Free Complications by Atul Gawande

this wound. I don’t even know if you’re in the right place. Can we get better light and suction?” New suction tubing was found and handed to him. He quickly cleaned up the wound and went to work.
    The patient’s sat had dropped so low that the oximeter couldn’t detect it anymore. Her heart rate began slowing down—first to the 60s and then to the 40s. Then she lost her pulse entirely. I put my hands together on her chest, locked my elbows, leaned over her, and started doing chest compressions.
    Ball looked up from the patient and turned to O’Connor. “I’m not going to get her an airway in time,” he said. “You’re going to have to try again from above.” Essentially, he was admitting my failure. Trying an oral intubation again was pointless—just something to do instead of watching her die. I was stricken, and concentrated on doing chest compressions, not looking at anyone. It was over, I thought.
    And then, amazingly, O’Connor: “I’m in.” He had managed to slip a pediatric-size endotracheal tube through the vocal cords. In thirty seconds, with oxygen being manually ventilated through the tube, her heart was back, racing at a hundred and twenty beats a minute. Her sat registered at 60 and then climbed. Another thirty seconds and it was at 97 percent. All the people in the room exhaled, as if they, too, had been denied their breath. Ball and I said little except to confer about the next steps for her. Then he went back downstairs to finish working on the stab-wound patient still in the OR.
    We eventually identified the woman, whom I’ll call Louise Williams; she was thirty-four years old and lived alone in a nearby suburb. Her alcohol level on arrival had been three times the legal limit, and had probably contributed to her unconsciousness. She had a concussion, several lacerations, and significant soft-tissue damage. But X rays and scans revealed no other injuries from the crash. That night, Ball and Hernandez brought her to the OR to fit her with a proper tracheostomy. When Ball came out and talked to family members, he told them of the dire condition she was in when she arrived, the difficulties “we” had had getting access to her airway, the disturbingly long period of time that she had gone without oxygen, and thus his uncertainty about how much brain function she still possessed. They listened without protest; there was nothing for them to do but wait.
    Consider some other surgical mishaps. In one, a general surgeon left a large metal instrument in a patient’s abdomen, where it tore through the bowel and the wall of the bladder. In another, a cancer surgeon biopsied the wrong part of a woman’s breast and thereby delayed her diagnosis of cancer for months. A cardiac surgeon skipped a small but key step during a heart valve operation, thereby killing the patient. A general surgeon saw a man racked with abdominal pain in the emergency room and, without taking a CT scan, assumed that the man had a kidney stone; eighteen hours later, a scan showed a rupturing abdominal aortic aneurysm, and the patient died not long afterward.
    How could anyone who makes a mistake of that magnitude be allowed to practice medicine? We call such doctors “incompetent,” “unethical,” and “negligent.” We want to see them punished. And so we’ve wound up with the public system we have for dealing with error: malpractice lawsuits, media scandal, suspensions, firings.
    There is, however, a central truth in medicine that complicates this tidy vision of misdeeds and misdoers: all doctors make terriblemistakes. Consider the cases I’ve just described. I gathered them simply by asking respected surgeons I know—surgeons at top medical schools—to tell me about mistakes they had made just in the past year. Every one of them had a story to tell.
    In 1991, the
New England Journal of Medicine
published a series of landmark papers from a project known as the Harvard Medical Practice Study—a review of more