Atul Gawande and his first book: Complications –A Surgeon’s Notes on An Imperfect Science

Atul Gawande: The skilled storyteller

Atul Gawande tells the story as it is. That is exactly how I can summarize the writings of Atul Gawande in one sentence. He uses the easy and time tested show and tell approach to telling a story. Atul Gawande writes about his patients and his friends in a way that makes them come alive as real person. You will able to get the visual image of the live real person when you read their stories. This is the same technique described in the classic book about writing: If you want to write by Brenda Ueland first published in the 1930s. Just like Brenda says, Atul Gawande just tells the truth as he sees it does not do anything he does not want to do.

Atul Gawande starts his book with a description of a chaotic ER of a  busy urban teaching hospital where a victim of gunshot wound was wheeled in. Just reading the first few paragraphs, you will know that he will be very honest in telling his stories. Atul Gawande does not try to hide anything and is not afraid to tell the truth even when it is ugly. You can feel the pain and suffering of the victim as Atul Gawande describes how the reluctant victim was persuaded to have the operation that did more harm to him than help. Yet, you can get inside the surgeon’s mind and completely understand why they had to make that decision.

Atul Gawande effortlessly leads you inside the mind of a surgeon by being completely honest with what he went through. Learning to insert a central line is one of the first few procedures any surgeon is required to master in the first year of training. Atul Gawande describes his failures, doubts and frustrations exactly as he felt them. He does not try to sugarcoat anything and is not afraid to share his embarrassment and self doubts with his readers. As he describes the several instances where he felt totally inept, Atul Gawande tells the readers how difficult it is to the master the skills needed to perform surgery on a live patient. He describes his failure in a way that readers can not help but start to cheer him and want him to succeed. When he finally gets the line in, he describes in in such a way that the readers finally take a sigh of relief. Atul Gawande then tells them the truth: he didn’t really know what he did differently that that. It is this kind of honest and down to earth comments that differentiates Atul Gawande from other surgeons. It is this total and unwavering honesty that touches the hearts of his readers. They see Atul Gawande not as an impersonal and arrogant surgeon but a kind compassionate doctor who cares about his patient. Atul Gawande accomplishes this by letting out his true thoughts from the bottom of his heart into his words. Atul Gawande does not try to polish his image but projects the imperfect human being inside him out for the readers to make the judgement.

Atul Gawande: The surgeon’s advocate

Throughout the book, Atul Gawande does talk directly to the readers and gives out his opinion but only does so after he has described the event or the topic with as much objective data as possible. In other words, Atul Gawande will move on to the “tell” portion of his show and tell only after he has given ample time to “show” it to his readers. What I found very interesting about his writing is that Atul Gawande always maintains a soft friendly voice even when he is describing things that are ugly, disgusting or controversial. Atul Gawande does not try to advocate and impose his opinions on his readers but gives out personal suggestions based on the story. Although Atul Gawande makes a strong case for allowing surgeons to practice on patients to improve their skills, he does not sound too pushy when doing so. He simply states that wanting excellent patient care from skilled surgeons and at the same time not proving ample opportunity to allow the surgeons to practice their skills can not go hand in hand.

Atul Gawande: The parent

Atul Gawande gives the opposing point of view about letting inexperienced surgeon practice on new patients when he is in the role of a parent of a patient. He describes how he was uncomfortable when a surgeon-in-training wanted to follow his sick child as a patient. He politely refused to let the inexperienced surgeon become the doctor of his child and instead opted for a more experienced surgeon. In doing so, Atul Gawande just reassured the readers that he understood their concerns when they did not want inexperienced surgeons practicing on their loved one. So, what does Atul Gawande advocate to achieve both goals?

Atul Gawande simply advocates that patients should be allowed to choose the doctors under selective situations but should not be given a choice under under normal and day to day hospital situations. You may or may not agree with this argument but you will enjoy his viewpoint as his writing makes you feel like you are actually reading his mind- unedited and unrefined. There are several other instances in this book where the parent Atul Gawande and the surgeon Atul Gawande have conflicting interests but they always  seem to find some common ground.

