Complications A Surgeon's Notes on an Imperfect Science

Atul Gawande




Trade Paperback

288 Pages


Request Exam Copy Request Desk Copy
National Book Award Finalist
A New York Times Notable Book
A Boston Globe Best Book
An American Library Association Notable Book
A Discover magazine Best Science Book
Finalist for the L.L. Winship/PEN New England Award

Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is—complicated, perplexing, and profoundly human.

Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur, why good surgeons go bad. He shows what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won't go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande also ponders the human factor that makes saving lives possible.

At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.


Praise for Complications

"Reading Complications we become aware of the emergence of a new medical voice, and a welcome one. Here we find clinical perception, a wide-ranging knowledge of the pertinent literature, and the precocious wisdom of a young physician confronting the realities of one of America's leading hospitals. He writes with directness and lucidity—and humility as well—that lift the veil of obscurity and obfuscation behind which so many of the most far-reaching dilemmas of today's medical care have been half-hidden. The writings of Atul Gawande convey the quiet assurance and tone of the doctor acting as both observer and participant. This is clinical watchfulness at its best [and Gawande] brings to modern high-tech medicine the same clinical watchfulness that writers such as [William Carlos] Williams and [Oliver] Sacks have brought to bear on the lives and emotions of often fragile patients . . . We get an honest sense of the complexities of twenty-first century healing."—Sherwin B. Nuland, The New York Review of Books

"None surpass Gawande in the ability to create a sense of immediacy, in his power to conjure the reality of the ward, the thrill of the moment-by-moment medical or surgical drama. Complications impresses for its truth and authenticity, virtues that it owes to its author being as much forceful writer as uncompromising character."—The New York Times Book Review

"Gawande's sharp eye, crisp prose, and insightful understanding make his book as enjoyable as it is edifying."—Los Angeles Times

"Gawande's prose, much like the scalpel he wields, is precise, daring but never reckless. But it is after he exposes what lies beneath that we see the full measure of Gawande's gift: his compassion, his honesty, and a trademark hypervigilance paired with scholarship. Much like reading George Orwell, the reader emerges entertained, enlightened, transformed and immensely satisfied."—Abraham Verghese, author of My Own Country and The Tennis Partner

"Atul Gawande is a Harvard-trained surgeon and a former White House official, but he writes like a human being—and a born writer. Curiosity, wit, compassion, and humility are among f0the qualities he brings to these tales of modern medicine. The stories in Complications are gripping medical mysteries that always have something extra. He draws you in with the story but leaves you wiser about science, about health care issues, and even about the human condition."—Michael Kinsley

"Gawande is a writer with a scalpel pen and an X-ray eye . . . He turns every case—from gunshot wounds to morbid obesity to flesh-eating bacteria—into a thriller in miniature. Diagnosis: riveting."—Time

"Complications is a book about medicine that reads like a thriller. Every subject Atul Gawande touches is probed and dissected and turned inside out with such deftness and feeling and counterintuitive insight that the reader is left breathless."—Malcolm Gladwell, author of The Tipping Point

"No one writes about medicine as a human subject as well as Atul Gawande. His stories about becoming a surgeon are scary, funny, absorbing, and always touched with both a tender conscientiousness and an alert, hyper-intelligent skepticism. He captures, as no one else has, the doubleness of doctoring: what it feels like to see other people as fascinating, intricate, easily breakable machines and, at the same time, as mirror images of one's own self. Complications is a uniquely soulful book about the science of mending bodies."—Adam Gopnik, author of From Paris to the Moon

"Complications is a literary version of an informed consent form. It's refreshingly honest, if not always reassuring. Some people still prefer to think of surgeons as infallible gods. But Atul Gawande is a rare and wonderful storyteller who portrays his profession with bravery and humanity."—Ellen Goodman, author of Value Judgements

"Gawande has taken the art of physician narrative to a new level."—The Nation

"In vivid prose that manages to seem at once dispassionate and compulsively intimate, Gawande offers his readers an insider's view of both mysteries—that of the body and that of its caretakers."—Newsday

"A gem-like collection of essays on medicine by eighth-year surgical resident, Harvard Med graduate, Rhodes scholar, and New Yorker staff writer Gawande, himself the son of physicians. Part I contains chilling stories of medical errors, some the near-inevitable results of young docs learning their craft by practicing on live patients, some due to the burnout or depression of seasoned specialists. (To his credit, Gawande includes a tale of his own poor judgment in a medical emergency that fortunately ended happily.) Practice does make perfect, the author demonstrates; hospitals specializing in hernia repair, for example, maximize their efficiency for the greater benefit of patients. With profound empathy, Part II chronicles medical mysteries. Readers will feel for the pregnant woman whose nausea and vomiting could not be stopped no matter what antiemetic drug she was given—until her twins were born and that same night she was able to eat a hamburger with blue cheese and fries. Sadly, these anecdotes often serve as reminders that what doctors can't pin down they often dismiss, as when a man with incapacitating back pain was advised by specialists to see a shrink. In Part III, Gawande addresses the issue of uncertainty, an ever-daunting challenge in a profession where information is always imperfect. Autopsies, which would help clarify many cases, are performed with appalling infrequency, perhaps because they reveal a depressing rate of misdiagnosis. The new, more democratic relationship between physicians and patients may also have a downside when patients make the wrong decision. The final chapter reports on a case of heart-stopping suspense, lacking clear indications and plagued by great uncertainty, in which the doctors' intuition was critical. If Gawande's hands in the operating room are as sure as his handling of words, his success in his chosen career is all but guaranteed."—Kirkus Reviews

"These exquisitely crafted essays, in which medical subjects segue into explorations of much larger themes, place Gawande among the best in the field."—Publishers Weekly

"Gawande is arguably the best nonfiction doctor-writer around . . . He's prescient and thoughtful . . . the heir to Lewis Thomas' humble, insightful and brilliantly crafted oeuvre."—

Reviews from Goodreads



Read an Excerpt

Atul Gawande is a surgical resident at a hospital in Boston and a staff writer on medicine and science for The New Yorker. A graduate of Harvard Medical School and the Harvard School of Public Health, he has had his writing selected to appear in The Best American Essays 2002. Gawande lives with his wife and three children in Newton, Massachusetts.
Read the full excerpt



  • Complications by Atul Gawande--Audiobook Excerpt

    Listen to an audiobook excerpt from Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science, a 2002 National Book Award Finalist for Nonfiction. In gripping accounts of true cases, surgeon Atul Gawande explores the power and the limits of medicine, offering an unflinching view from the scalpel's edge. Complications lays bare a science not in its idealized form but as it actually is—uncertain, perplexing, and profoundly human.



  • Atul Gawande

  • Atul Gawande is a surgical resident at a hospital in Boston and a staff writer on medicine and science for The New Yorker. A graduate of Harvard Medical School and the Harvard School of Public Health, his writing has been selected to appear in The Best American Essays 2002 and The Best American Science Writing 2002.
  • Atul Gawande Tim Llewellyn
    Atul Gawande