Excerpt from Better by Atul Gawande, plus links to reviews, author biography & more

Summary |  Excerpt |  Reviews |  Beyond the Book |  Readalikes |  Genres & Themes |  Author Bio

Better

A Surgeon's Notes on Performance

by Atul Gawande

Better by Atul Gawande X
Better by Atul Gawande
  • Critics' Opinion:

    Readers' Opinion:

  • First Published:
    Apr 2007, 288 pages
    Paperback:
    Feb 2008, 288 pages

  • Rate this book


Book Reviewed by:
BookBrowse Review Team

Buy This Book

About this Book

Print Excerpt


People often look to great athletes for lessons about performance. And for a surgeon like me, athletes do indeed have lessons to each—about the value of perseverance, of hard work and practice, of precision. But success in medicine has dimensions that cannot be found on a playing field. For one, lives are on the line. Our decisions and omissions are therefore moral in nature. We also face daunting expectations. In medicine, our task is to cope with illness and to enable every human being to lead a life as long and free of frailty as science will allow. The steps are often uncertain. The knowledge to be mastered is both vast and incomplete. Yet we are expected to act with swiftness and consistency, even when the task requires marshaling hundreds of people—from laboratory technicians to the nurses on each change of shift to the engineers who keep the oxygen supply system working—for the care of a single person. We are also expected to do our work humanely, with gentleness and concern. It’s not only the stakes but also the complexity of performance in medicine that makes it so interesting and, at the same time, so unsettling.

Recently, I took care of a patient with breast cancer. Virginia Magboo was sixty-four years old, an English teacher, and she’d noticed a pebblelike lump in her breast. A needle biopsy revealed the diagnosis. The cancer was small—three-quarters of an inch in diameter. She considered her options and decided on breast-conserving treatment—I’d do a wide excision of the lump as well as what’s called a sentinel lymph node biopsy to make sure the cancer hadn’t spread to the lymph nodes. Radiation would follow.

The operation was not going to be difficult or especially hazardous, but the team had to be meticulous about every step. On the day of surgery, before bringing her to the operating room, the anesthesiologist double-checked that it was safe to proceed. She reviewed Magboo’s medical history and medications, looked at her labs in the computer and at her EKG. She made sure that the patient had not had anything to eat for at least six hours and had her open her mouth to note any loose teeth that could fall out or dentures that should be removed. A nurse checked the patient’s name band to make sure we had the right person; verified her drug allergies with her, confirmed that the procedure listed on her consent form was the one she expected. The nurse also looked for contact lenses that shouldn’t be left in and for jewelry that could constrict a finger or snag on something. I made a mark with a felt-tip pen over the precise spot where Magboo felt the lump, so there would be no mistaking the correct location. Early in the morning before her surgery, she had also had a small amount of radioactive tracer injected near her breast lump, in preparation for the sentinel lymph node biopsy. I  now used a handheld Geiger counter to locate where the tracer had flowed, and confirmed that the counts were strong enough to indicate which lymph node was the “hot” one that needed to be excised. Meanwhile, in the operating room, two nurses made sure the room had been thoroughly cleaned after the previous procedure and that we had all the equipment we needed. There is a sticker on the surgical instrument kit that turns brown if the kit has been heat-sterilized and they confirmed that the sticker had turned. A technician removed the electrocautery machine and replaced it with another one after a question was raised about how it was functioning. Everything was checked and cross-checked. Magboo and the team were ready.

By two o’clock I had finished with the procedures for my patients before her and I was ready too. Then I got a phone call.

Her case was being delayed, a woman from the OR control desk told me.

Why? I asked.

The recovery room was full. So three operating rooms were unable to bring their patients out, and all further procedures were halted until the recovery room opened up.

Copyright © 2007 by Atul Gawande. All rights reserved.

Membership Advantages
  • Reviews
  • "Beyond the Book" backstories
  • Free books to read and review (US only)
  • Find books by time period, setting & theme
  • Read-alike suggestions by book and author
  • Book club discussions
  • and much more!
  • Just $10 for 3 months or $35 for a year
  • More about membership!

Editor's Choice

  • Book Jacket: The Overstory
    The Overstory
    by Richard Powers
    Many glowing adjectives can be used to describe a novel by Richard Powers: brilliant, moving, ...
  • Book Jacket: American Histories
    American Histories
    by John E. Wideman
    In American Histories, a collection of 21 short stories, John Edgar Wideman draws America's present ...
  • Book Jacket: I Found My Tribe
    I Found My Tribe
    by Ruth Fitzmaurice
    Ruth O'Neill was only 28 when she married film director Simon Fitzmaurice in 2004. Changing her...
  • Book Jacket: The Art of the Wasted Day
    The Art of the Wasted Day
    by Patricia Hampl
    Patricia Hampl wants you to know that daydreaming is not a waste of a day. Nor is spending time ...

Book Discussion
Book Jacket
Music of the Ghosts by Vaddey Ratner

A love story for things lost and restored, a lyrical hymn to the power of forgiveness.

About the book
Join the discussion!

Readers Recommend

  • Book Jacket

    The Girl Who Smiled Beads
    by Clemantine Wamariya & Elizabeth Weil

    A riveting story of survival, and the power of stories to save us.
    Reader Reviews

Win this book!
Win The Leavers

The Leavers by Lisa Ko

One of the most anticipated books of 2017--now in paperback!

Enter

Word Play

Solve this clue:

T E H N Clothes

and be entered to win..

Books that     
entertain,
     engage

 & enlighten

Visitors can view some of BookBrowse for free. Full access is for members only.

Join Today!

Your guide toexceptional          books

BookBrowse seeks out and recommends books that we believe to be best in class. Books that will whisk you to faraway places and times, that will expand your mind and challenge you -- the kinds of books you just can't wait to tell your friends about.