Complications: A Surgeon's Notes on an Imperfect Science, by Atul Gawande. Picador, (Page references are to this paperback edition.) Pressed for time. Editorial Reviews. homeranking.info Review. Gently dismantling the myth of medical infallibility, Dr. Complications: A Surgeon's Notes on an Imperfect Science - Kindle edition by Atul Gawande. Download it once and read it on your Kindle device. Complications: A Surgeon's. Notes on an Imperfect . practice that Author: Atul Gawande. downloads Views KB Size Report. DOWNLOAD PDF.
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PDF | Author-surgeon's book describes the limitations of surgery and A Surgeon's Notes on an Imperfect Science by Atul Gawande (Book. PDF | On Sep 21, , Sanjay A Pai and others published Book: Complications: A Surgeon's Notes on an Imperfect Science. As well as being a. surgeon, Atul Gawande is a staff writer on. medicine and science .. We note Gawande's observation that the exer- cise of autonomy means being able to relinquish it. 10 Par-. Complications by Atul Gawande excerpt - Free download as PDF File .pdf), Text File .txt) or read online for free.
In two years, malnutrition dropped 65 to 85 percent in every village the Sternins had been to. And Semmelweis strangely refused to either publish an explanation of the logic behind his theory or prove it with a convincing experiment in animals. The norms began to shift. This would require taking a two-centimeter margin—almost an inch—of healthy skin beyond the lesion. He winced and paused to consider his answer.
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Views Total views. Actions Shares. We grabbed retractors and pulled him open. And what we found inside was.
No blood. No hole in the bladder. No hole in the rectum. No bullet. We peeked under the drapes at the urine coming out of the catheter.
It was normal now, clear yellow. It didn't have even a tinge of blood anymore. We had an X-ray machine brought into the room and got X rays of his pelvis, his abdomen, and also his chest. They showed no bullet anywhere. All of this was odd, to say the least. After almost an hour more of fruitless searching, however, there seemed nothing to do for him but sew him up. A couple days later we got yet another abdominal X ray. This one revealed a bullet lodged inside the right upper quadrant of his abdomen.
We had no explanation for any of this how a half-inch-long lead bullet had gotten from his buttock to his upper belly without injuring anything, why it hadn't appeared on the previous X rays, or where the blood we had seen had come from. Having already done more harm than the bullet had, however, we finally left it and the young man alone.
We kept him in the hospital for a week. Except for our gash, he turned out fine. Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world.
We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, howeverclose enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes is how messy, uncertain, and also surprising medicine turns out to be. The thing that still startles me is how fundamentally human an endeavor it is. Usually, when we think about medicine and its remarkable abilities, what comes to mind is the science and all it has given us to fight sickness and misery: But we rarely see how it all actually works.
You have a cough that won't go awayand 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. Recently, a boy was flown in by helicopter to one of the hospitals where I work as a resident.
Lee Tran, as we can call him, was a small, spiky-haired kid barely out of elementary school. He had always been healthy. But for the previous week, his mother had noticed he had a dry, persistent cough and seemed less energetic than usual. For the last couple days he'd hardly eaten.
She thought it was probably a flu. That evening, however, he came to her pale, tremulous, and wheezing, suddenly unable to catch his breath. At a local emergency room, the doctors gave him vaporized breathing treatments, thinking he was having an asthma attack.
But then an X ray revealed an immense mass filling the middle of his chest. They got a CT scan for a more detailed picture. In stark black and white, it showed the mass to be a dense, almost football-size tumor enveloping the vessels to his heart, pushing the heart itself to one side, and compressing the airway to both lungs.
The tumor had already completely crushed the passage to his right lung, and without air coming through, the lung had collapsed to a gray nubbin on the scan.
A sea of fluid from the tumor occupied his right chest instead. Lee was living entirely off his left lung, and the tumor was pressing down on the airway to it, too. The community hospital he was in did not have the resources to deal with this.
So the doctors there sent him to us. We had the specialists and high-tech equipment. But that didn't mean we were sure what to do. By the time Lee arrived in our intensive care unit, his breathing was a buzzing, reedy stridor. You could hear it three beds away. The scientific literature is unequivocal about this situation: Just laying him down could cause the tumor to cut off the remainder of his airway. Giving him sedatives or anesthesia could do the same.
Surgery to remove the tumor is impossible. Chemotherapy, however, is known to shrink some of these tumors over the course of a few days. The question was how to buy the child time to find out. It wasn't clear he'd last the night. We had two nurses, an anesthesiologist, a pediatric surgery junior fellow, and three residents at the bedside, myself included; the senior pediatric surgeon was on his cell phone, driving in from home; an oncologist was on page.
So much for the wisdom of intuition, the ripening of perception from long years of practice. But to what extent do these studies apply specifically to medicine? If his fears are well grounded, he would need to do a biopsy and possibly an amputation. Can decisions like these best be made by algorithms free of the errors of human judgment?
Or is there something to the idea that medical intuition offers insight into cases that defy all the usual expectations? Much is at stake here, starting of course with the lives and the well being of individual patients. There are public policy implications as well, for both diagnosis and treatment.
If insurance companies use algorithms and outcomes research and require physicians to adhere to their strict guidelines, what will be the result?
One possibility is that patients would no longer be victims of hidebound or arrogant physicians who would otherwise insist on doing things the way they have always done them. But another possibility is that seasoned medical intuition is a crucial component of good medical decision-making which cannot be reduced to computer- programmable formulas.
If so, public health would suffer from the loss of this imperfect yet precious all-too-human resource. Should medicine use its resources for this kind of problem? I can imagine conservative bioethicist Leon Kass asking: He writes like an anthropologist about the behavior of surgeons at a huge conference in Chicago. But he also highlights both the genuine learning and the tribal bonding which, I think, point to his own pride in the nobility of his profession: Once a year, however, there is a place full of people who do know.
If these weekly meetings truly work as Gawande describes them, they suggest how institutions can operate to promote the virtues of humility, openness, and the best kind of ambition, the drive to improve.
Judging by the character traits revealed in these essays, I cannot think of anyone who better embodies the intellectual and moral virtues of the medical profession than Atul Gawande. I judge it to be excellent as well, but I would recommend Complications as the slightly stronger of the two collections.