Published on 20 May 2022.
Cite this Essay
MLA:
Sundaram, Neeraja. “Atul Gawande (1965-).” Indian Writing In English Online, 20 May 2022, https://indianwritinginenglish.uohyd.ac.in/atul-gawande-1965-neeraja-sundaram/ .
Chicago:
Sundaram, Neeraja. “Atul Gawande (1965-).” Indian Writing In English Online. May 20, 2022. https://indianwritinginenglish.uohyd.ac.in/atul-gawande-1965-neeraja-sundaram/ .
Atul Gawande poses a stimulating challenge to the biographer. Characterised often by the American media as someone who “wears many hats”, his place in public life is too dynamic to be constrained by labels like “surgeon”, “writer” or “administrator”. Even as he practices surgery at the Brigham and Women’s Hospital in Boston, Massachusetts, he is credited with teaching at Harvard Medical School and inaugurating centres for research and innovation in medicine. His college and medical training in the late eighties and nineties were punctuated by his work in Al Gore’s Senate and the Clinton administration. His work as a writer began almost simultaneously with his surgical practice in the form of bi-weekly posts for the online magazine Slate in 1996. In a Medscape interview, using a characteristically Gawandesque analogy, he finds common ground between producing a column in a periodical and the routine performance of gall-bladder surgery [i]. Both constitute a process of learning before the acquisition of mastery and like any other craft, are made up of conventions and institutions that uphold these. His research and writing, primarily in the field of public health, would influence healthcare policy during Obama’s presidency and earn him a MacArthur grant in 2006. In 2018, he was invited to serve as the CEO of Haven Healthcare, a not-for-profit venture formed through a partnership between American corporate giants Amazon, Berkshire Hathaway and JP Morgan Chase – a role he has since stepped down from. In November 2020, he was appointed to the Biden Harris Transition COVID-19 advisory board by the then president-elect Joe Biden. For a student of Indian Writing in English, Gawande’s life and work require a rethinking of what constitutes the work of literary production and the role of the author in our time.
Gawande was born in New York in 1965 to Indian parents who both migrated there to practice medicine. His life story is well-chronicled in the manner of any celebrity. A large volume of his own writing offers vivid detail about his life – his surgical practice, being raised by doctor-parents, his political work and productivity hacks among others. His first three books for instance, Complications (2002), Better (2007) and The Checklist Manifesto (2009), all widely reviewed bestsellers in the American media, build on the minutiae of his medical residency and surgical practice: the challenges of being a doctor in the twenty first century, the very personal struggles of being a parent and negotiating the emotional cost of a high-stress, high-stakes profession. Complications compiled some older pieces written for The New Yorker where Gawande joined as a staff writer in the third year of his surgical residency. Most of the pieces in this book illustrate the autobiographical element that characterises Gawande’s short-form journalism. He offers us an insight into his state of mind as a newly minted doctor on the first day of surgical residency in a chapter titled “Education of a Knife”. Here, Gawande is fumbling, anxious, goofy and unable to make diagnoses or perform simple procedures without consulting senior residents and all the while, several cases are assigned to him. The “real work” that is cut out for him though is to appear to patients “like someone who had not just got his medical diploma the week before. Instead, I was determined to be nonchalant, world-weary, the kind of guy who had seen this sort of thing a hundred times before” (8). This unflattering portrait of Gawande as a novice surgeon allows him to speak of broader and more significant questions about the role of the student-in-training in any medical institution. The conundrum, as Gawande identifies it, is that the physician’s learning curve is a necessary part of medical progress but is at odds with patient safety.
Being Mortal is perhaps the most “revealing” of Gawande’s books, chronicling as it does his experiences with providing care for his ageing parents. This book uses a personal tragedy, the death of Gawande’s father and the struggle to ensure good end-of-life care for him, as the impetus for exploring problems and innovations in elder-care. Much like his own short-form pieces, media portraits of Gawande also follow the style reserved for pop icons and inspirational leaders when narrating details about his daily life. A 2007 New York Times piece titled “Atul Gawande Rocks in the OR” describes his (often self-confessed) love for the operating room by offering readers a glimpse of his surgical performance. “On a recent day”, the article reads, suggesting routine occurrence, “when he took out a gallbladder, two thyroids and what was supposed to be a parathyroid gland but maybe wasn’t, the playlist included David Bowie, Arcade Fire, Regina Spektor, Aimee Mann, Bruce Springsteen, Elvis Costello, the Decemberists and the Killers” [ii]. Gawande’s team, comprising an anaesthesiologist, the OR nurse and the medical instruments in-charge, the reporter observes, indulged in head-bobbing, toe-tapping and finger-drumming. This fascinating visual insight into Gawande’s workday, replete with a mention of how a copy of Sylvia Plath’s “The Surgeon at 2 AM” sits by his desk, seeks to transform our notions about doctors as much as writers.
