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Complications (thoughts)

September 3, 2009

ComplicationsI’ve mentioned a couple times that the most difficult part of my recent POC resolution was to read 25% nonfiction by POC authors. So I’ve been researching it pretty heavily, and I was delighted to come across Complications: a Surgeon’s Notes on an Imperfect Science written by Atul Gawande. I was even more delighted when I started reading it and realised it was an essay collection, since I’m horribly behind in the My Year of Reading Dangerously Challenge, for which I promised to read more essays.

And then I forgot all about that, and just became lost in Gawande’s wonderful prose, his thoughtful philosophies, and his compelling stories. Which is to say, I love this book and I think everyone should read it.

As implied by the title, the book is about medicine in the twenty-first century, with all of its ambiguities. Gawande doesn’t shy away from tough issues: topics include the morality of teaching doctors their craft on actual patients, whether autopsies should be performed, and the rate of mistakes in hospitals. As regular readers know, I have a chronic illness called fibromyalgia. It’s one of those things that can’t be magically treated with a pill or surgery, one of those that makes me, in Gawande’s words, “a spectral, ever-present reminder of failure-the kind of patient whose very existence is a reproach to [the doctors] and their expertise.” It took them over a year to diagnose me, and during that time not only did I go through every test known to man, but I was regularly accused of being a hypochondriac or simply a liar (I was 15, and despite having friends and being a straight-A student, several doctors thought I just didn’t feel like going to school). Even upon diagnosis, there wasn’t much they could do to help me (other than an awesome biofeedback thing), and I came out of the whole experience with a deep distrust of the medical establishment.

All of that being said, there were two or three doctors who were simply wonderful (including the one who taught me biofeedback), who gave me hope and worked with me and who obviously cared. And in reading Complications, I felt like I had found another one of those doctors. Gawande’s willing to admit the flaws in his profession, but he’s not unrelentingly negative. After all, modern medicine can do some pretty miraculous things, and most doctors do want to help people.

I don’t think I’m reviewing this book very well! I suppose I wanted to provide background, so you know going in that I was more than a bit skeptical of anyone with an M.D. after their name. That way, when you hear me gush all about the book, you’ll realise just how big a gap Gawande bridged to affect me as a reader.

So let’s start the gushing! There’s a marvelous mix in here of Gawande’s personal stories as a surgical resident, individual patient stories, medical innovations and discoveries, and medical philosophy. The balance is perfect; I was constantly interested in and entertained by the essays, and I had to force myself to slow down so that book would last longer. I read a lot of nonfiction, but there aren’t too many nonfiction books I would describe as page-turning. Complications is one of them.

In addition to the fascinating subject matter, Gawande’s voice, his ability as an essayist, makes the book. He comes off as so human, with a deep care for his patients, worry about dilemmas, wonder at the latest technology. I think it’s impossible to not empathise with him, and the way he recreates events it feels like you’re there. I found myself holding my breath with him, as a patient crashed in the ER, as if I were watching a medical drama! He also talks with many of the patients long after their initial contact, so it’s obvious he invests in the patient-doctor relationship. And by getting to know them more, he can tell the reader more about their lives, which makes for stronger essays. The whole book works on both the intellectual and emotional levels!

I think the best way to convince you that you need to read this book is simply share some excerpts. From the introduction:

We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is sciencein what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.

From “The Pain Perplex,” an essay which discusses new discoveries that *all* pain is ‘in your head’ and equally real regardless of how it originates (as a fibro sufferer, who has to endure a lot of skepticism, this essay made me cry simply because it validated me):

When doctors encounter a patient who has chronic pain without physical findings to account for it-and such patients are exceedingly common-we tend to be dismissive. We believe the world to be decipherable and logical, to come with problems we can see or feel or at least measure with some machine.

When you feel pain, it’s your brain running an neuromodule that produces the pain experience, as if someone pressed the PLAY button on a CD player. And a great many things can press the button…The way Melzack explains it, a pain neuromodule is not a discrete anatomical entity but a network, linking components from virtually every region of the brain. Input is gathered from sensory nerves, memory, mood, and other centers, like members of some committee in charge of whether the music will play. If the signals reach a certain threshold, they trigger the neuromodule. And then what plays is no one-note melody. Pain is a symphony-a complex response that includes not just a distinct sensations but also motor activity, a change in emotion, a focusing of attention, a brand-new memory.

