Writing about books has two positive results and one negative. The positive results first. One -I never run out of subjects provided I keep on reading new books, and two - suppose I want to remind myself of this book, say a few years later, I can just read this review of mine. I have often felt the need for the latter. The negative result - I will be writing about things I have not experienced personally. Many of the ideas will not be my own. But I am willing to take that risk. Henceforth I plan to write about all the interesting books I read. I hope to intersperse the "book-review posts" with other subjects, but let that be for now.
The latest book I read, 'Complications' written by Atul Gawande, was very, very interesting, and it is an understatement. I have been interested in the medical field for as long as I remember. When I go to the doctor either as a patient or as the patient's relative, I am informed. I usually have a fair idea of the side effects of the medicines prescribed. However, after reading 'Complications', I realized how inadequate all that was. It was an epiphany. I trust a couple of doctors implicitly, and the fact that they too can be fallible, is scary, but true. The book talks about mistakes that even good doctors might make, and that wee bit of extra cautiousness that has often saved patients' lives.
Gawande writes with the clinical precision and detachment capable only of a surgeon. And yet there is humanity, there are the intense emotions that even doctors experience. There is not a dull chapter, or even a dull sentence in the book. It could be called delightful, if the subject were not so morbid and serious.
I remember freaking out when I went to the hospital at an unearthly hour and saw the young, inexperienced duty doctor instead of my usual gynecologist. One cannot deny that more experience makes better doctors. And age does matter. Most people I have met are more comfortable with old, experienced doctors than younger doctors with sophisticated degrees. Gawande states an instance where experience came in real handy. A patient came in with a reddened and swollen leg. All the indications were pointing toward cellulitis, a common but treatable infection. But just weeks ago, Gawande had lost one of his patients to necrotizing fasciitis, a rare and fatal bacterial infection that can be treated surgically, only in the very initial stage. (These bacteria, usually strains of streptococcus A, can enter the body through a "wound" as small as a pinprick.) His experience made him order a biopsy and his fears were indeed true. The patient had most of the tissue removed from her leg, but she survived. What would have happened to her if the doctor did not have this kind of an experience earlier? Would the warning bells have sounded even then? It is really hard to say!
There is also this matter of statistics. Cellulitis is a common infection. And about 5% of the cases, thought to be cellulitis at first, turn out to be necrotizing faciitis. Does this help the doctor make a decision on whether the patient in front of him right then has one or the other? Can a good doctor assume that exactly 5 out of a hundred cellulitis-patients that see him have the flesh-eating bacteria? No! Statistics are there to just comfort and/or caution, but they can never be used as a guideline.
From the days of Hippocrates and our own Sushruta, Medical Science has been improving. But newer technology has its own costs. I remember feeling elated when I read about "laparoscopic cholesystectomy" in my high school days. I thought of all the lives that would be saved because of the new technology. The thought that never came to me till I read "Complications" was the learning curve of the doctors. Gawande describes a laparoscopic cholesystectomy (the removal of the gall bladder) that he performed. Only after reading that did I realize how complicated it was, how difficult it was to learn new techniques. Doctors, like all others, take time to learn. But unlike us engineers, their experiments are with life; the stakes are high. One mistake, just half a second of haziness while wielding the scalpel can kill. Okay, I may be exaggerating, but the point is that doctors are responsible for the most precious things in this world.
And they deserve that responsibility. Risks have to be taken if lives are to be saved. Gawande talks about an unusual surgery, the gastric bypass surgery. (There was a report about this surgery in this week's 'Health' supplement of the Indian Express). In this surgery, the stomach is stapled, thereby reducing its size, and about a metre of the small intestine is bypassed, so that less food is absorbed. This is the best cure now available for morbid obesity. I mean, just think of the capability of one four-hour surgery! Many people are leading healthy and happy lives because of the surgery. So, at some point, a decision has to be made. For doctors, however, difficult decisions have to be made all the time.
In the Indian tradition, we say that one should trust the doctor completely. Indeed, it is said that the result is proportional to our trust. From a psychological perspective, this makes complete sense. Though *all* our illnesses are not rooted in the mind, many of them are. Therefore, trusting the doctor is important. But how far do we go? Ultimately it is our own body we are talking about. In Kannada they say 'ಹೊಸ ವೈದ್ಯರಿಗಿಂತ ಹಳೆ ರೋಗಿಯೇ ಮೇಲು', which is true to some extent (My grandma used to do this. She had diabetes, and whenever she ate an extra sweet, she would take a little more of her diabetes medication, without consulting the doctor!). There should be a sort of a compromise between the doctor and the patient as to who listens to whom, to what extent.
'Complications' got me started on thinking about a related thing. There are happy endings and sad endings. But, isn't 'Life' mysterious? A person who has four heart attacks may survive and thrive, whereas another may die of a pinprick. A pacemaker can help an ailing heart, a ventilator can substitute the lungs and a dialysis machine, the kidneys. What is the nature of that "one thing" that keeps all these and more working together in so much harmony that if one organ fails, all the others gradually fail, too. I am delving into Philosophy here, but isn't that a question worth considering?