complications a surgeon's notes on an imperfect science review

Gawande's prose displays both the strengths and faults of reportage: an immediacy that takes the reader close to whatever is happening and a tendency towards observations that are at times superficial and trite. Many of the chapters were originally written as articles for the New Yorker and some unwieldy repetitions suggest that a little more editing would have helped turn them into a book. This may be because the book, although the product of an engaging, inquisitive intelligence, is not as systematic as its three-part structure suggests. What are the psychological effects of cutting open the unconscious bodies of patients you have talked to and in some cases come to like? Although Gawande has a philosophical turn of mind - he studied PPE as a Rhodes Scholar at Oxford before training as a surgeon at Harvard - these are not questions he chooses to pursue. This sentence touches on the paradox at the heart of the surgeon's profession, which requires him or her to perform acts that would, in another context, constitute an assault. 'The experience was odd and addictive,' Gawande admits, 'mixing exhilaration from the calculated violence of the act, anxiety about getting it right, and a righteous faith that it was somehow good for the person.' Human skin, he discovers, is thick and springy and he has to make two attempts to get through. The first time Gawande is called on to make an incision, the senior surgeon draws a six-inch line on a sleeping patient's abdomen and hands him a knife.

Mistakes are sometimes solved by surprisingly low-tech solutions, such as marking the patient's leg with felt-tip to ensure that the correct limb is operated on. There is the doctor who biopsied the wrong section of a woman's breast, delaying a diagnosis of cancer for months. There is the surgeon who left a large metal instrument in a patient's abdomen, where it tore through the bowel and the bladder wall.

The book is also about split second decisions that could mean life or death and the limits - often unsuspected by the patient - of both doctors and medical science. One of the most striking features of Complications is the unsparing detail about what happens in the operating theatre.

Complications a surgeon's notes on an imperfect science review