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Complications: A Surgeon's Notes on an Imperfect Science

Complications: A Surgeon's Notes on an Imperfect Science

4.3 149
by Atul Gawande

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A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine.

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


A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine.

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. 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 won't 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.

Complications is a 2002 National Book Award Finalist for Nonfiction.

Editorial Reviews

“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.
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.
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
From the Publisher

“None surpass Gawande in the ability to create a sense of immediacy, in his power to conjure the reality of the ward, the thrill of the moment-by-moment medical or surgical drama. Complications impresses for its truth and authenticity, virtues that it owes to its author being as much forceful writer as uncompromising chronicler.” —The New York Times Book Review

“No one writes about medicine as a human subject as well as Atul Gawande. His stories about becoming a surgeon are scary, funny, absorbing....Complications is a uniquely soulful book about the science of mending bodies.” —Adam Gopnik, author of Paris to the Moon

“Gawande is arguably the best nonfiction doctor-writer around....He's prescient and thoughtful...the heir to Lewis Thomas' humble, insightful and brilliantly crafted oeuvre.” —Salon.com

“Complications is a book about medicine that reads like a thriller. Every subject Atul Gawande touches is probed and dissected and turned inside out with such deftness and feeling and counterintuitive insight that the reader is left breathless.” —Malcolm Gladwell, author of The Tipping Point

“Gawande is a writer with a scalpel pen and an X-ray eye.... He turns every case--from gunshot wounds to morbid obesity to flesh-eating bacteria--into a thriller in miniature. Diagnosis: riveting.” —Time

“Gawande's prose, much like the scalpel he wields, is precise, daring, but never reckless....Much like reading George Orwell, the reader emerges entertained, enlightened, transformed and immensely satisfied.” —Abraham Verghese, author of My Own Country

“Wrenching human tales...Gawande has pushed the medical yarn in a new direction.” —The Boston Globe

“Atul Gawande is a rare and wonderful storyteller who portrays his profession with bravery and humanity.” —Ellen Goodman, Pulitzer Prize-winning columnist

The stories in Complications are gripping medical mysteries that always have something extra. Gawande draws you in with the story but leaves you wiser about science, about health care issues, and even about the human condition.” —Michael Kinsley

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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.

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.

Atul Gawande is author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. His latest book is Being Mortal: Medicine and What Matters in the End. He is also a surgeon at Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation, and chairman of Lifebox, a nonprofit organization making surgery safer globally. He and his wife have three children and live in Newton, Massachusetts.

Brief Biography

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

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Complications: A Surgeon's Notes on an Imperfect Science 4.3 out of 5 based on 0 ratings. 149 reviews.
Anonymous More than 1 year ago
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.
MaestraD More than 1 year ago
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.
DocT More than 1 year ago
Written very well, not quite as good as his other book 'Better', but still very good.
Anonymous More than 1 year ago
I love to read memoirs and this was one that I couldn't put down. I want to read all of his books.
photodoc More than 1 year ago
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.
Anonymous More than 1 year ago
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.
Anonymous More than 1 year ago
GarycUT More than 1 year ago
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.
Anonymous 10 months ago
Anonymous More than 1 year ago
As a Pre-Medical student at Saint Louis University, I read this book as part of my class, Foundations of Medicine. This isn't a text book or a set of medical instructions; this is a novel that tells the story of medicine (as I like to describe it, "a 'Diary of a Wimpy Kid' for current and future doctors." This novel made me question medicine as a whole and whether or not this field is where I want to be. Ultimately, I no longer want to go to medical school and become a surgeon, but I am perfectly okay with that. This book has helped me to determine what I want to do in my life. Thank you, Gawande, for sharing your experiences.
Arianna-Bly More than 1 year ago
“Complications” is an amazing collection of stories written by a surgeon who shows the difficulty and complications of surgery and medicine in general. Atul, the author is a training surgeon who talks about the challenges he faces in his training. I loved this book, it was interesting for me to see how surgery and medical procedures can be complicated, and pointless. Atul writes this book like a diary and tells his stories using somewhat informal language. The audience that I think he wrote this for is people who are interested in medicine and medical procedures. He uses specific and graphic details in order to successfully explain the procedure he is completing. I do not think that this book should be made into a movie because there are a lot of little stories, but there is not a main plot that would allow for a quality movie. Anyone who is curious about medical procedure and how surgeries are performed should read this book, and anyone who is sensitive to gory details should not read this book because he specifically explains how it feels to cut into someone and the specificity of each procedure. Overall, I felt like this book was very informative, and I enjoyed reading it because I want to go into medicine.
DoranneLongPTMS More than 1 year ago
Being Mortal and Checklist Manifesto are must-reads; I enjoyed Complications as well. Atul Gawande is a gifted, and yet humble man.
Anonymous More than 1 year ago
Anyone contemplating surgery should read this book.
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