Seven years ago, Atul Gawande faced a crucial moment in his medical training. The student, who had never operated before, was observing an abdominal procedure when it came time to make the first incision. “The patient was put under, the belly exposed.

• Complications A Surgeon's Notes On An Imperfect Science Summary

And then, the nurse handed me the knife,” he recalls with a laugh, reliving the nervous thrill that went through him. “I picked it up and drew it across the skin. It was a lot tougher and springier than I thought it would be, so I had to cut twice.Still, I was exhilarated,” he said. “There is something about the feeling that you are entering a world that others don’t get to see – and that slightly sickening feeling of sticking a knife into somebody.”Gawande, 37, who spoke by phone from Brigham and Women’s Hospital in Boston, is in his last year of surgical residency. While he recently overcame his queasiness, he hasn’t lost his sense of wonder.In “Complications: A Surgeon’s Notes on an Imperfect Science” (Metropolitan Books, 288 pages, $24), a collection of 14 pieces, some of which were originally published in The New Yorker and Slate magazines, Gawande uses real-life scenarios – a burned-out doctor who refuses to quit; a terminal patient who opts for risky surgery, with fatal results – to explore the larger ethical issues that underlie medicine. He asks: How much input should a patient have?

How can young doctors gain hands-on experience without endangering lives? And how responsible are these doctors for their mistakes?The son of two physicians, Gawande attended Oxford on a Rhodes scholarship, then worked in a research laboratory and as an adviser to the Clinton administration on health policy before earning his M.D. (“I guess I always knew that I’d eventually come around to it,” he says.) Soon after, Slate editor Jacob Weisberg, a friend, approached him about writing a column on being a doctor.

Gawande had never tried journalism before and struggled with it at first, though he says he enjoyed the process. “A lot of the topics I ended up writing about came from experiences that I didn’t understand or that bothered me. They were often things patients ask about and I don’t have answers for, and I wanted to get answers.”Many readers will blanch at the cases Gawande describes, like the surgeon who biopsied the wrong part of a woman’s breast, delaying her cancer diagnosis by 18 months.

Other failures are his own: He once needed to perform an emergency tracheotomy, a procedure he had little experience with, under time pressure. His hesitation, he admits now, nearly cost the patient her life.While “Complications” is full of tragic errors and near misses, the book is not intended to be an expose. Rather, Gawande asserts, it is meant to deepen our understanding of the intricacies of medicine. “In most medical writing, the doctor is either a hero or a villain,” he says, with an edge in his voice. “What I am trying to do is push beyond that and show how ordinary doctors are – and at the same time show that what they can do is extraordinary.”In a section called “Mystery,” the author revisits cases that continue to baffle him, such as a woman whose initially unremarkable morning sickness persisted until the day she gave birth. Throughout the book, Gawande suggests that no complaint or treatment is routine. “During a surgeon’s career, there is a lot of uncertainty about exactly what to do,” Gawande explains.

“You’d love for there to be clear guidelines for everything, but that’s not the case.”Gawande has experienced the limitations of his profession not only as a surgeon, but as a parent. During the first month of his residency, his newborn son, Walker, suddenly went into heart failure.

“I had to go straight from assisting in the ER to the hospital across the street, where doctors explained to me what my son had to do to survive,” Gawande remembers. Walker recovered, and while he will need another surgery soon, the boy is expected to live a full, healthy life.Because he works at the hospital up to 110 hours a week, Gawande has to squeeze in his writing on nights and weekends. He says his long hours allows him to digest new experiences. And as he emphasizes in “Complications,” ambiguous and problematic situations arise with alarming frequency: “Last week, I operated on a woman in her forties who had a tumor in her abdomen. We opened her up and found the thing was huge. It had latched onto everything; we couldn’t get it out.

So we sewed her back up, and I had to sit down and explain to her that this was, well, it was the end of the line. At the end of this conversation, she just sat there looking at her belly.

There was our incision, which had been no good whatsoever. And she asked me, “Did you do that?’ And I said, “Yeah, I did.’ And she said, “It’s beautiful.’”Gawande retreats into himself for a moment. Finally, he says, “While I hadn’t done any good for her, there are those moments. It certainly does affect you.”John Freeman, Copyright (c) 2002 The Denver Post.

A brief summary and reflection of each chapterChapter 1: Education of a KnifeThis chapter was about introductory medicine and some misconceptions that are associated with learning how to become a doctor. In his first year as a resident, Gawandetalks about his experiences administering a central line and his initialstruggles. It was interesting to learnthe actual learning curve, and the way associate doctors teach new residents ormedical students.

Like any otherprocedure, practice makes perfect. Weoften look at medicine as infallible, but with learning comes inevitable mistakes.Chapter 2: The Computer and the Hernia FactoryThis chapter was very interesting.

First, this article emphasizes that practiceand ritual makes efficiency in the operating room. This was evident through the hernia repair systemthat worked so well.

Also, a Swedishstudy that was trying to answer if artificial intelligence was more reliablethan even the most specialized, trusted doctor proved that machine beat man by20 percent. There was the question ifgood medicine even needs good doctors, but that was quickly answered whentaking into consideration the human aspect to medicine.

Man is needed for healing, understanding, andadministering care than machine cannot provide.Chapter 3: When Doctor's Make MistakesGawande used this chapter to tell a story of one of hispersonal downfalls that almost lead to the death of a patient under hiscare. He also notes other surgicalmishaps that seem so obvious, such as leaving a metal instrument in someone’sabdomen or biopsying the wrong side of a breast. His point here is, all doctors make mistakesand it is a big part of being a doctor.Good doctoring is all about paying attention to detail and remainingdiligent and efficient. M &Mconferences are secret meetings where the truth is revealed and good doctorstake responsibility, incompetent ones blame others for mistakes or neglect themeeting all-together.Chapter 4: When Good Doctors Go BadThis chapter was all about the downfall of good doctors, andhow that decline comes about.

