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
  • 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

Introduction

Several years ago, in my final year of medical school, I took care of a patient who has stuck in my mind. I was on an internal medicine rotation, my last rotation before graduating. The senior resident had assigned me primary responsibility for three or four patients. One was a wrinkled, seventy-something-year-old Portuguese woman who had been admitted because—I’ll use the technical term here—she didn’t feel too good. Her body ached. She had become tired all the time. She had a cough. She had no fever. Her pulse and blood pressure were fine. But some laboratory tests revealed her white blood cell count was abnormally high. A chest X-ray showed a possible pneumonia—maybe it was, maybe it wasn’t. So her internist admitted her to the hospital, and now she was under my care. I took sputum and blood cultures and, following the internist’s instructions, started her on an antibiotic for this possible pneumonia. I went to see her twice each day for the next several days. I checked her vital signs, listened to her lungs, looked up her labs. Each day, she stayed more or less the same. She had a cough. She had no fever. She just didn’t feel good. We’d give her antibiotics and wait her out, I figured. She’d be fine.

One morning on seven o’clock rounds, she complained of insomnia and having sweats overnight. We checked the vitals sheets. She still had no fever. Her blood pressure was normal. Her heart rate was running maybe slightly faster than before. But that was all. Keep a close eye on her, the senior resident told me. Of course, I said, though nothing we’d seen seemed remarkably different from previous mornings. I made a silent plan to see her at midday, around lunchtime. The senior resident, however, went back to check on her himself twice that morning.

It is this little act that I have often thought about since. It was a small thing, a tiny act of conscientiousness. He had seen something about her that worried him. He had also taken the measure of me on morning rounds. And what he saw was a fourth-year student, with a residency spot already lined up in general surgery, on his last rotation of medical school. Did he trust me? No, he did not. So he checked on her himself.

That was not a two-second matter, either. She was up on the fourteenth floor of the hospital. Our morning teaching conferences, the cafeteria, all the other places we had to be that day were on the bottom two floors. The elevators were notoriously slow. The senior resident was supposed to run one of those teaching conferences. He could have waited for a nurse to let him know if a problem arose, as most doctors would. He could have told a junior resident to see the patient. But he didn’t. He made himself go up.

The first time he did, he found she had a fever of 102 degrees and needed the oxygen flow through her nasal prongs increased. The second time, he found her blood pressure had dropped and the nurses had switched her oxygen to a face mask, and he transferred her to the intensive care unit. By the time I had a clue about what was going on, he already had her under treatment—with new antibiotics, intravenous fluids, medications to support her blood pressure—for what was developing into septic shock from a resistant, fulminant pneumonia. Because he checked on her, she survived. Indeed, because he did, her course was beautiful. She never needed to be put on a ventilator. The fevers stopped in twenty-four hours. She got home in three days.


What does it take to be good at something in which failure is so easy, so effortless? When I was a student and then a resident, my deepest concern was to become competent. But what that senior resident had displayed that day was more than competence—he grasped not just how a pneumonia generally evolves and is properly treated but also the particulars of how to catch and fight one in that specific patient, in that specific moment, with the specific resources and people he had at hand.

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!

Support BookBrowse

Become a Member
and discover your next great read!

Join Today!

Book Discussion
Book Jacket
The Opposite of Everyone
by Joshilyn Jackson

"Quirky and appealing characters, an engaging story, and honest dialogue make this a great book!"
- BookBrowse

About the book
Join the discussion!

Award Winners

  • Book Jacket: All We Have Left
    All We Have Left
    by Wendy Mills
    September 11, 2001 is a date that few Americans will ever forget. It was on this day that our ...
  • Book Jacket: A Great Reckoning
    A Great Reckoning
    by Louise Penny
    Canadian author Louise Penny is back with her twelfth entry in the Chief Inspector Armand Gamache ...
  • Book Jacket: Homegoing
    Homegoing
    by Yaa Gyasi
    It's all very well to challenge people to be the masters of their own destiny, but when you&#...

First Impressions

  • Book Jacket

    Victoria
    by Daisy Goodwin

    Daisy Goodwin breathes new life into Victoria's story, and does so with sensitivity, verve, and wit." - Amanda Foreman

    Read Member Reviews

Who Said...

There is no such thing as a moral or immoral book. Books are either well written or badly written. That is all.

Click Here to find out who said this, as well as discovering other famous literary quotes!

Word Play

The Big Holiday Wordplay:
$400+ in Prizes

Enter Now

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.