Gawande’s writing career lies at the intersection of several interesting cultural phenomena. The first has to do with the public perception of medical practice and the bearing this has, if at all, on literary ambition and success. While the notion of a celebrity-author and a shrewd management of one’s image and the reading public can be traced back to the nineteenth-century in England and America, the doctor-as-polymath or adored public figure is a late twentieth-century phenomena. In his famous 1818 “Cockney-School Attack” against John Keats’ then recently published poetry, the critic John Gibson Lockhart would sardonically advise it was “a better and wiser thing to be a starved apothecary than a starved poet” [iii]. The review derives great merriment from using medical metaphors to characterise Keats’ lack of poetic talent as an “affliction” and reserves disdain for the idea that a person could be both a surgeon (Keats was a surgeon’s apprentice at the time) and a poet. Another famous instance from later in the nineteenth-century is the public perception of Arthur Conan Doyle, who earned public accolades as a writer rather than as a surgeon. Doyle’s detective stories, historical and political writing would impact the training and practice of English police detectives and earn him a knighthood. Here too, the literary career had little to do with medical training. Chekov too reflects in his letters that the idea of practicing two professions is perceived as unusual, especially those as demanding as literature and medicine. But Chekov writes as a doctor that “literature is my mistress” and that neither profession is harmed by his infidelity. Does Gawande have anything in common with his doctor-writer forebears?
He writes because he is a surgeon, not despite it. Speaking as a resident-in-training in Complications, he confesses to having “a distinctive vantage on medicine” and being “an insider, seeing everything and a part of everything; yet at the same time you see it anew” (xix-xx). The medical practice is Gawande’s occasion to write, and his body of work is a lens to critically appraise the humaneness, efficiency and relevance of medical science and healthcare. Like his literary forebears, Gawande is an innovator with a keen eye on the conventions of form. Speaking of how he became persuaded to start a Twitter account, he says, “All art is defined by constraints” and that working with 140 characters is akin to the constraints posed by the sonnet form to Shakespeare. Gawande’s membership in the writing profession is also cemented by his own vision and practice of the same. He demystifies the writing process by offering insights into his “idea notebooks” and the trial by fire of his early days as a staff writer for the New Yorker. His work for the magazine allowed for the development of a shrewd sensibility about readership, social media and engaging in healthcare debate. Even as we glimpse a great deal of Gawande’s life, the cornerstone of his short-form pieces and books are the stories of others. Some of these are narrated to him first-hand by his patients, others are narrated by colleagues who share the burden of medical firefighting. The heroes in his stories are not always doctors: they come from several unusual locations like the history of science, the medical laboratory and even other industries like finance, hospitality, and aeronautical engineering. Gawande emerges here as a surgeon who understands his profession through and as storytelling. The interpretative frames he applies to the cases featured in his books, the thick detailing of patients’ characters and the close attention to perspective when he presents a colleague’s experiences show us how the doctor’s literary sensibility is no longer an illicit passion occupying a wholly different sphere. Even as a spokesperson for healthcare reform, Gawande asks difficult questions of medical institutions and practitioners, rather than governments. His writing is rooted in and inseparable from medicine all the while demonstrating that the healthcare worker emerges as a new kind of storyteller.
Gawande’s popularity and success as a public figure and writer are also embedded in the unprecedented cultural appetite for the memoir in the twentieth and twenty-first centuries. Memoirs that curate an experience of managing and treating illness are an important source of information on the quality of healthcare access and delivery. Other American doctors of Indian origin, of whom Abraham Verghese and Siddhartha Mukherjee deserve notable mention, have also achieved literary fame via their journalistic and fictional writing about the medical profession. While all physician-writers boast a unique style, they essentially contribute to a change in the way problems in healthcare and medicine are discussed in the public sphere. There is, in their writings, an insistence on thickening the stories of people who provide and receive healthcare to ensure a more humane medical practice. This agenda is also what drives the field of Narrative Medicine, inaugurated by Rita Charon in the early 2000s to improve medical education and care. Narrative Medicine as a field mirrors the interdisciplinary training of early practitioners who often held degrees in medicine and the Humanities. Physicians and other healthcare workers, Charon believes, could benefit from the interpretative skills taught by literary studies. “Close reading” as a method is now taught to doctors-in-training, nurses and writers at Columbia University’s Narrative Medicine programme to instill attentiveness to individual contexts in the face of for-profit and dehumanising medical systems. Each patient, doctor and healthcare worker has stories to tell, as Gawande’s writing amply illustrates, and sharpening their interpretative skills makes for a more humane practice.
What sets Gawande apart from the best-selling science writers of our time? Rather than a focus on innovations in a particular branch of science, Gawande’s characteristic mode is the search for patterns across knowledge domains and systems of every kind. Consider this extract from The Checklist Manifesto where he “sees” a version of the checklist as a solution to many operational problems in industries that are seemingly unrelated to medicine:
I came away from Katrina and the Builders with a kind of theory: under conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgement, but judgement aided – and even enhanced — by procedure.