Atul Gawande: A friend in need

There is a chapter in this book where Atul Gawande puts his complete focus on his friend and college whom he calls Dr. Hank Goodman to mask his real identity. He describes a great surgeon with great skills who got burnt out with overwork and depression. Without being judgmental, Atul Gawande describes the situation as something that can happen to anyone. As his college slacked off, the patients suffered. Atul Gawande creates a conflict in the readers’ heart as he describes the story with his truly felt compassion for both parties. On one hand Atul Gawande makes his readers feel sympathetic to the good doctor who was seemed to have broken down under pressure but at the same time he makes them aware of the fact that the patients were suffering unnecessarily. In doing so, Atul Gawande describes the difficulty that our medical system has in dealing with impaired physicians who need help. He describes how people close to the physician were trying to help him and at the same time secretly working to protect patients from his. Atul Gawande was so obsessed with the subject that he even went out of his way and visited a psychiatrist who dealt with impaired physicians to see if that would help his friend. Instead of trying to distance himself from a troubled college, Atul Gawande gets him the help he desperately needed. He describes an amazing journey where the college went through so much pain, suffering and humiliation but was finally able to pick himself up start a new life. Atul Gawande was truly a friend in need.

Atul Gawande: The patient advocate

For a surgeon, Atul Gawande shows an exceptional degree of compassion for his patients and he clearly defies the general stereotype of surgeon in doing so. Surgeons are normally thought of as “doers” not “thinkers”. In general, they are mostly concerned with fixing things as in fixing a leak, clearing an obstruction, removing a tumor, draining an abscess and other physical abnormalities in the human body. Most other physicians seem to think of surgeons as men of action, not men of compassion. Then you meet a surgeon like Atul Gawande and you are forced to throw out for general assumptions about surgeons. Yes, I have met surgeons in my real practice who are compassionate and caring but those are considered relatively rare.

Atul Gawande not only seems to acknowledge with patient’s suffering but is willing to advocate for them. From his writing, it is clear that he is as interested in helping their symptom as he is in fixing their body. Atul Gawande believes in prompt pain relief and he believes that patients could be in pain even when we doctors can not see any physical evidence that the pain exists. Some patients with chronic pain do not have any physical evidence of any pathological changes that can explain the pain. It does not mean the pain is not real. Some of those patients not only suffer from physical pain but are also under a lot of mental stress and fear of being labelled as “drug seekers’ by the doctors. In this day of “evidence based medicine”, even the most compassionate doctors are forced to think twice before prescribing strong pain medicines for those whose pain can not be explained by physical evidence. The most important factor for curing such patients is to make them confident that their doctor believes that the pain is real and is working to find the right treatment. Atul Gawande seems to that doctor. He describes the painful story of a patient with severe pain who finally got some relief after being referred to a pain specialist.

Atul Gawande: Amused by the inner child in every surgeon

There is a chapter in the book about a surgeons’ conference in which the you will Atul Gawande having a slightly different tone of voice. Here Atul Gawande seems to be more playful, amused and somewhat funny. He describes his conference experience as kind of a first-time-in-Disney-World story. He seemed to be greatly enjoying the break from his daily routine. The funny part is that readers seem to agree with with. By the time readers get to that page after a long interesting, adventurous and intense experience of being a surgeon in residency, they feel somewhat concerned for Atul Gawande and want him to have a nice break.

Atul Gawande seemed to have enjoyed the conference a lot. He was amused to see how surgeons were waiting in line to play with the latest toys that the vender had to offer. He seemed to enjoy how rich surgeons were falling for cheap goodies and were willing to listen to sales pitch just to bag some key-rings and cup-holders. Some critiques of the book argue that this particular chapter is out of place and was unnecessary but I beg to differ. I think this chapter shows a part of surgeons that we don’t get see often. And that is why this particular chapter is so important in this book which is the story based on the experiences of a surgeon. People who read the book want to feel like a surgeon for the day. Without knowing the inner child that lives inside every surgeon, the experience would have been incomplete.