Complications [Book Review]


Complications: A surgeon’s notes on an imperfect science.

I need to find more books written in this type of style. A book chocked full of page-turning stories and thought-provoking narratives. It’s like watching a thriller of a man/woman about to accomplish a tremendous feat, where portions of the video cut out to flashbacks on life-changing events that sculptured the dream in which the individual is driving to complete. This book takes that feeling and applies it to surgery. This isn’t just the imperfections of what we know about the human body, but also the social implications behind the medical sciences.

The author, Atul Gawande, is a resident surgeon. A resident is someone that is fresh out of medical school and starts practicing medicine and surgery. Yes, they start practicing it. They acquired the textbook knowledge and proved that they have the mental perseverance to stick it out through 8 years of college. Then they start learning how to do specific procedures on patients.

There’s always the question of when and on whom new doctors should work on. While it’s important that residents get the experience to become the leaders of the next generation of treatment, even doctors themselves will try to avoid treatment from other residents. They are just like us, they want the best treatment for their loved ones, but they have the inside knowledge.

Even when the doctor has 1 or 20 years of experience, mistakes always happen. Each human is relatively similar, but different enough that you can never truly break every procedure from easily read statistical model. However, our society makes both doctors the ultimate fail-proof machine but will socially destroy those that do make mistakes. This makes it difficult to learn from those errors to the point that hospitals can only do it internally [Morbidity and Mortality (M&M) conferences] with a strict sense of discreteness involved. The system itself, ironically, can lead to many “burnt out” professionals, which ironically can result in the production of “bad doctors.” It’s almost a chicken-and-egg scenario of which came first.

The novel has another section devoted to the treatment of “mysteries.” This includes a lot of nerve and hormonal based diseases including unknown pain, uncontrollable blushing, and insatiable appetites. Regardless of how far we have come, there’s still a lot to learn about the human body. Due to the pressure of society for something to be done, either in the form of an easy pill or a instant-fix surgery, the medical society has implemented various forms of “experimental” procedures with some becoming norms throughout the industry (ex. gastric bypass surgery). The author pads some specific topics with the results of scientific studies, but still shows the struggles doctors face when dealing with similar topics.

The most thrilling, and my favorite, section of the book was the last third titled “Uncertainty.” It’s main theme is the interaction between the doctor and patient in terms of limited judgement, individual variation, and the doctor’s unique prior experiences.

When someone is approaching death, there are many options one can choose. However, who should be the one that has the final say? Does the doctor with the medical degree? Or the individual that has to risk possible side effects and mortal consequences? It’s this difficult balance where the patient wants the best for their future, but they may not be in the state of mind to make the best call. Individuals may know what they want, but sometimes don’t want the commitment of possibly choosing the wrong treatment and suffering the long-term guilt associated with it. Even doctors (including the author) will give up medical decision making for themselves and their family to their co-workers, knowing their decision is free from emotional stress and attachment bias.

In the other half of cases, doctors and surgeons need to convince their patients when…. or when not ….. to undergo certain procedures. Some may want to risk surgery at the cost of their life. Others may be too afraid to look into the possibility of what they may have……cancer, infections, genetic diseases. And not all decisions can be made by a supercomputer-driven algorithm crunching statistical data……”making decisions under uncertainty everyday” is what makes doctors the miracle workers that they really are. They are able to connect with their patients and reason out the best course of action for each unique individual.

I learned at a young age that I am highly susceptible to stress and what it can do to your body. Every time some sales person barks to me over some urgent matter that needs immediate attention for “the customer,” it unconsciously drives a vicious cycle of stress hormones in my body. But when it does occur, I can stop, take deep breaths, and come to the realization that no matter the outcome……. no is dying over the choices I make as an applications engineer.

That’s why I have a lot of respect for many career paths that result on the fate of people’s lives: police officers, soldiers, ……… and doctors.




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