That’s just a small flavour, but I think you can get a sense of Gawande’s marvelous writing ability from it. As for me, I’ve already put his second book, Better on hold.

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30 Comments leave one →
  1. September 3, 2009 7:28 am

    Wow–you were really rewarded for challenging yourself!

  2. September 3, 2009 7:30 am

    This sounds really good! Peter and I have had the opposite of your experience, though admitedly the reasons for all the doctors were very different for the two of you. Atrial fibrillation is also a condition difficult to initially diagnose. He was told numerous times he was having anxiety and panic attacks and was sent to a psychologist rather than a doctor. Once the condition was finally discovered, however, the medical community was amazing for us!

    It must have been va bonus to have all the health care reform hoopla going on while you were reading this. It had to have given the book and the debates even more meaning.

    Lezlie

  3. September 3, 2009 7:52 am

    I agree, it’s so hard to find nonfiction POC books. There are so many good books *on* POC but *by* non-POCs, which is what I usually read. Thanks for the review of what sounds like a wonderful POC nonfiction book!

  4. September 3, 2009 9:10 am

    This book does sounds really amazing, Eva. But your review, well, that was beyond amazing. My heart breaks for all the emotional pain you had to endure, on top of all the physical pain, just to get someone to really listen and take you seriously. But I’ve told you all that before, and I don’t want to sound like a broken record. I do want to say that I think it’s so wonderful that you share your story…because I suspect that you’ve helped others that you don’t even know you’ve helped.

  5. Shannon permalink
    September 3, 2009 9:17 am

    I was going to suggest this one when you asked for recommendations, but I thought POC meant only African Americans, which Gawande is not. I’m really glad you ended up finding it on your own, though! I read this earlier this year and I loved it. He seems so smart and honest, and I felt like I had learned a lot about surgeons and hospitals. I tried to read his second book with my boyfriend, but it didn’t quite work out lol.

  6. September 3, 2009 10:44 am

    As usual, Eva, you are my Oprah. I will be snagging this from the library (and then, with any luck, Joel will see it and be intrigued and my continual plan to get him to READ more will thank you).

  7. September 3, 2009 10:48 am

    This is a book I’ve been planning to read for a while, but now I’m clicking right over to my library’s website and placing a hold. I need to read more essays before the end of the year, too!

  8. September 3, 2009 1:41 pm

    Great review, Eva! The book sounds very interesting. The quote about pain really made me think & I’d love to read the essay it’s from. I’ll have to check if this book is available in any library over here.

    Greetings,
    Tiina

  9. September 3, 2009 1:59 pm

    Thanks for your review! I think I will be reading this one. I’ve had a similar experience to what you have had. I was passed around and poked and prodded for years before someone finally diagnosed me and provided a treatment that is, generally, working. The doctor that diagnosed me and continues to treat me also teaches at a medical school, so he is constantly updating his knowledge — I think that worked to my benefit. It also helped that he took my condition seriously.

  10. stacybuckeye permalink
    September 3, 2009 2:03 pm

    What a wonderful review. Thanks for sharing your experiences the book.

  11. September 3, 2009 2:18 pm

    I swear Eva! You have a way of making me want to read books that I would otherwhise NEVER pick up! This one just sounds awesome though!! I’m going to see if my library has it! That’s ashame that you went so long without getting the help you needed for your fibro :( I’ve heard that from a lot of people…I had the same thing with my migraines. I basically got “take some tylenol and stop complaining”. Yeah, if that worked I”D BE DOING IT!!!!

  12. September 3, 2009 2:44 pm

    I read this last year (I think, might have been his other one, but this seems right!) and the part that really stuck with me is that patients think drs should be experienced in everything, but no one wants to be the practice dummy. While *I* don’t want to be the practice dummy either, it does makes me a lot more understanding.

  13. September 3, 2009 3:27 pm

    While my experience is very minor compared to yours, I can in a small way sympathize. I have several problems with my feet which basically mean it always hurt to walk- I practically limped my entire way through high school. Nobody took it seriously and I was always shrugged off, until they finally found out what was really wrong. It’s still just something I have to deal with, but knowing how to buy the right kinds of shoes and having orthodics made a lot of difference.

    I think I’d find this book really interesting.

  14. Laura permalink
    September 3, 2009 5:29 pm

    Eva-
    I’m a longtime reader and first-time commenter. I had to comment because I’ve read both of Dr. Gawande’s books and I agree that he is absolutely incredible. He is also a regular contributor to The New Yorker, and wrote an amazing piece on health-care reform:

    http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

    He’s a great writer. I work as a medical editor and can tell you that’s a rare thing!!!!

