Better: A Surgeon's Notes on Performance by Atul Gawande

By Atul Gawande

The recent York occasions bestselling writer of issues examines, in riveting bills of scientific failure and triumph, how luck is accomplished in a fancy and risk-filled profession The fight to accomplish good is common: each folks faces fatigue, constrained assets, and imperfect talents in no matter what we do. yet nowhere is that this force to do larger extra vital than in medication, the place lives are at the line with each choice. In his new booklet, Atul Gawande explores how medical professionals attempt to shut the space among top intentions and top functionality within the face of stumbling blocks that typically look insurmountable.Gawande's gripping tales of diligence, ingenuity, and what it capability to do correct by means of humans take us to battlefield surgical tents in Iraq, to hard work and supply rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms round the state. He discusses the moral dilemmas of medical professionals' participation in deadly injections, examines the impact of cash on sleek medication, and recounts the astoundingly contentious historical past of hand washing. And as in all his writing, Gawande supplies us an inside of examine his personal lifestyles as a practising health care professional, supplying a searingly sincere firsthand account of labor in a box the place blunders are either unavoidable and unthinkable.At as soon as unflinching and compassionate, larger is an exciting trip narrated by means of "arguably the simplest nonfiction doctor-writer round" (Salon). Gawande's research into doctors and the way they development from simply sturdy to nice offers infrequent perception into the weather of good fortune, illuminating each sector of human undertaking.

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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.

Hence the recent CDC guidelines requiring hospital personnel to keep their nails trimmed to less than a quarter of an inch and to remove artificial nails. Plain soaps do, at best, a middling job of disinfecting. Their detergents remove loose dirt and grime, but fifteen seconds of washing reduces bacterial counts by only about an order of magnitude. Semmelweis recognized that ordinary soap was not enough and used a chlorine solution to achieve disinfection. Today's antibacterial soaps contain chemicals such as chlorhexidine to disrupt microbial membranes and proteins.

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.

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