Gawande described a shining memory: "I believe that one version of the good in life can be defined by the moments I sometimes had playing tennis as a sixteen-year-old," He recalled. "You’d be out on the court and for an hour, two hours, sometimes an entire roasting hot day, and every single thing you hit would go in. Hit that ball as hard as you wanted, wherever you wanted, and it went in. It was effortless power, achieved out of practice. But my game’s gone to hell. And I have not had a moment like that since high school."

A serious surgeon and writer by day, Gawande has been known to rock out. He told Barnes &, "I have always believed that there is nothing greater than a life in rock n' roll -- it has to be good rock n' roll -- and I still think it is true."

Gawande claims not to have any one source of inspiration for his writing. I don’t write out of inspiration," he told us. "I write because it’s my way of finding cool ideas, thinking through hard problems and things I don’t understand, and getting better at something. I was never born to write. I was taught to write. And I am still being taught to write."

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    1. Hometown:
      Newton, Massachusetts
    1. Date of Birth:
      November 5, 1965
    2. Place of Birth:
      Brooklyn, New York
    1. Education:
      B.A.S., Stanford University, 1987; M.A., Oxford University, 1989; M.D., Harvard Medical School, 1995

Read an Excerpt

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.

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Table of Contents

Author's Note 1
Introduction 3
Pt. I Fallibility
Education of a Knife 11
The Computer and the Hernia Factory 35
When Doctors Make Mistakes 47
Nine Thousand Surgeons 75
When Good Doctors Go Bad 88
Pt. II Mystery
Full Moon Friday the Thirteenth 109
The Pain Perplex 115
A Queasy Feeling 130
Crimson Tide 146
The Man Who Couldn't Stop Eating 162
Pt. III Uncertainty
Final Cut 187
The Dead Baby Mystery 202
Whose Body Is It, Anyway? 208
The Case of the Red Leg 228
Notes on Sources 253
Acknowledgments 265
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Customer Reviews

Average Rating 4.5
( 144 )
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See All Sort by: Showing 1 – 20 of 144 Customer Reviews
  • Anonymous

    Posted March 24, 2012

    I Also Recommend:

    This is a great read from a very respected surgeon. As a physic

    This is a great read from a very respected surgeon. As a physician myself, I've always enjoyed reading books by physicians. Dr. Gawande has emerged as quite possibly the most reasonable, insightful, and even poetic of all physician writers. This book is a great read for anyone interested in the ethics of being a surgeon. Dr. Gawande's other books are also interesting reads, especially for doctors.
    Other books by surgeons I highly recommend are Dr. Anthony Youn's "In Stitches," which is his absolutely hilarious and heartwarming story of becoming a doctor, and "Hot Lights Cold Steel" by orthopedic surgeon Dr. Michael Collins. These are geared towards a general audience and very worthwhile reads.

    3 out of 5 people found this review helpful.

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  • Posted February 13, 2010

    Grey's Anatomy

    I loved this book. At times, it felt like I was reading an episode of my favorite T.V. program, Grey's Anatomy. I am not in the medical profession but Dr. Gawande writes so well that his explanations and storytelling are easy to read and follow.

    3 out of 4 people found this review helpful.

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  • Anonymous

    Posted February 21, 2010

    I Also Recommend:

    Great Read

    An inspirational book that is a must read. Insightful and original, Gawande depicts the reality of complex problems that arise in the medical profession.

    2 out of 4 people found this review helpful.

    Was this review helpful? Yes  No   Report this review
  • Posted December 12, 2009

    Overly hyped and I fell for it

    Although eager to learn something from this physician's account, I found I was willing to leave the book after 50 pages. I did not, I did read it entirely but it was a waste of time. Some physicians can write, some cannot. This is a "not".

    2 out of 5 people found this review helpful.

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  • Posted August 2, 2009

    more from this reviewer

    Great literary analysis of the art of surgery

    Written very well, not quite as good as his other book 'Better', but still very good.

    2 out of 2 people found this review helpful.

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  • Posted December 27, 2009

    informative info on real surgeons actions

    Very good. Easy writing style, many new concepts, many chuckles also. Still biased as a surgeon, but tells many incidents from real life. Wish my doctor would read it.

    1 out of 2 people found this review helpful.

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  • Posted June 13, 2014

    A great and informative read!

