Complications: A Surgeon's Notes On An Imperfect Science Quotes
"The patient needed a central line. 'Here's your chance,' S., the chief resident, said. I had never done one before."
"In experienced hands, problems of this sort occur in fewer than one case in a hundred."
"There is a saying about surgeons, meant as a reproof: 'Sometimes wrong; never in doubt.'"
"In surgery, as in anything else, skill and confidence are learned through experience—haltingly and humiliatingly."
"The most important talent may be the talent for practice itself."
"We find it hard, in medicine, to talk about this with patients. The moral burden of practicing on people is always with us, but for the most part unspoken."
"No formula can take into account the infinite range of such exceptional events."
"Medical malpractice suits are a remarkably ineffective remedy."
"In the increasingly tangled web of experts and expert systems, a doctor has an even greater obligation to serve as a knowledgeable guide and confidant."
"When things go wrong, it's almost impossible for a physician to talk to a patient honestly about mistakes."
"In a sense, then, the physician's dodge is inevitable. Learning must be stolen, taken as a kind of bodily eminent domain."
"If error were due to a subset of dangerous doctors, you might expect malpractice cases to be concentrated among a small group, but in fact they follow a uniform, bell-shaped distribution."
"In the hierarchy, addressing my errors was Ball’s role."
"This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong."
"It is one thing to be aware of one’s limitations. It is another to be plagued by self-doubt."
"There are surgeons who will see faults everywhere except in themselves."
"The M & M is a cultural ritual that inculcates in surgeons a 'correct' view of mistakes."
"Medicine isn’t a matter of delivering a fixed product; it may well be more complex than just about any other field of human endeavor."
"Not only do all human beings err, but they err frequently and in predictable, patterned ways."
"Disasters do not simply occur; they evolve."
"It isn’t enough to ask what a clinician could or should have done differently so that he and others may learn for next time."
"Operations like that lap chole have taught me how easily error can occur, but they’ve also showed me something else: effort does matter; diligence and attention to the minutest details can save you."
"If any link between psychology and the full moon exists, it would seem to be protective."
"As for other forms of craziness, the moon seems to play no role."
"Neither the full moon nor the inauspicious date threatened my night on call."
"We believe the world to be decipherable and logical, to come with problems we can see or feel."
"Pain that doesn’t arise from physical injury is no less real than pain that does—in the brain it is precisely the same."
"The truth is that doctors like me are grateful to the pain specialists, too."
"There is a virtual epidemic of back pain in this country today, and nobody can explain why."
"Pain is a symphony—a complex response that includes not just a distinct sensation but also motor activity, a change in emotion, a focusing of attention, a brand-new memory."
"The solution to chronic pain may lie more in what goes on around us than in what is going on inside us."
"Nausea is a typical side effect of drugs."
"The sheer loathsomeness of nausea and vomiting does seem to serve a biological purpose."
"Nausea and vomiting as something that protects against toxins."
"Uncontrolled nausea remains a persistent problem."
"Blushing is at once physiology and psychology."
"Embarrassment provides painful notice that one has crossed certain bounds."
"Embarrassment serves an important good."
"Blushing intensifies embarrassment, which may be to one's ultimate advantage."
"A blush is physical, mental, and inseparable even by a surgeon’s blade."
"For the very obese, general anesthesia alone is a dangerous undertaking; major abdominal surgery can easily become a disaster."
"Once he was on the table, his haunches rolled off the sides, and I double-checked the padding that protected him from the table’s sharp edges."
"Inside his abdomen, his liver was streaked with fat, too, and his bowel was covered by a thick apron of it, but his stomach looked ordinary—a smooth, grayish-pink bag the size of two fists."
"The operation took us a little over two hours. Caselli was stable throughout, but his recovery was difficult."
"By the third day after surgery, he was well enough to take sips of clear liquids (water, apple juice, ginger ale), up to one ounce every four hours."
"‘I’m a man of habits,’ he told me. ‘I’m very prone to habits.’ And eating, he said, was his worst habit."
"‘Eating felt good instantaneously,’ he said, ‘but it only felt good instantaneously.’"
"‘I must have gained and lost a thousand pounds,’ he told me."
"He hadn’t been on an airplane since 1983, and it had been two years since he had been to the second floor of his own house, because he couldn’t negotiate the stairs."
"‘Last year or two, I’m in hell,’ he said."
"‘Your heart is good. Your lungs are good. You’re strong,’ the doctor told him."
"‘If you cannot take off this weight, we are going to have to do something drastic.’"
"‘Hasn’t she been through enough?’ a nephew said, horrified at the suggestion of an autopsy."
"We believe in will—in the notion that we have a choice over such simple matters as whether to sit still or stand up, to talk or not talk, to have a slice of pie or not."
"The history of weight-loss treatment is one of nearly unremitting failure."
"Whatever the regimen—liquid diets, high-protein diets, or grapefruit diets, the Zone, Atkins, or Dean Ornish diet—people lose weight quite readily, but they do not keep it off."
"We are a species that has evolved to survive starvation, not to resist abundance."
"In even the most gruesome operations—skin grafting, amputations—surgeons maintain some tenderness and aestheticism toward their work."
"‘One SIDS death is a tragedy. Two is a mystery. Three is murder.’"
"Good decisions can have bad results, and bad decisions can have good results."
"Our contemporary medical credo has made us exquisitely attuned to the requirements of patient autonomy."
"A good physician cannot simply stand aside when patients make bad or self-defeating decisions."
"In fact, there was also the new and delicate matter of talking patients through their decisions—something that sometimes entailed its own repertoire of moves and techniques."
"Medicine's ground state is uncertainty. And wisdom—for both patients and doctors—is defined by how one copes with it."
"Patients frequently don't want the freedom that we've given them."
"The uncertainties were savage, and I could not bear the possibility of making the wrong call."
"Patients commonly prefer to have others make their medical decisions."
"What patients want most from doctors isn't autonomy per se; it's competence and kindness."
"The real task isn't to banish paternalism; the real task is to preserve kindness."
"Decisions in medicine are supposed to rest on concrete observations and hard evidence."
"Human beings have an ability to simply recognize the right thing to do sometimes."
"Human judgment, like memory and hearing, is prone to systematic mistakes."
"It is because intuition sometimes succeeds that we don’t know what to do with it."
"The possibilities and probabilities are all we have to work with in medicine."
"I feel like there is some kind of purpose, like there has to be some sort of reason that I’m still here."