  15. September 3, 2009 7:55 pm

    I’m sorry you had such difficulty with doctors – it’s so maddening not to be listened to. But this book sounds great!

  16. September 3, 2009 11:45 pm

    Wow, what a lovely review Eva. I don’t think I’ve read anything like that, so I’m putting this book on my wishlist. Thanks a ton for the review.

  17. September 4, 2009 1:36 am

    I love it when I pick up a book for some reason or other but end up totally immersing myself in it.

  18. September 4, 2009 3:19 am

    Lisa, this is what I’m loving about my new POC resolutions-I get pushed to read interesting bokos I probably wouldn’t have otherwise!

    Lezlie, I’m so glad the doctors have been able to help your husband. :D I try to avoid reading much about domestic politics, but it definitely made the book a bit more interesting!

    Rhapsody, I know! Isn’t that weird?! lol Most of the ones I’ve found are either memoirs or deal with race issues (which is fine, but where are the POC science books?! or international relations books?! you get the drift), which I find frustrating.

    Debi, thank you so much. *hugs*

    Shannon, nope; POC=pretty much anyone who isn’t white, lol. I’ve never had a boyfriend who loved to read, so I can’t imagine trying to read along with one! :)

    Raych, oh: let me know if Joel reads it too! And I hope you enjoy it!

    JoAnn, I hope you enjoy it!

    Tiina, it’s an older release, so with any luck you’ll be able to get your hands on it. :) Some of his other essays are available online at his website; just google his name and it’ll come up.

    Terri, it’s good you finally have a great doctor! But the medical establishment really sucks sometimes, right?

    Stacy, thanks!

    Chris, yay! I hope you enjoy it! lol @ the migraine thing; really bad migraines is actually what I first got sick with (and what triggered my fibro), so I’m with you there. They randomly went away for me-I have no idea why, but I don’t question gifts from the universe! I hate it when people give unsolicited advice; lots of people when finding out I’m a vegetarian think if I just ‘ate a hamburger’ once in awhile, my fibro would go away.

    Lisa, that essay was incredible, wasn’t it? It definitely struck me too; since I was at a teaching hospital when I got sick, I got used to having to meet with a different resident every single time. It got old pretty fast though!

    Jeane, that’s awful! I’m glad that now you know how to deal with it, but having such pain without acknowledgement could not have been fun. :(

    Laura, thanks so much for commenting! Do you have a blog for me to visit? I’ll be reading the article you linked to momentarily-thanks.

    Jenny, I think you’d enjoy it!

    Violet, thanks so much. I had a hard time writing this one, so I’m glad to see other people like it more than I did!

    J.T., I love it too!

  19. September 4, 2009 10:21 am

    I like reading books about medicine and doctors anyway, so this book appeals to me.

    I had some interesting experiences with doctors when I was trying to figure out what was wrong with me a few years ago – it turned out to be hypothyroidism.

    My sister is unfortunate enough to have both hypothyroidism and fibromyalgia. I had subclinical hypothyroidism, and have heard that it can act just like fibromyalgia too. (That’s when your TSH score is on the high end of the acceptable range but you still have all the symptoms. Thankfully my score went into the abnormal range and I got the right treatment. The doctors didn’t know what to do until then. I have to keep my score under 2 even though anything under 5 is considered normal.).

    Ok, probably too much information there, but it was a hard-won battle to figure out what was wrong with me and how to fix it. I went through a lot of doctors (one of which thought I had some tropical disease, another thought I had a neurological disorder).

    I’m glad that you have found doctors who have been more caring and helpful.

  20. September 5, 2009 10:34 am

    This sounds like a truly amazing book. Not only is the premise very intersting and right up my alley, your samples of his writing are stunning. Must get my hands on it. Must!

  21. justicejenniferreads permalink
    September 5, 2009 6:50 pm

    One of my goals this year is to read a lot more nonfiction – you can learn so much! Adding this to my list in that category, which is growing so fast! Didn’t know there is so much awesome stuff out there!

  22. September 7, 2009 7:25 am

    Alyce, I’m so sorry for you and your sister. :/ It’s so fristrating when it takes so long to get a diagnosis!

    Andi, yeah-he’s one of the best essayists I’ve ever read.

    Jennifer, I LOVE nonfic! So if you want any suggestions, just let me know. :)

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