    Atul Gawande is a great writer and some of his stories are really page-turners, especially the last one about the patient with flesh-eating bacteria. He brings to his readers an in-depth understanding of what surgical residents go through during their training. Anyone who has ever been or ever will be (that is all of us) a patient should read this book.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted April 6, 2013


    What an incredible look into both the expertise and fallibility of surgeons. The larger application is that we all need to aspire to learn as much as possible about our own areas of interest or professional endeavors, but in the final analysis we must trust our intuition. While reading Dr. Ben Carson's "Gifted Hands," I notice how often he prays and actually senses or truly knows God's leading. With both authors, there is a keen awareness of human imperfection.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted May 20, 2012

    Couldn't stop reading

    I love to read memoirs and this was one that I couldn't put down. I want to read all of his books.

    Was this review helpful? Yes  No   Report this review
  • Anonymous

    Posted December 11, 2011

    Loved it!

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  • Posted August 27, 2011

    Great book

    Very good book. Not boring like some books in this genre can be. All of his books are good. I only posted 2 reviews thus far, in 9mo, this book is worth a positive review!

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  • Anonymous

    Posted March 2, 2011

    Great author - great book!

    This was my favorite of Atul Gawande's books, but I loved them all!! Would recommend them to everyone!

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  • Anonymous

    Posted November 10, 2010

    Complications: Always Kept me on the Edge of my Seat!

    Atul Gawande's Complications, is a view on the less publicized uncertain half of the medical field. The half that attempts new surgeries and ideas most of which turn out to be failures rather than successes. And who better to test these new methods out on than the common patient who enters the hospital for an ordinary reason. Gawande, who is a doctor himself, discusses how this is helpful and hurtful to today's society and the overwhelming mystery that still surrounds medical science. He tries to get across the message that medicine and surgery is a necessary evil. We will never be able to improve unless we practice. The lives of some experiments are not as important as the many that could be saved in the future. He wants to get across the point that this is a harsh fact society needs to accept. I like the way he wrote the story giving examples of patients, then explaining the controversy that surrounds decisions and techniques that surgeons use. I like how he explains what really happens in the medical world. I dislike how the book rarely shows who Gawande is. By the end of the book you have no idea what he does for a living after residency or about his family or anything else. I think the story could have benefited from a personal touch. People should read this book because not only is it a good story, but it reveals many things about the medical field one would not expect. In this sense, readers can be informed when making their own medical decisions. I give the book an overall rating of 5 stars because it was informative and entertaining.

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  • Posted November 4, 2010

    more from this reviewer

    Highly Recommend ---and I haven't even read the whole book yet!

    I haven't finished this book yet and it is the greatest book. But then again I want to be a surgeon so that is an unfair advantage for liking this book. I probably would recommend this for someone that doesn't enjoy the anatomy of the human body... But is still best book ever!!! :)

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  • Anonymous

    Posted April 9, 2010

    An amazing read for anyone involved in medicine in any capacity!

    Complications is an engaging informative book about Dr. Gawande's accounters with the medical system. He sheds light on many issues in medicine that most people probably aren't too familiar with. It's a great read for anyone who is interested in medicine or even interacts with the medical system in any way, which is pretty much all of us. I learned so much about what it's like to be a doctor and a patient from reading this book. I found the first section the most interesting as it is the most applicable to patients but the last two sections are also really engaging when Gawande discusses different interesting medical phenomena. Overall, I think this book is a must read for everyone!

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  • Posted March 20, 2010

    more from this reviewer

    I Also Recommend:

    Inside Workings of the Medical Field

    I read Atul Gawande's Complications a while ago and greatly enjoyed it. Dr. Gawande is an amazing writer and creates a detail image of topics in the medical field. It is very apparent that Dr. Atul Gawande is very educated and has extensive knowledge in what he writes about. Complications has the information and knowledge of a well-written peer-reviewed journal article but a writing style that is easy for anybody to read. I find that the information that Dr. Atul Gawande discusses are important for everybody to be familiar with. As a health educator I find the topics very interesting. His other book, Better, is just as good. The topics are similar in nature and just as interesting. Very well written and I recommend Complications for people who liked Better and vice versa. I believe those who are interested in the medical field will benefit and be entertained by Complications.

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  • Anonymous

    Posted December 10, 2009

    very informative

    shows that we all are not perfect, but we can build a team around us to prevent dilemmas.

    0 out of 1 people found this review helpful.

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  • Posted November 15, 2009

    complications from Surgery

    T. his book was a true story about a surgeon in the making some of the detail was not needed. I feel unless you are in the medical profession you would not have liked this book it gets boring. I have read better books written by doctors about their practice.

    0 out of 1 people found this review helpful.

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  • Anonymous

    Posted July 10, 2009


    Truly inspiring for anyone considering a career in the health professions.

    Was this review helpful? Yes  No   Report this review
  • Posted June 18, 2009


    Great book for anyone in the medical profession

    Was this review helpful? Yes  No   Report this review
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