In a stunning collage of metaphor and medicine, seemingly unrelated vignettes of consultations, treatments, and surgeries are woven together to create conclusions that reflect upon human nature and the state of medicine. Atul Gawande’s breathtaking sophomore work, Better: A Surgeon’s Notes on Performance, is infused with countless insightful lessons on improvement, shaped by his personal experiences as a surgeon and relevant to all aspects of life. The reader is transported between war zones, delivery rooms, and village hospitals, where Gawande examines with surgical precision the doctors, teams, and hospitals striving to do more than just enough.
Alongside seamless transitions between India and the West, Gawande introduces his philosophies through situations of emergency surgery in an overcrowded Maharashtrian hospital, malpractice cases in American courtrooms, a polio mop-up in Karnataka, a high-performing cystic fibrosis clinic in Minneapolis, and a 39-hour delivery in Boston. Each story is stunningly real and human, breaking down the barrier between doctors and patients in a genuine endeavour to cultivate a greater depth of medical understanding and empathy within the labyrinth of the contemporary healthcare system.
Within the three sections of Diligence, Doing Right, and Ingenuity, Better outlines Gawande’s advice for “becoming a positive deviant” in the vast field of medical practitioners. He carefully and successfully juxtaposes technical improvements that can refine a doctor’s performance with the ideological changes that lead to enhanced capabilities. To illustrate just how far scientific principles can carry medicine, a middling cystic fibrosis clinic in Cincinnati is contrasted with the number-one CF centre in the United States. This comparison demonstrates how ingenuity in mindset can create, “the difference between being 99.5 percent successful and being 99.95 percent successful.” Similar in their attempt for progress, the nine general surgeons of a district hospital in Nanded, Maharashtra, constantly rely on “quick, finely honed clinical judgement,” as each treats dozens of patients every morning. Even with afflictions that seem extreme and almost impossible from a Western perspective, the surgeons of this district hospital have learned to constantly adapt for the sake of their patients – simply because they refuse to accept the alternative. Better pushes against the conception that medicine is limited to contained, clinical settings where the ideal is always available by joining Gawande in his journeys to the many environments in which doctors make their mark.
In a brief 200 pages, Gawande covers the expanse of medical care from early life to its end. As he overviews the history of medical delivery practices and the heart-wrenching nature of palliative care, Gawande’s writing is imbued with existential ponderings that begin at childbirth and perhaps never cease throughout life. From the unique perspective of a healthcare provider, whose very purpose lies in navigating and influencing the moments between life and death, Gawande leads us to ponder when to continue the fight, innovating at every opportunity, and when to surrender to nature. Gawande’s exploration may end in more questions than answers from the reader, but it is that constant search to be better, not the static view of improvement, that leads to insight and growth.
Perhaps what has made Atul Gawande’s writing so capable of touching a wide range of audiences is his conscious effort to avoid alienating any group of people. Never will you find an unfounded generalisation or a statement with unreasonable biases. Instead, each topic is approached with neutrality and a logical perspective not devoid of that necessary touch of human compassion. As science refines its methods to reach heightened accuracy, this approach is necessary for development and awareness. Furthermore, Gawande’s lack of hesitancy in criticising himself builds credibility, as it is clear that his utmost goal is not to present himself and fellow doctors as omniscient or stagnant in growth. Instead, he seeks to learn, and share that acquired knowledge with others, with an instinct to help that is perhaps intrinsic to the practice of medicine.
A work of literary excellence and technical detail, Better intertwines observations from a surgeon on enhancing medical performance with subtle and perceptive notes on the nature of humanity. Going beyond discussions on performance, Gawande’s astute commentary manages to grasp at elusive facets of life that may be best observed in the context of healing others. This masterpiece of medical writing illustrates the urgency and precision involved in a physician’s profession, where lives are on the line with every decision and the necessity of doing better doesn’t cease.
Feature image from medicinspires.com
Asha is Editor-in-Chief
Edited by Kyra.