Complications

Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however—close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes—is how messy, uncertain, and also surprising medicine turns out to be.

The audience watched wide-eyed and incredulous.

The most elegant clip, however, was from a Houston, Texas, surgeon who unveiled a procedure for repairing a defect of the esophagus known as Zenker’s diverticulum. This is an abnormality that normally requires an hour or more to repair and an incision in the side of the neck, but in the film the surgeon managed to do it through a patient’s mouth in fifteen minutes with no incision at all. I stayed and watched movies for almost four hours. And when the lights went up, I walked out into the day silent, blinking, and exhilarated.

It began with a close-up of a patient’s open abdomen. The surgeon, unseen but for his gloved and bloody hands, was attempting an exceedingly difficult and dangerous operation—the excision of a cancer in the tail of a patient’s pancreas. The tumor lay deep, enveloped by loops of bowel, a latticework of blood vessels, the stomach, and the spleen. But the surgeon made getting it out seem like play. He plucked at fragile vessels and slashed through tissue millimeters from vital organs. He showed us a couple of tricks for avoiding trouble, and the next thing we knew he had half the pancreas on a tray.

In another film, a team from Strasbourg, France, removed a colon cancer from deep in a patient’s pelvis and then reconnected her bowel entirely laparoscopically—through tiny incisions that required only Band-Aids afterward. It was a startling, Houdini-like feat—

each to show reel upon reel of actual operations all day, every day. I scooted into one darkened room and was instantly riveted. I saw daring operations, intricate operations, ingeniously simple operations.

In the afternoon, I went to the movies. The organizers had set up three theaters

I debated going to a lecture on the proper way to dissect a neck or a session on new advances in managing gunshot wounds to the head, but finally decided on a panel debate about the best way to repair hernias of the groin.

But there are distinct limitations to the industrial cure, however necessary its emphasis on systems and structures.

Given the results they’ve achieved in anesthesiology, it’s clear that we can make dramatic improvements by going after the process

Operations like that lap chole have taught me how easily error can occur, but they’ve also showed me something else: effort does matter; diligence and attention to the minutest details can save you.

There’s one looming danger, though: the stalk of the gallbladder is a branch off the liver’s only conduit for sending bile to the intestines for the digestion of fats. And if you accidentally injure this main bile duct, the bile backs up and starts to destroy the liver. Between 10 and 20 percent of the patients to whom this happens will die. Those who survive often have permanent liver damage and can go on to require liver transplantation. According to a textbook, “Injuries to the main bile duct are nearly always the result of misadventure during operation and are therefore a serious reproach to the surgical profession.”