Whendoctors have learned their skill and have plenty of experience, as in the caseof Dr. Goodman, they may be tempted to take short cuts to save time. More time means more patients and moremoney. The fame that comes along withbeing the most productive or successful doctor sometimes clouds judgment andleads to hurting people.

Working fast asa doctor can really work against you, especially given the fact that these arereal people with families. Gawande alsotalks about the importance of being sensitive toward fellow doctors.

Family issues, health troubles, and manyother common problems often affect physicians and their practice but can beprevented by fellow partners being alert and willing to help.Chapter 5: Full Moon Friday the ThirteenthThis chapter dealt with superstition and the connectionbetween human activity and the lunar cycle. Gawande talks about a specific night during his residencythat was Friday the 13 th. At first, he refuses to believe that the moon canalter human behavior but is taken back by the severity and types of cases thatnight.Chapter 6: The Pain PerplexIn this chapter, Gawande talks about the mystery behindchronic pain. He admits that atfirst, chronic pain patients seem to be a waste of time and doctors actdismissive.

For patients, it seemsthat they do not necessarily need their pain to be understood but to be heardand treated. However, there is adifference behind physical and mental pain, and dependence on painkillers seemsto be typical for chronic pain patients. Multiple studies about pain have been carried out but seem to presentinconclusive findings. In somecases, it seems that killing certain brain cells or neuromodules in the braincan treat pain. Other patients canonly be treated with drugs, the pain acting more as a social epidemic. We should never assume people arefaking it, but we must be aware that pain can be theoretical and also carries apolitical aspect.Chapter 7: A Queasy FeelingThe feeling of queasiness is much more complicated than wethink.

Nausea is the most frequentcomplaint for which patients consult physicians, but it seems to get overlookedin the medical field. Nausea seemsto be memory related and adaptive. One case of a mother with untreatable pregnancy sickness points out thatdrugs do not always solve the problem, and a person can “cure” oneself if theyare in the right pace with themselves. Medications have limitations, and feeling truly comfortable limitspossible anticipatory symptoms felt by some patients.Chapter 8: Crimson TideAn interesting case was presented that dealt with a newsanchor that had a severe blushing problem. She loved her job but her autonomic nervous system responsesprevented her from progressing in her field. Gawande describes a procedure involving severing fibers of aperson’s sympathetic nervous system. After having the procedure done, the patient is completely relieved ofher blushing and acts like a completely new person.

The fact that this procedure was so successful makes onewonder what will be possible in the future. For the woman in this case, her problem involved both thephysical and the mental. Could itbe possible to cut a different nerve to solve other mental and behavioralproblems?Chapter 9: The Man Who Couldn’t Stop EatingThis chapter dealt with the obesity epidemic and the medicalperspective behind people who cannot stop eating. People eat because food tastes good, and they usually willeat until they are full. For some,as in the case of Vincent Caselli, it took an enormous amount of food tosatisfy his hunger.Physiologically, eating fast allows one to eat more before feeling fullor before the hypothalamus receives a “stop eating” signal from the gut. One of the most interesting storiesinvolves two men with profound amnesia.They were given meal after meal, but because their brain didn’t rememberthat they had just eaten they would finish every meal. It supports the theory that some peopledo not have control over their hunger or ability to feel satisfied.

Complications A Surgeon's Notes On An Imperfect Science Summary

For some, surgeries seem to fix theproblem if the patients are willing to abide by a new lifestyle.Chapter 10: The Final CutThis chapter was about the differing perspectives onautopsies from a family and physicians’ perspectives. Doctors seem to be desensitized by dead bodies as soon asthey receive their cadaver at medical school. Dissections are not pretty, and incomparable to a gentile,surgical procedure.

When there isa tough case, and one that you may be unsure about after the patient isdeceased, an autopsy may be necessary to determine the actual cause ofdeath. For a doctor, it is abusiness question but for a family the idea of an autopsy can be a bitintrusive. Gawande makes theanalogy that people are a medium between a hurricane and an ice cube: permanently mysterious but entirelyscrutable.Chapter 11: The Dead Baby MysteryThe dead baby mystery turns out to be a mass murder ofnewborns by a crazy mother. Atfirst, a puzzling disease known as SIDS, or sudden infant death syndrome, wassuspected because there was no other plausible pathological explanation. Doctors are taught to follow theirinstinct, and if a situation with a patient looks abusive they should act. In the end, she was found to havemurdered all eight of her babies. Sometimes not science but what people tell us is the most convincingproof we have.Chapter 12: Whose Body is it Anyway?This chapter brought up life or death decisions in medicineand the art of being a good doctor and a good patient.

Both must choose when to submit andwhen to assert. Even when patientsdecide not to decide, they should still question the doctor and insist onexplanations. For a doctor, youmust be a good listener and assure them that they have control over vitaldecisions. When a tough case ispresented, it is important to take into consideration the status of the patientand what is best for them at that point in their life.Chapter 13: The Case of the Red LegThe case in this chapter was almost mystical.

A flesh-eating bacteria that mimicsother common bacterial diseases infects a young girl. Gawande introduces a common error made by doctors to linkcases together and base diagnoses on previous cases. In the case of the red leg, Gawande was correct insuspecting it was A Streptococcus and ended up saving the girls life. Our intuition should never be questionedin moments of stress. It will notalways turn out the way we expect, but it will turn out for the better moretimes than not.