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Summary

In the novel Complications, Atul Gawande, surgeon and author, brings the reader into the world of medicine and surgery. Gawande divides the novel into multiple essays. In his essay "When Doctors Make Mistakes", Atul explores the faults in medicine. Having an inside perspective, Gawande knows that all doctors make mistakes. Whether they are caused by unknown errors or plain negligence, he points out that mistakes are inevitable. Atul states, "The fact is that virtually everyone who cares for hospital patients will make serious mistakes, and even commit acts of negligence, every year," (Gawande 56). He describes a case in which he made a lapse in judgment, almost costing him a life. As one of his surgical partners attempted to clear a woman's airway, Atul noticed that she was getting progressively worse. However, he did nothing, "I should have called Dr. Ball for backup. I should have got the tracheotomy equipment out-lighting, suction, sterile instruments-just in case. But for whatever reasons-hubris, inattention, wishful thinking, hesitation, or the uncertainty of the moment-I let the opportunity pass," (51). This resulted in the woman temporarily losing her air supply and almost dying. Although Gawande believes that most doctors will never fully admit to their faults, he attempts to come to terms with his small, but significant error. Gawande also describes the dangers of anesthesia. Although it is a rare occurrence for patients to react badly to anesthesia, they surrender their bodies to the surgeons. Atul points out that many disasters evolve from other mistakes; once one doctor is at fault, another doctor is likely to make a mistake because of it. Yet, in spite of all this, Atul defends these surgeons, because human error is unavoidable.

Making a Mistake

Starting with his personal story, Gawande describes how common it is for doctors to make mistakes; he was called to the emergency room when a victim from a bad car crash arrived at the hospital. The victim was an older, heavy set woman who was unconscious and having difficulty breathing, therefore requiring a ventilator. As Gawande put it in, he hit the vocal cords, which caused immense swelling and bleeding in the woman's airway. Finally, the he inserted the tube and moved to other problems. Suddenly, he noticed the woman's oxygen level was dropping. After much hesitation, Gawande realized he needed to perform an emergency tracheotomy. Unsure of how to proceed, and unable to find the correct spot to cut, Gawande chose the wrong area of the neck, and hit a vein. After realizing that enough time had passed for the woman to suffer severe brain damage, Gawande called for help from a superior doctor who eventually completed the tracheotomy. In this short, personal story, one can see how common it is for doctors to lose control of a situation quickly and make a simple mistake. In Gawande's case, it was cutting through the woman's vein and wasting time before calling for help from another doctor. Upon realizing the reality and commonplace that doctors make mistakes, Gawande points out, “How could anyone who makes a mistake of that magnitude be allowed to practice medicine? We call such doctors ‘incompetent’, ‘unethical’, and ‘negligent’. We want to see them punished. And so we’ve wound up with the public system we have for dealing with error: medical malpractice lawsuits, media scandals, suspensions, firings.” (Gawande 55). Mistakes are a common occurrence in the medical field. Although we view doctors as all knowing and perfect, they are just like everyone else, and are subject to the possibility of making mistakes.

Examples of Mistakes

Gawande goes on to list other medical mistakes that doctors have made in the past. A general surgeon once left a large metal instrument in a patient’s abdomen, where it then tore through the bowel and the wall of the bladder. A cancer surgeon biopsied the wrong part of a woman’s breast, and thereby delayed her diagnosis of cancer for months. A cardiac surgeon skipped a small but key step during a heart valve operation, thereby killing the patient. A general surgeon saw a man racked with abdominal pain in the emergency room, and without taking a CT scan, assumed that the man had a kidney stone. Eight hours later, a scan showed a rupturing abdominal aortic aneurysm and the patient died not long afterward. These examples of mistakes are things that occur in the medical field which have consequences typically end with the death of the patient. A Harvard Medical School Practice Study found that about 4% of hospital patients have suffered complications from treatment, which either prolonged their hospital stay or resulted in disability or death. Two thirds of such complications were due to errors in care. One in four of these cases involved actual negligence. Nationwide, upwards of forty-four thousand patients die each year partly as a result of errors in care. The British psychologist James Reason argues in his book Human Error that, "our propensity for certain types of errors is the price we pay for the brain’s remarkable ability to think and act intuitively- to sift quickly through the sensory information that constantly bombards us without wasting time trying to work through every situation anew."

Anesthesiology

Gawande describes the dangers of anesthesia. He admires the efforts of Ellison Pierce and Jeffrey Cooper in their attempts to make anesthesia a safer practice. Anesthesiology is an extremely complicated field in which medical error can occur. When a patient is put under general anesthesia, the doctor is assuming complete control of the patients' body. Under anesthesia, the body is paralyzed and hooked up to a machine that is controlling the general vital functions like breathing, heart rate, and blood pressure. The brain is rendered unconscious. There is a seemingly infinite amount of things that can go wrong while under anesthesia, even in minor surgeries. Today, anesthesiologists have found that if they detect problems early, they are typically solvable. Ellison Pierce was a major campaigner for minimizing error during the procedure of anesthesiology. In 1982, Pierce was elected vice president of the American Society of Anesthesiologists, and was determined to minimize the death rate. With the help of a study conducted by engineer Jeffrey Cooper, Pierce was able to discover multiple errors which occurred under anesthetic procedure. Pierce then implemented changes in the way the procedure worked. He reduced the number of hours anesthesiologists worked, standardized machines with fallible human beings in mind, and created dials that turned in a uniform direction; locks were also put in to prevent accidental administration of more than one anesthetic gas, and controls were changed so that oxygen delivery could not be turned down to zero. Through these implements, the procedure of anesthesia became safer.

Relation to the topic of Healing Narratives

In recent times, Narrative medicine has become a field of high interest. In today's culture, one can study modern narrative medicine as well as historic narrative medicine. Atul Gawande's novel, Complications, relates to modern day healing narratives. Gawande incorporates the patients feelings along with medical background, which is a common theme in many illness narratives. These narratives typically follow patients throughout their illness, describing their feelings that are a result of the illness. They are either depicted by an outside source who has insight into the life of the patient, or by the patients themselves. In the novel, Suffering in the Land of Sunshine, the narrator is also the patient, therefore a direct view of his illness is given to the readers. Conversely, in the novel, The Lonely Patient, the doctor narrates the patients' stories, giving an outside view of their illnesses. Different illness narratives can give readers varying types of insights into illnesses.

External Links

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