Complications Fever Chart

Ava Janish and Mei Chiang

Complications Fever Chart

Humanity Certainty

“We are instructed to request an autopsy on everyone as a means of confirming the cause of death and catching our mistakes. And this was the moment I was supposed to ask-- with the wife despondent and reeling with shock. But surely, I began to think, here was a case in which an autopsy would be pointless. We knew what had happened... We were sure of it. What would cutting the man apart accomplish? And so I let Mrs. Sykes go... I could have called her... But I never did.” (Page 191)

Gawande was very confident that Mr. Sykes died because of an infection and a rupture. He had no doubt in his mind and explicitly stated: “We were sure of it”. He made an easy decision not to bother Mrs. Sykes by requesting an autopsy and he never thought twice about it.

“As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine’s ground state is uncertainty. And wisdom – for both patients and doctors – is defined by how one copes with it” (Gawande 229).

Surgery is an imperfect science; no single person can ever have all the answers. That is what makes it human, giving surgeons the ability to question and innovate. The ability to adapt and learn breeds success, and that would never be possible without failure of some kind.

“No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it” (Gawande 74).

Doctors are only human, so some level of imperfectness is expected. It would be unreasonable to assume a doctor as that of a machine, capable of flawless execution every time. However, this nature of failure must be minimized as the lives of other people are at stake.

“I felt a little foolish considering the diagnosis... If you hear hoofbeats in Texas, think horses not zebras.. I couldn't help it. I was thinking it... choosing not to do something... is far harder than choosing to do it.” (Pages 233-235)

This quote seems very hesitant. Gawande feels foolish to think Eleanor has necrotizing fasciitis. This segment is at a high confidence level because Gawande pushed for a surgical test to determine the diagnosis although he had no evidence separating his guess from cellulitus. It takes a tremendous amount of confidence in oneself to stick to such intuition with no proof.

“The conclusion was obvious. The blood meant that the bullet had gone inside him, through both his rectum and his bladder, I told him... He needed surgery, I said, and we had to go now.” (Page 3)

We can see Gawande’s confidence through his word usage: “obvious... We had to go now”. Although Gawande was clearly confident in his conclusion, he was incorrect. They found no trace of a bullet and opened the patient up for no reason.

“We’ve all heard about individuals who defy the statistics” … “No formula can take into account the infinite range of such exceptional events. That’s why doctors are convinced that they’d better stick with their well-honed instincts when they’re making a diagnosis” (Gawande 42).

There is an innate instinct involved in surgery that coexists with knowledge to breed success. The human nature of this feeling could never be replicated by a machine. A computer would look at the cold, hard data and find the most probable diagnosis. But it could never account for those one in a million cases that tug doctors to look deeper.

“I am six feet two, but even with the table as low as it goes, I had to stand on a step stool to operate; Dr. Randall stood on two stools stacked together. He nodded to me, and I cut down the middle of our patient’s belly, through skin and then dense inches of glistening yellow fat.” (Page 163)

This scene does not have a higher confidence level because Dr. Randall’s nodding to Gawande signifies that he looked at him for reassurance, but after, Gawande was positive he knew how to do the operation.

Vulnerable

Imperfect

Instinctual

Curious

Arrogant

Deceitful

Experimental

Cruel

Unwavering

Confident

Mostly Certain

Assured

Impartial

Hesitant

Unsure

Oblivious

“There are surgeons who will see faults everywhere except in themselves. They have no questions and no fears about their abilities. As a result, they learn nothing from their mistakes and know nothing of their limitations” (Gawande 61).

Those unwilling to admit to mistake think they are above everyone else, God-like even, and their arrogance rules them. It separates them from reality, and thus leads them to make drastic repetitive errors, only leading to harm.

"Do we ever tell patients that because we are still new at something, their risks will inevitably be higher, and that they’d likely do better with others who are more experienced? Do we ever say that we need them to agree to it anyway? I’ve never seen it” (Gawande 30).

New surgeons must gain experience in real-life situations, and to do that, the choice must be taken away from patients. However, the deceit is introduced as Gawande expresses how surgeons don’t allow their own family members to be operated on by new surgeons. That choice is stripped from them, and they are left in the dark.

“It is painful enough taking responsibility for one's own failures. Being handmaiden to another’s is something else entirely. It occurs to me that I could have broken open a kit and had her do an actual dry run. Then again, maybe I can't. The kits must be a couple of hundred dollars each. I'll have to find out for next time.” (Page 33)

Gawande is hesitant of his mentoring a junior resident and about how he should be teaching her. He was unsure when he did his first lines and now he wants to make sure that this resident learns in the most effective way possible.

“I asked her the required question. I told her that we wanted to perform an autopsy and needed her permission. We thought we already knew what had happened, but an autopsy would confirm it, I said. She considered my request for a moment. If an autopsy would help us, she finally said, then we could do it. I said, as I was supposed to, that it would. I wasn't sure I believed it.” (Page 196)

It is clear that Gawande is much less confident in this cause of death than with the patient from page 191. Rather than saying he was sure, he said he “thought” he already knew what had happened and that he “wasn’t sure” if he believed an autopsy would help.

“One Friday was being conspicuously bypassed... This is ridiculous... For a moment-- only a moment, mind you-- I felt my confidence slip. Perhaps I really would be in for a miserable night, I began to think... I went to the library to check.” (Page 110)

Gawande tells us that his confidence only slipped for a moment, but we can see his unsurety through his actions. He went to the library to check if Friday the 13th would bring him bad luck. He had an underlying fear that things would go wrong for him during that shift.

“Complicating matters further, individual surgeons are promoting a slew of variations on the standard operation which haven’t been fully researched” … “And a few surgeons are pursuing new populations, such as adolescents and people who are only moderately obese” (Gawande 182).

In the name of advancement and deceit, these doctors are playing around with an already risky surgery to market next-best alternatives. Such new procedures are not fully tested and researched, putting patients in danger. Further, they are marketing to a broader audience as to attract even more patients, those not even suited for it, to an already highly demanded procedure.

Goodman, “He began to cut corners, became sloppy. Patients were hurt, some terribly. Colleagues who had once admired him grew appalled. It was years, however, before he was stopped” (Gawande 88).

The level of cruelty to which Goodman was described of being capable of is inherently inhumane. He neglected his patients for years before anyone finally stood up. Being a doctor entails a level of dedication and devotion to patients, both of which Goodman, and anyone like him, lacked.

Part 1- Fallibility Part 2- Mystery Part 3- Uncertainty

The End