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where the magic happens

July 12, 2012

I recently read a book that I probably would never have read had it not been recommended by a friend. It was definitely out of my comfort zone. But sometimes, you have to step out of your comfort zone to see the magic happen- even if it is as simple as reading a book you normally wouldn’t read.

Complications: A Surgeons’ Notes on an Imperfect Science by Atul Gawande is a fascinating book about the journey to becoming a surgeon: the OR, the patients, the hours- but most importantly a doctor’s personal journey, doubts, successes and everything in between. First hand. From the inside.

I’m the kind of person that gets queasy at the sight of a even a little blood so reading about surgeries (with my wild wild imagination) wasn’t fun. I did, however, learn a lot and I now have a new found appreciation for doctors. This is the kind of book that asks the rest of us to appreciate not what a doctor does but who a doctor is. as a person.

So without further ado, here are some of my favorite quotes from the book:

  • You have a cough that won’t go away—and then? It’s not science you call upon but a doctor. A doctor with good days and bad days. A doctor with a weird laugh and a bad haircut. A doctor with three other patients to see and, inevitably, gaps in what he knows and skills he’s still trying to learn.
  • 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. There is science in what we do, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. this gap complicates everything we do.
  • When you are a medical student in the operating room for the first time, and you see the surgeon press the scalpel to someone’s body and open it like fruit, you either shudder in horror or gape in awe.
  • The surgeon drew a six-inch dotted line with a marking pen across a sleeping patient’s abdomen and then, to my surprise, had the nurse hand me the knife… (he) had me stretch the skin taut with the thumb and forefinger of my free hand. He told me to make one smooth slice down to the fat. I put the belly of the blade to the skin and cut. The experience was odd and addictive, mixing exhilaration from the calculated violence of the act, anxiety about getting it right, and a righteous faith that it was somehow good for the person.
  • In surgery, as in anything else, skill and confidence are learned through experience—haltingly and humiliatingly. Like the tennis player and the oboist and the guy who fixes hard drives, we need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon.
  • In medicine, we have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think patients actually benefit from teaching. Studies generally find teaching hospitals have better outcomes than non-teaching hospitals. Residents may be amateurs, but having them around checking on patients, asking questions, and keeping faculty on their toes seems to help. But there is still no getting around those first few unsteady times a young physician tries to put in a central line, remove a breast cancer, or sew together two segments of colon. No matter how many protections we put in place, on average these cases go less well with the novice than with someone experienced. As patients, we want both expertise and progress. What nobody wants to face is that these are contradictory desires.
  • If learning is necessary but causes harm, then above all it ought to apply to everyone alike. Given a choice, people wriggle out, and those choices are not offered equally. They belong to the connected and the knowledgeable, to insiders over outsiders, to the doctor’s child but not the truck driver’s. If choice cannot go to everyone, maybe it is better when it is not allowed at all.
  • Doctors belong to an insular world—one of hemorrhages and lab tests and people sliced open. We are for the moment the healthy few who live among the sick… Ours is a world even our families do not grasp… isolation of practice take you away from anyone who really knows what it is like to cut a stomach cancer from a patient or lose her to a pneumonia afterward or answer the family’s accusing questions or fight with insurers to get paid.

Reading material on topics out of your norm is a great way to learn something new while gaining perspective on your world. I highly recommend reading Complications in its entirety.

What are some interesting books/articles you’ve read lately?

2 Comments leave one →
  1. July 12, 2012 6:35 pm

    Having worked with and around doctors for many, many years I agree with everything you wrote. My favourite docs are the ones who know that nurses have much knowledge to contribute. Residents wouldn’t survive without nurses watching their back.

    • July 12, 2012 9:46 pm

      That’s great to hear- I had no idea about the medical world until I read this book. But it certainly shed a different light on something I knew so little about to begin with!

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