Having hit on this “theory”, I began to recognise checklists in odd corners everywhere – in the hands of professional football coordinators, say, or on stage sets. (79)
A theory of writing (or writing about theories encompassing domains outside medicine) takes Gawande out of the sphere of popular science writing and into the literary. Moreover, references to interlinkages between various industries that may share similar problems and solutions broaden the scope of his readership. What is compelling about what Gawande writes are the cornerstones of several popular genres: detective fiction, medical thriller, self-help, and productivity to name a few. Several of his pieces begin with high-octane action – a nervous intern about to make a mistake in the operating-theatre, a critically wounded patient wheeled into the emergency room, a young child helicoptered away from the site of a drowning accident. There is also a unique vantage point as we witness the routine occurrences of situations necessitating medical intervention. Gawande permits us a view of the operating theatre, specialty departments, doctor’s meetings, laboratory, morgue, examination room and medical performance management systems along with other normally inaccessible locations through which we follow the individual case. There is also the sudden and thrilling dive into the body of the patient. Recounting a colleague’s memory of attending to a stab wound he writes,
He drew the electrified metal tip of the cautery pen along the fat underneath the skin, parting it in a line from top to bottom, then through the fibrous white sheath of fascia between the abdominal muscles. He pierced his way into the abdominal cavity itself and suddenly an ocean of blood burst out of the patient. (2)
There is evocative character-building and a preservation of voice in his stories even in the face of provocative debates about the effectiveness of technological innovations, traditions or ethics in medical practice. In The Checklist Manifesto, while presenting the Indian polio-eradication campaign as a test case for diligence and relentlessness in medical care, he weaves the following portrait of the first patient identified in a 2003 outbreak of the disease: “The index case was an eleven-month-old boy with thick black hair his mother liked to comb forward so that the bangs rimmed his round face. His family lives in the Southern Indian state of Karnataka, in a village called Upparahalla, along the Tungabhadra River” (16). He rarely recounts a case, a diagnosis or innovative practice without offering a glimpse into lives, homes and texture of voice. Gawande also enjoys a taste for the unique and the macabre best illustrated by his pieces about rare conditions like necrotising fasciitis in “The Case of the Red Leg” or the role of superstition in medicine in “Full Moon Friday the 13th” or the mysteries of physical sensations like “The Itch”. Gawande’s work also informs the popular image of healthcare workers and whets a public taste for medical tales evidenced by the enduring appeal of American medical-themed television series like Dr Kildare (1961 – 1966), Emergency! (1972 – 1977), and more recently, Doogie Houser MD (1989 – 1993), House MD (2004 – 2012), the long-running Grey’s Anatomy (2005 – present) and Dhadkan (2002), Kuch Toh Log Kahenge (2011 – 2013) and Sanjivani (2002 – 2005) in India.
In 2014, Gawande was honoured with the Thomas Lewis prize for Science Writing. The prize, established by the Rockerfeller University recognises the “Scientist as Poet”. A brief description of the Prize’s vision for awardees sums up the unique position Gawande occupies in any history of writing: “[The prize] honors the rare individual who bridges both worlds [scientists and writers]—whose voice and vision can tell us about science’s aesthetic and philosophical dimensions, providing not merely new information but cause for reflection, even revelation”[iv].
Further Reading
Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Picador, 2015.
—. Better: A Surgeon’s Notes on Performance. New Delhi: Penguin, 2007. Print.
—. Complications: Notes From the Life of a Young Surgeon. New Delhi: Penguin, 2002. Print.
—. The Checklist Manifesto: How to Get Things Right. New Delhi: Penguin, 2010. Print.
Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford UP, 2006. Print.
Verghese, Abraham. My Own Country: A Doctor’s Story. New York: Vintage Books, 1995. Print.
Pollock, Donald. “Physician Autobiography: Narrative and the Social History of Medicine.” Narrative and the Cultural Construction of Illness and Healing. Ed. Cheryl Mattingly and Linda C. Garro. Berkeley: U of California P, 2000. 108-127. Print.
Mukherjee, Siddhartha. The Emperor of all Maladies: A Biography of Cancer. London: Fourth Estate, 2011. Print.
Notes
[i] Topol, Eric J and Atul Gawande (2013), “Atul Gawande on the Secrets of a Puzzle-Filled career”, available at https://www.medscape.com/viewarticle/815241
[ii] Available at https://www.nytimes.com/2007/04/03/books/03atul.html
[iii] Available at http://spenserians.cath.vt.edu/TextRecord.php?textsid=36160
[iv] The Rockefeller University page on the Lewis Thomas prize, available at https://www.rockefeller.edu/lewis-thomas-prize/
