On a Berkeley Saturday afternoon marked by weather that is the envy of friends who don't live in the Bay Area, I trotted over to my local branch of the Berkeley Public Library to pick up the latest book on hold for me: Complications: A Surgeon's Notes on an Imperfect Science The book first entered my consciousness when I encountered an essay in The New Yorker by Atul Gawande, the book's author. When my friend Grace then emailed me some of her thoughts about Complications, I threw the book on my Berkeley Public Library hold list (a la Netflix), looking forward to reading the popular book whenever it happened to come my way.

That time came today. With book in hand, I partook in one of my favorite lazy afternoon activities -- drinking Darjeeling tea while reading in a local cafe. After reading the first three chapters, I am ready to write some of my preliminary thoughts on the book.

First of all, Gawande reminds me quite a bit of Malcolm Gladwell and Adam Gopnik -- two fellow staff writers for The New Yorker-- who wrote endorsements of the book. I can invariably count on essays from Gladwell, Gopnik, and, as I'm learning, Gawande, to be sparklingly intelligent works that make routinely inspire me to write this or that point down and tell my friends about some neat thing I had just learned. (Never read Gladwell? Then try his "Six Degrees of Lois Weisberg" -- I was glad to see Catherine's mention of it several weeks ago.) Their essays are memorable and satisfying.

(Trouble is that they are too satisfying sometimes, certainly for my questioning, never-quite-settled-life-can't-be-that-simple mentality. After reading some of the essays in The New Yorker, I think, "wow, is it really that simple?" Now, that can be the mark of superb explication and things really weren't that difficult after all. However, I often get the feeling that a lot of things have been swept under the carpet. I can't point to any specific example right now -- so I may just be full of hot air. But I digress.)

Complications is a book about surgery written by a young surgeon who happens to also be a superb writer. There are probably better surgeons than Dr. Gawande, but few are able to tell us outsiders about surgery the way that he can. I love books of this ilk, written by practitioner-essayists, ones that promise to unveil the mysteries of a field in wonderful prose.

So why do I care about surgery? No one I know is about to undergo surgery (knock on wood) -- but it's almost a certainty that my loved ones and I wll undergo major sugery some point in our lives. I've been feeling this urgency to be prepared for that event, to know as much about this mysterious process of modern medicine as I can as a layman so that I can be an effective advocates for others and for myself. When I was a kid, I used to have this implicit, imperturbable trust of doctors. When my parents questioned their judgement, I was thought that my parents were rubes; surely, my mom and dad just didn't grok the sophistication of modern western medicine.

I now think that I was the rube. I now am quite skeptical of what the medical system can provide in the way of care. Not that I've stopped going to my doctor. But I have a caveat emptor attitude. Doctors are human, very imperfect like the rest of us. This is also very scary since I don't want my doctor to make mistakes, especially with me and with the ones I love. Thankfully, it seems, physicians are often correct and the system works well enough. But that next mistake might be the one that kills you or someone you care about -- and it's that thought that fuels my interest in books like Complications (I'll just mention in passing that Frederick Wiseman's six hour documentary Near Death, which I saw recently has also been part of my recent exploration about modern medicine.)

Gawande jumps right in with a question that has probably bothered a lot of us: Physicians (and specifically, surgeons) have to practice on people in order to become proficient -- so how do we reconcile this reality with our individual demand for the very best care for ourselves and for our loved ones? It is both reassuring (but a bit disturbing) to read that many physicians -- when push comes to shove -- don't want residents (the inexperienced members of the profession) to operate on their loved ones either. The author was one such person. (pp.31-32) And because they are the insiders, they often get the best treatment because they know how the system works. As Gawande writes poignantly: "If learning is necessary but causes harm, then above all it ought to apply to everyone alike. Given a choice, people wriggle out, and those choices are not offered equally. They belong to the connected and the knowledgeable, to insiders over outsiders, to the doctor's child but not the truck driver's. If choice cannot go to everyone, maybe it is better when it is not allowed at all." (pp. 32-33) I'm looking forward to seeing some answers to this dilemma. The next time I have to advocate for someone, do I say, "sure, go ahead, let your people learn on my mother because if it's not my mother, it's someone else's" or do I say, "I know how this system works -- there's no way that my mother will be the guinea pig."

Above I mentioned that my eternal infatuation with doubt. No wonder I was then struck by the following passage: "There is a saying about surgeons, meant as a reproof: 'Sometimes wrong; never in doubt.' But this seemed to me their strength. Every day, surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect....But he [the surgeon] still cut." (pp. 15-16)

There's more to say -- and I hope to return to writing more about Complications. The first chapters have lots of intriguing thoughts about how surgery might benefit from systemic reform instead of a focus on individual faults and an unexpected discussion on human errors (a systematic study of human error still strikes me as slightly paradoxical). But I got to stop for now.

(If this little blog entry is not enough to arouse an interest in the book, perhaps an interview with Gawande in The Atlantic will. Google also yielded a book review that comes from a medical perspective.)