Analysis of The Book "Complications; a Surgeon's Notes on an Imperfect Science" by Atul Gawande: Mistakes in Medicine

Most medical books offer a new perspective into the complex realm of medicine that only a few choose to delve into due to the long, grueling hours of constantly serving your community and disregarding your own needs. Due to medicine being flawed, mistakes happen but only few people are brave enough to discuss the issues that arise within practicing medicine, and the mistakes that are hidden from the public eye due to the fear of judgement, but Atul Gawande was one of those brave souls. Complications; a surgeon's notes on an imperfect science is written by Atul Gawande in 2002. In this book, Gawande, who is a surgical resident at a hospital in Boston, Massachusetts, discuss the inevitable complications that doctors face, or in some controversial cases, are the cause of those complications. This book consists of Gawande's personal mistakes, and his colleagues' mistakes as well.

Due to this book being a book of flaws, there are a lot of medical issues that were discussed in which I'll write about two of them. Rumination syndrome is the first intriguing medical issue. In the book, Gawande was telling us the story of a pregnant woman who would constantly feel severely nauseous despite the fact that she was no longer during her first trimester, which is usually when women get their morning sickness. While telling us about the possibilities that made the woman nauseous, he recalled a childhood classmate who would vomit at "will" without feeling sick and that would eventually introduce our topic Rumination. With Rumination, the food is still undigested and still tastes the same as when it was first eaten. While vomiting happens usually when you have consumed something your body is not used to, Rumination happens all the time, each day, regardless of what you ate and generally occurs in children and infants. It's important to keep in mind that rumination is not a conscious decision, but rather a reflex of the body. Physicians are still not sure why Rumination even happens in the first place but fortunately, there's almost never physical damage, and rarely can cause problems with the esophagus. What's also interesting to note is that Rumination syndrome has been associated with anxiety, depression, obsessive compulsive disorder, and post-traumatic stress disorder (UpToDate, 2018).

The second medical issue that I choose to write about is the mental impact on chronic back pain or any physical pain in general. One would assume that chronic pain is due to a problem in the patient's bones or muscles because that would be a logical assumption and it was what most physicians assumed, but it turns out that that's not always the case. In the book, Atul mentioned two examples of this. Rowland Scott Quinlan, an architect, suffered from severe back pain. That would be very common, especially for workers, but what perplexed Gawande is that no one understood the origin of the pain, until one day Rowland's wife noticed that the pain would always start when Rowland was in a bad mood and would stop immediately once he got into a better mood. This left Atul with the conclusion that Rowland's pain was a "mental" pain. Multiple studies also demonstrate that patients with chronic pain are more likely to suffer from a mood disorder. ( Bair MJ, 2003 ) Atul Gawande also wrote about the Australian pain epidemic that happened back in the early 1980s when workers, more specifically keyboard operators, felt a sudden arm pain, in which doctors will later name this epidemic as the RSI or "repetition strain injury". What baffled physicians is that there was no evidence of broken bones or strained muscles, and yet workers were suffering from the pain. This epidemic eventually stopped completely in 1987. What's strange about this is that when the workers were given diagnostic labels and provided with disability pay, the epidemic continued but the instant it was taken away from them and their pain wasn't validated anymore, their pain has stopped, and this epidemic has officially ended. It's not that they were faking it, but the origin of the pain was new to physicians.

As Melzack's said, pain that doesn't arise from physical injury is no less real than pain does. Out of all the pain theories that Atul mentioned in the chapter, this one, according to him, was the oddest and most far-reaching because in a sense, it made pain a political issue. In conclusion, Complications proves to the world that medicine is based on mistakes and this is the only way for doctors to learn, despite it being a morbid way. In the two issues I discussed, we can tell that despite physicians being seen as this "godly" figure, they're still flawed human beings. In the first case, I mentioned that the cause of Rumination is still unknown despite how progressed medicine is. When it comes to mental pain, physicians to this day are still perplexed by it and some don't even acknowledge it as an issue. When it comes to medicine, one must understand that physicians are just normal human beings and they will make mistakes, but that's what we need to improve as human beings.