Gawande - Complications
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Those who believe, as many of us need to at some time in our lives, that doctors know best will not be pleased to read Atul Gawandes book. But any Briton brought up on the folk-legends of Doctor in the House will be unsurprised at its revelations: surgery is unpredictable; sometimes a doctor acts on a hunch he cant logically justify, and turns out to be right; diseases run in fashions; surgeons can go to pieces, drink, lose their nerve, foul things up.
Michael Bywater, Telegraph Arts and Books
With outstanding honesty Complications recognises the need for doctors as well as patients to acknowledge the limits of medical science without losing their trust in themselves, or each other. Herald
Engaging, a breath of fresh air Without lecturing us, by the sole expedient of telling us fascinating stories, Gawande leads us to ponder the knotty philosophical riddles enmeshed in the very nature of disease Complications impresses for its truth and authenticity, virtues that it owes to its author being as much forceful writer as uncompromising chronicler. New York Times Book Review
This book is just what the doctor ordered Gawande is a bright spark, too. At other times I have been a laboratory scientist, a public health researcher, a student of philosophy and ethics, and a health policy adviser in government. What this CV omits is the fact that hes also a very good writer and when he writes about medicine he does so superbly. Patrick Gilmore, Ham and High
Gawande is a writer with a scalpel pen and an X-ray eye A surgical resident himself, he turns every case into a thriller in miniature. Diagnosis: riveting.
Time Magazine
Gawande is arguably the best nonfiction doctor-writer around and this collection showcases his work well. Hes prescient and thoughtful humble, insightful and brilliantly crafted. Dr. Ivan Oransky, Salon
Complications, by the surgeon Atul Gawande, is an excellent and terribly shocking book about the fact that surgeons are all too human. William Leith, TheYearsBest Reads, Evening Standard.
No one writes about medicine as a human subject as well as Atul Gawande. His stories about becoming a surgeon are scary, funny, absorbing, and always touched with both a tender conscientiousness and an alert, hyper-intelligent skepticism. He captures, as no one else has, the doubleness of doctoring: what it feels like to see other people as fascinating, intricate, easily breakable machines and, at the same time, as mirror images of ones own self. Complications is a uniquely soulful book about the science of mending bodies. Adam Gopnik, author of Paris to the Moon
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
Dr Gawande insists upon what should always have been obvious: that doctors have to act, and act dramatically, in the absence of definitive knowledge. Sometimes this leads to tragedy, sometimes to triumph. His book, not surprisingly, ends with an account of a triumph rather than a disaster: appropriately enough, for with all its deficiencies and all the carping of its critics, medicine is a noble enterprise. Complications will help to convince the lay reader of this increasingly unacknowledged truth. Anthony Daniels, Sunday Telegraph
Gawandes revelation of life behind the surgical mask should shatter our nave preconceptions for good. Graham Ball, Sunday Express
Gawande casts himself as a guide, holding a lantern across the divide between patient and physician. Economist
Atul Gawande offers one intriguing route to medical salvation nothing less than a complete reinvention of the covenant between patient and doctor Instead of praising the scientific victories that most practitioners of Western medicine would like us to celebrate, Gawande shows that medicine is, at best, an imperfect science. Richard Horton, The Times
Complications
Atul Gawande is one of the worlds most distinguished doctors. A 2006 MacArthur Fellow, he is a general surgeon at the Brigham and Womens Hospital in Boston, a staff writer for the New Yorker, an assistant professor at Harvard Medical School and the author of Better: ASurgeonsNotes onPerformance, also published by Profile. He lives with his wife and children in Newton, Massachusetts.
Complications
A Surgeons Notes on an Imperfect Science
Atul Gawande
First published in Great Britain in 2002 by
PROFILE BOOKS LTD
3A Exmouth House
Pine Street
Exmouth Market
London EC1R 0JH
www.profilebooks.com
First published in the United States in 2002 by
Metropolitan Books
This eBook edition first published in 2010
Copyright Atul Gawande, 2002, 2003, 2010
The moral right of the author has been asserted.
This eBook is copyright material and must not be copied, reproduced,transferred, distributed, leased, licensed or publicly performed or used inany way except as specifically permitted in writing by the publishers, asallowed under the terms and conditions under which it was purchased or asstrictly permitted by applicable copyright law. Any unauthoriseddistribution or use of this text may be a direct infringement of the authorsand publishers rights and those responsible may be liable in law accordingly.
A CIP catalogue record for this book is available from the British Library.
eISBN 978-1-84765-124-2
FOR KATHLEEN
Contents
T he stories here are true. In order to tell them while protecting peoples confidentiality, however, I have needed to change the names of some patients, their families, and a few of my colleagues. In certain instances, I have also needed to change minor identifying details of individuals. Nonetheless, wherever such changes were made, I have indicated so in the body of the text.
I was once on trauma duty when a young man about twenty years old was rolled in, shot in the buttock. His pulse, blood pressure, and breathing were all normal. A clinical assistant cut the clothes off him with heavy shears, and I looked him over from head to toe, trying to be systematic but quick about it. I found the entrance wound in his right buttock cheek, a neat, red, half-inch hole. I could find no exit wound. No other injuries were evident.
He was alert and scared, more of us than of the bullet. Im fine, he insisted. Im fine. But on the rectal exam, my gloved finger came back coated with fresh blood. And when I threaded a urinary catheter into him, bright red flowed from his bladder, too.
The conclusion was obvious. The blood meant that the bullet had gone inside him, through both his rectum and his bladder, I told him. Major blood vessels, his kidney, other sections of bowel may have been hit as well. He needed surgery, I said, and we had to go now. He saw the look in my eyes, the nurses already packing him up to move, and he nodded, almost involuntarily, putting himself in our hands. Then the gurney wheels were whizzing, IV bags swinging, people holding doors open for us to pass through. In the operating room, the anesthesiologist put him under. We made a fast, deep slash down the middle of his abdomen, from his rib cage to his pubis. We grabbed retractors and pulled him open. And what we found inside was... nothing.
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