Complications: A Surgeon’s Notes on an Imperfect Science

Surgical scenes appear in almost every essay in Complications. The scenes stand for themselves, in the sense that they describe what happened, but they also act symbolically, underscoring themes of fallibility, mystery, and certainty. Gawande’s descriptions of surgery aren’t purely mechanical or medical; instead, he sets the scene, develops characters, and employs other literary mechanisms to separate one surgical scene from the next and to give the stories depth and meaning.

In “When Doctors Make Mistakes,” Gawande uses repetition to underscore the urgency and uncertainty he felt performing a tracheotomy: “Finally, I took the scalpel and cut. I just cut” (52). In “Education of a Knife,” Gawande illuminates the concept of practice triumphing over talent by tracking his own ability in installing a central line. At first, he approaches his patient in clumsy terms: He “kept spearing his clavicle instead of slipping beneath it” (14). Later, however, performing the same operation, he says, “I felt the tip slip underneath his clavicle […] I was in” (21).

In “The Computer and the Hernia Factory,” Gawande describes Dr. Sang’s operation on a hernia patient at the Shouldice Hospital with a quickened pace that reflects the surgery itself. He stops at each step to say other hospitals might do differently to highlight Shouldice’s innovation. Emphasizing the hospital’s unique efficiency, he adds, “the procedure had taken just half an hour” (40).

In “Nine Thousand Surgeons,” Gawande showcases doctors in their off-the-clock mode, emphasizing their playfulness and their susceptibility to spectacle. Gawande uses word choice to emphasize the fun, rather than the seriousness, of an operation he watches on film: “the surgeon made getting it out seem like play. He plucked at fragile vessels and slashed through tissue millimeters from vital organs” (78). In “Final Cut,” Gawande also uses language to emphasize the crudeness of the autopsy compared to other operations, using verbs like “flayed” and “sawed open” and a simile to underline the mechanical nature of the procedure: “she lifted the rib cage as if it were the hood of a car” (189).