COMPLICATIONS

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 great uncertainty, 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.