Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science is a collection of essays that weaves narratives from Gawande’s personal experience as a surgical resident together with research, philosophy, and case studies in medicine. Published in 2002, Complications became a 2002 National Book Award Finalist for Nonfiction. Complications A Surgeon’s Notes on an Imperfect Science PDF Free Download Preface: ‘Those who believe, as many of us need to at some time in our lives, that doctors know best will not be pleased to read Atul Gawande’s book.

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. Momodora reverie under the moonlight download. 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.

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.

Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande. Metropolitan Books, $24, pp 288. ISBN 080 506 3196.

Rating: ★★★Complications is a collection of essays about doubt and uncertainty in medicine. As well as being a surgeon, Atul Gawande is a staff writer on medicine and science at The New Yorker, and some of the essays in this volume have appeared before. For example, “When Doctors Make Mistakes,” which is a frank account of what often happens “behind the scenes,” was included in a collection of the “best American science and nature writing 2000,” and with good reason. Gawande has a way of writing that demystifies medicine.In “Education of a Knife,” Gawande touches upon the sensitive issue of training in a way that is rarely discussed outside the medical fraternity. Medicine—especially surgery—is the classic example of learning by trial and error. For obvious reasons, no one wishes to be the patient on whom the learning is done.

What this means is that the learning, and the mistakes—sometimes fatal ones—have to be done at the expense of the unconnected and the poor, usually in teaching or university hospitals, while the rich get the choice of being seen by fully qualified senior physicians.Gawande would, however, be happy to know that at least one study has shown that, contrary to common belief, there is no increase in deaths in early August, when newly qualified doctors become house officers. Practice makes perfect, however, and this is amply shown by the stupendous results at the Shouldice Hospital, Canada. Here surgeons restrict themselves to performing only hernia operations, take from 30 to 45 minutes per operation, and have a recurrence rate of 1%. In contrast, most general surgeons would take about 90 minutes per case, yet have a relapse rate of 10% to 15%.Gawande takes a dig at medical conventions—and at medical morals—when he refers to chintzy freebies (golfballs, fountain pens, canvas bags) being lapped up by six-figure surgeons who should be immune to such petty bribery. There are also essays dealing with everyday medical problems such as nausea, pain, and blushing. Although Gawande expands on the current thinking on the pathophysiology, the focus is on the unanswered questions.

He examines the role of sentiment and gut feeling, which is often the sum total of our experiences in a world of evidence based medicine. Importantly, he also boldly questions the blind acceptance of patient autonomy as an absolute truth.Gawande adopts an interested third person approach—like, say, an Isaac Asimov, rather than an involved, treating physician like Richard Selzer. He confirms Somerset Maugham's belief that the best “training for a writer is to spend some years in the medical profession.”.