Atul Gawande
Atul Gawande; drawing by David Levine

Among the huge number of men and women practicing medicine during the past century, only a few have been able to write well about their profession for the general reader. Of the most accomplished among them, it can be said that their words are a natural extension of their healing. Any physician becoming familiar with the stories and essays—and the poems too—of such doctors soon recognizes the depth of their concern for those who come to them for help and their understanding of the difficulties and satisfactions of caring for the sick.

The best example of such dedicated physician-writers is William Carlos Williams, who was for seventeen years co-director of pediatrics at the Passaic General Hospital and physician to tens of thousands of adults and children, some three thousand of whom he delivered. In the poems and stories of Dr. Williams can be sensed what it means to be in a state of clinical watchfulness, and it serves him well. Like Dr. Williams, the best medical writers have let the story come forward unhampered, though they themselves are not only in it but of it as well. Being good clinicians, they have not hesitated to immerse themselves in another’s life or another’s narrative, but they do not take it over. The contemporary writer who best exemplifies these qualities is surely Oliver Sacks, whose immense learning is so unobtrusively woven into his accounts of nervous disorders and evocations of his own personal experiences and those of his patients.

Now we have Dr. Atul Gawande with a new and different voice, bringing to modern high-tech medicine the same clinical watchfulness that writers such as Williams and Sacks have brought to bear on the lives and emotions of often fragile patients. The reader feels that he is accompanying Dr. Gawande at the bedside or operating table and senses that the events are being described and confronted as they should be if we are to get an honest sense of the complexities of twenty-first-century healing. If there is a genre to which the chapters of his collection of essays belong, it is not that of any known form of literature, but is instead an experience familiar primarily to surgeons—the Mortality and Morbidity Conference, in which doctors meet to discuss what went wrong in particular cases or how a better outcome might have been achieved. The purpose of the conference is to reveal and examine human error, specifically the errors of members of specific surgical teams. Acknowledging fallibility is the key to improvement.

But at such conferences, that acknowledgment of fallibility is made only to other physicians. Laws in most states protect the conference discussions from public scrutiny; otherwise few if any participants would be as forthcoming about their errors as they must be if the meetings are to be useful. If the participants cannot be absolutely frank, the aims of the conference are frustrated. Nothing is…

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