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Complications: A Surgeon’s Notes on an Imperfect Science

  • Book by Dr Atul Gawande (£8.99, Profile Books, 2008)
  • Reviewed by Dr Omar Mukhtar, ‘Darzi’ Fellow, Health Education South London (UK)

Complications: A Surgeon’s Notes on an Imperfect Science is a collection of essays focusing on the fundamentals and imperfections of modern surgery. With many originally written for The New Yorkermagazine, where Atul Gawande has been a staff writer since 1998, the essays provide an honest insight into the world of modern healthcare that extends beyond the operating theatre and the consulting room – ultimately, affording readers an opportunity to reflect on the human condition itself.

Broadly grouped around three central themes – Fallibility, Mystery and Uncertainty – Gawande’s essays slowly dismantle the misconceptions held by the general public whilst challenging the status quo fostered and maintained by the medical hierarchy. He admits freely that medical professionals make mistakes, that much of the knowledge we hold so dear is based on a loose interpretation of facts (often acquired many years ago) and that we do learn ‘on the job’. He also acknowledges that there is much about the human body that remains stubbornly mysterious, that good doctors do go ‘bad’ and that there might be a case for super-specialisation from the outset of medical training.

Written with a clarity often lacking in ‘populist’ musings on healthcare, Gawande’s work draws not only on his experiences as a general/endocrine surgeon at Brigham and Women’s Hospital, Boston, Massachusetts, but also on his experiences as a father. Equally, many of the essays make reference to the scientific literature without resorting to a dry recall of facts, in a manner that must be applauded – regardless of whether they relate to the chronic pain of a stranger or the horror of a life-threatening respiratory infection afflicting his youngest child (born prematurely). That said, despite being a Rhodes Scholar who studied PPE at Oxford, Gawande’s observations tend towards the superficial cliche – perhaps a consequence of the immediacy required when writing for a periodical that is published 47 times a year.

Despite this, Complications has a charm, confidence and humility that you suspect is intrinsic to Gawande himself. The first of three books (the others being Better: A Surgeon’s Notes on Performance and The Checklist Manifesto: How to Get Things Right), you might not be wrong in assuming that it is Gawande’s personal testament to a quality and safety agenda that is only now taking root in certain countries – a decade after Complications was first published.

The Secret Anatomy of Candles

  • Book by Quentin Smith (£8.99, Troubador Publishing LTD, 2012)
  • Reviewed by Dr Catherine Walton, CT3 Psychiatry, Wales (UK)

Quentin Smith has delivered a promising debut novel. The Secret Anatomy of Candles is a medicolegal drama with an ethical dilemma that will hook even the most world-weary of medics, and stir them to discuss the central themes with colleagues over coffee.

The ideas and questions raised by the novel are topical and relevant; for example, one important theme of the book is the MMR vaccine. The week I read the novel was during the time of intense media coverage of the measles outbreak in the Swansea area. So it was immediately relevant.

The world of Jasper Candle, a “ruthless compensation lawyer”, is set in the courts, bars and streets of Durham. The description of the city is excellent: Smith shows a flair for this, and it was effortless to conjure up the areas described in my mind’s eye.

The man himself, Jasper Candle, is a character of some depth, with the flaws and nuances one would expect of a successful lawyer of his standing. Unfortunately, the character is perhaps rather too typical – the flaws and nuances feel somewhat unoriginal. It is clear that Candle is troubled by a physical ailment, the development and diagnosis of which is essential to the plot. Unfortunately, as a medic reading this novel, the diagnosis became clear rather sooner than I feel the author would have hoped in order to maintain suspense through to the twist at the end.

However, having discussed the plot with family members, I feel that this would not have been so apparent to a non-medical audience. Other characters within the book are somewhat more intriguing. In particular, the investigator Lazlo is perhaps the most interesting. His clothes and ‘cheap’ piercings put him firmly in the lower class, but he shows understanding and insight into the feelings and motivation of his employer, Candle.

The plot itself is complex and several themes run in parallel. This would be confusing were it not for some skill on Smith’s part in keeping the chapters short and succinct. It also had the added benefit of keeping the pages turning. If I had any criticisms of the novel it was the use of cockney rhyming slang to add ‘depth’ to Candle as a character – it felt unnecessary and at times plain out of place. I also think that sometimes Smith utilised long and challenging words and sentences, which over-complicated the style of the book.

Overall, I felt that this was a great read. The storyline is relevant, up-to-date, and made me think about certain issues from a different perspective; it is certainly one to consider for your next bedtime book.

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