Surgical resident Atul Gawande had just 45 minutes to eat dinner, tuck his three kids into bed and say goodnight to his wife before heading from his Newton home back to Brigham & Women's Hospital. Awaiting him was a difficult case: an elderly woman with a dead bowel, caused by a stroke from a blood clot.
The operation, which took about three hours, was a tricky one, but according to Gawande, "It went as well as you could hope it would." By 1 a.m., he was back at home, where he grabbed about four hours of sleep before returning to the hospital at 5:45 a.m.
All in all, it was a pretty typical day.
"I call him a fiendish ball of energy," says his wife, Kathleen Hobson. "He's always wanting to go on to the next thing, he doesn't just sit still."
That's how, despite working an average of 110 hours a week at the hospital, he has the time - not to mention the talent - to become a staff writer for The New Yorker magazine, where he turns out four lengthy pieces a year on complex medical issues.
And one more thing: In April, Gawande completed his first book, "Complications: A Surgeon's Notes on An Imperfect Science". Several of the chapters had already appeared in The New Yorker - such as "The Man Who Couldn't Stop Eating," "Education of a Knife" and "When Good Doctors Go Bad." They caused quite a stir.
"My goal was to take on a subject that I thought is at the edges of medicine, but that is very revealing, which is imperfection in medicine - why things don't turn out the way we necessarily expect them to," Gawande says.
In clear, gripping prose, he explores the mysteries and uncertainties of the medical profession, dwelling on miraculous saves, as well as tragic errors.
But by turning his attention to the touchy topic of when and why mistakes happen, Gawande enters sensitive territory. Through candid, anecdotal narratives, he probes not just the errors of other doctors, but also his own. In "Complications," he invites his readers into the inner sanctum, where we stand right next to the surgeon wielding the scalpel under the bright lights of the operating room.
Gawande takes us through the procedures and decisions that doctors encounter every day, allowing us a rare opportunity to see the practice of medicine up close. The result is a book that, by sharing some of its secrets, manages to humanize the medical profession and its practitioners. What's more, it does so in jargon-free terms that the layman can understand.
Surgical resident Atul Gawande had just 45 minutes to eat dinner, tuck his three kids into bed and say goodnight to his wife before heading from his Newton home back to Brigham & Women's Hospital. Awaiting him was a difficult case: an elderly woman with a dead bowel, caused by a stroke from a blood clot.
The operation, which took about three hours, was a tricky one, but according to Gawande, "It went as well as you could hope it would." By 1 a.m., he was back at home, where he grabbed about four hours of sleep before returning to the hospital at 5:45 a.m.
All in all, it was a pretty typical day.
"I call him a fiendish ball of energy," says his wife, Kathleen Hobson. "He's always wanting to go on to the next thing, he doesn't just sit still."
That's how, despite working an average of 110 hours a week at the hospital, he has the time - not to mention the talent - to become a staff writer for The New Yorker magazine, where he turns out four lengthy pieces a year on complex medical issues.
And one more thing: In April, Gawande completed his first book, "Complications: A Surgeon's Notes on An Imperfect Science". Several of the chapters had already appeared in The New Yorker - such as "The Man Who Couldn't Stop Eating," "Education of a Knife" and "When Good Doctors Go Bad." They caused quite a stir.
"My goal was to take on a subject that I thought is at the edges of medicine, but that is very revealing, which is imperfection in medicine - why things don't turn out the way we necessarily expect them to," Gawande says.
In clear, gripping prose, he explores the mysteries and uncertainties of the medical profession, dwelling on miraculous saves, as well as tragic errors.
But by turning his attention to the touchy topic of when and why mistakes happen, Gawande enters sensitive territory. Through candid, anecdotal narratives, he probes not just the errors of other doctors, but also his own. In "Complications," he invites his readers into the inner sanctum, where we stand right next to the surgeon wielding the scalpel under the bright lights of the operating room.
Gawande takes us through the procedures and decisions that doctors encounter every day, allowing us a rare opportunity to see the practice of medicine up close. The result is a book that, by sharing some of its secrets, manages to humanize the medical profession and its practitioners. What's more, it does so in jargon-free terms that the layman can understand.
"The language is determinedly un-showy, because he's aiming for a kind of transparency," says Gawande's New Yorker editor, Henry Finder. "It's very difficult to achieve."
Achievement and Gawande are well-acquainted. In addition to obtaining both a medical degree and a master's in public health from Harvard University, he attended Oxford University as a Rhodes scholar. He also served as the chief social policy adviser for Bill Clinton's infamous "War Room" - the group of bright young thinkers who helped shape Clinton's winning campaign in 1992.
Gawande later secured a job in government as a senior adviser to the Department of Health and Human Services. But in the end, he decided he preferred medicine to politics. "I got lucky to be one of the young Turks who were part of that world," Gawande recalls. "But once I was in the administration, there was only so far that someone as young as I was could go."
So Gawande, the son of two doctors who immigrated to Ohio from India, stuck to his family roots and returned to medicine. Although he says he wasn't pushed to become a doctor by his parents, Gawande does credit his heritage as a second-generation immigrant with his need to excel.
"I think it's a large part of why I'm so driven," he explains. "I think it comes from the sense of wanting to belong, and that you can imagine that you don't really fit in, and so the way you're gonna allow yourself to fit in is to try to earn your way, and I definitely have a strong sense of having tried to do that."
Gawande admits that luck has also played a role in his success. "I've gotten a lot of breaks and I've been very connected at times," he explains. "I have great friends, who then happen to go on and do great things."
A case in point is Malcolm Gladwell, a friend of Gawande's who writes for The New Yorker, and who eased his entree to the august magazine.
He also has a highly supportive wife. "I am definitely the ultimate back-up, so he doesn't have that worry," says Hobson, who gave up her career as an editor to stay at home and raise their three kids. And Newton, where the couple has lived since 1993, has proven to be a good fit.
As a surgical resident and writer on medical issues who also has a deep knowledge of politics, Gawande is uniquely positioned to affect change in the closed world of medicine.
In "Complications," he breaks with tradition by revealing some of his own mistakes, detailing what he did wrong and why.
For example, in an early chapter of the book, Gawande describes how an obese trauma patient, whom he calls Louise, arrived at the hospital at 2 a.m., unconscious after a car crash. She was having difficulty breathing, and so Gawande decided she needed to be intubated.But Gawande, due to a combination of exhaustion, inattention and possibly hubris, did not call for backup.
Finally, the situation had deteriorated to the point where he asked for Dr. Ball, the surgical attending, who was with a patient one flight below.When Ball arrived, there was little anyone could do. Louise was in danger of dying when Johns finally managed to squeeze a much smaller, pediatric endotracheal tube down her throat, and save her.
Gawande believes that the practice of medicine could only benefit from greater openness. "Your training is to deal with those situations by, number one, admitting them up front, admitting them to everybody in the hierarchy, and (explaining) how it's going to be different next time," he says. "And number two, also having to begin to admit these things to patients, and that's part of why I'm writing about it, I think. It's not so much to expiate my sins, but I think to fulfill a responsibility that we have."
It is Gawande's hope that his book will help both doctors and patients see the inevitable "complications" that take place in a more constructive light. His message, as Gawande sees it, is that "Medicine turns out to be less perfect than we expected it would be, but at the same time, more extraordinary."
Gawande is now writing another article for The New Yorker, and has one more year to go to complete his residency. Although his plans for the future are fluid, he says he would someday like to join the faculty of a medical school as a professor of surgery. And he intends to keep on writing.
Beyond that?
"Just take the ride wherever it goes," he says. "It's been fabulous so far."
