Complications: A Surgeon's Notes on an Imperfect Science is a nonfiction book collection of essays written by the American surgeon Atul Gawande. Gawande wrote this during his general surgery residency at Brigham and Women's Hospital and was published in 2002 by Picador. The book is divided into three sections: Fallibility, Mystery, and Uncertainty, all going in depth into the problems physicians may face when practicing a variety of procedures in medicine. Each of these sections puts forth different challenges doctors must face that make them imperfect and errant, resulting in the inevitable occurrence of errors.
Background
Atul Gawande wrote the Complications during his surgical residency at Brigham and Women’s Hospital. Working approximately 110 hours a week, Gawande would have to leave his writing of his essays for the nighttime and the weekends. Although the amount of time Gawande would spend working made it more difficult to complete his writing projects, this large workload allowed him to be exposed to more experiences. Before the publication of Complications, Gawande published some of the essays on The New Yorker, including The Pain Perplex, When Doctors Make Mistakes, A Queasy Feeling, Whose Body Is It, Anyway?, When Good Doctors Go Bad, Crimson Tide, Final Cut, and The Man Who Couldn’t Stop Eating. The Dead Baby Mystery was also published prior to the release of Complications on Slate magazine.
Themes
Fallibility in medicine
In the writing of Complications, Gawande attempts to elucidate medicine. In many of the essays included in the book, in particular When Doctors Make Mistakes and Education of a Knife, demonstrate many of the mistakes physicians may make when treating their patients. In these two essays, Gawande discusses his own struggles inserting a central venous catheter and performing an emergency tracheotomy that nearly results in the death of the patient. These anecdotes serve the purpose of shedding light on the fallibility of doctors and the imperfect nature of medicine. Since doctors are humans, they are also prone to making mistakes when assessing the conditions of their patients or when performing a certain procedure. This humanizing of doctors that takes place in Complications relieves the pressure doctors may feel when they make human mistakes and it also calls for a new patient culture. By knowing the fallibility present in medicine, patients with more information may know how to ask the right questions at the right moments to challenge doctors that may reduce the possibility of errors while also knowing when to have faith in the system during emergency situations.
Mystery in medicine
A major theme Gawande touches on is the theme of mystery in medicine. The entire second section of the book, Mystery, goes over patient cases Gawande attends to that stem from unknown causes or are just rarely found. The Case of the Red Leg (this is in part 3 - Uncertainty), is an example of how the mystery behind a disease impacts the work physicians must do. When confronted with a scenario in which the patient could either have a common cellulitis disease or a rare, deadly necrotizing fasciitis. Heavily influenced by his recent exposure to necrotizing fasciitis, Gawande decides to do a biopsy. This case reflects how sometimes, physicians must use not only science to treat patients, but intuition as well due to the fact current science can’t clearly identify a disease. This theme is also resonated in The Pain Perplex which concerns itself with the problems of treating pain that is caused by the brain. Doctors are unsure of the causes of this pain and don’t exactly know how to treat it. This mystery surrounding medicine demonstrates its own imperfection that doctors and patients should both be aware of. By knowing the shortcomings of medicine, doctors and patients alike are able to improve the care and doctor-patient relationship since they are aware of what medicine can accomplish through science and its limitations.