by Atul Gawande
There is a third person at The New Yorker besides Henry and Malcolm to whom I owe particular thanks: David Remnick. Despite my unpredictable schedule as a resident, and the reality that my patient responsibilities must come first, he has stuck with me. He has built a great and special magazine. And most of all, he has made me feel part of it
In writing this book, I have found two new kinds of people in my life. One is an agent, which seems like something everyone should have—especially if you can have one like Tina Bennett, who has looked after both me and the book with dedication, unshakable good cheer, and eminently sound judgment in everything (even as she carried and gave birth to a child in the midst of the project). The other is a book editor, which turns out to be a species as different from magazine editors as surgeons are from internists. With an uncommon combination of tenacity and gentleness, Sara Bershtel at Metropolitan Books got me to find the broader frame that caught what it is I write and think about, showed me how a book could be more than I imagined it to be, and somehow kept me going though at times the task seemed overwhelming. I am immensely fortunate to have her. My thanks, too, to her colleague Riva Hocher-mann, for her careful reading of the manuscript and invaluable suggestions.
Trying to write as a surgical resident is a sensitive and tricky matter, particularly when one is as interested, as I am, in writing about how things go wrong as how things go right. Doctors and hospitals are usually suspicious of efforts to discuss these matters in public. But to my surprise I have found only encouragement where I am. Two people in particular have been instrumental in this. Dr. Troy Brennan, a professor of medicine, law, and almost anything else you can think of, has been a mentor, a sounding board, a collaborator in research, and an unstinting advocate for what I have attempted to do. He even gave me the office space, computer, and phone that let me get this work done.
Dr. Michael Zinner, my hospital’s chairman of surgery, has likewise given me his backing and protection. I remember approaching him after I had written my story trying to explain what happens when doctors make mistakes, intending to publish it in The New Yorker. I knew it was something I could not publish without permission from him. So I gave him the manuscript and then, a few days later, walked into his office braced for the worst. As it turned out, he didn’t love it. How could he? No hospital public relations department in the world would have let an essay like that go out. But he did a remarkable thing: he supported me anyway. The article could easily backfire, he warned me, with the public or with other doctors. But if there was flak he would help me, he promised. And he let me go ahead.
In the end, there never was any flak. Even when my colleagues from work have disagreed with what I’ve written, they have been constructive and engaged and have held nothing against me. We are all, I’ve found, in the process of trying to understand how much of what we do is good, how much of it can be better.
To the patients and families who go named and unnamed in this book, I wish to extend a great and special thanks. Some I am fortunate to still keep up with. Others I was never given the chance to know as well as I wish I could have. All of them have taught me more than any could know.
There is just one person, however, who has been involved in all the parts of what is here—the writing, the doctoring, and the struggling to succeed at both: my wife, Kathleen. She’s stuck with me through the long hours and turmoil of surgical training and bolstered me when my confidence and resilience have failed me. Then, when I’ve come home, she’s helped me to talk through the ideas I’ve had for writing and stayed up late with me to help hammer them into words. A magnificent editor herself, she has red-penciled this entire manuscript and, though I’ve sometimes not wanted to admit it, made everything better. She has also, most critically, kept our sweet and demented children in my life—even bringing them to the hospital to see me when I’ve missed them and been away for too long. This book exists thanks to her love and dedication. So it is dedicated to her.
About the Author
ATUL GAWANDE is a resident in surgery in Boston and a staff writer on medicine and science for The New Yorker. He received his M.D. from Harvard Medical School as well as an M.P.H. from the Harvard School of Public Health. His writing has appeared in The Best American Science and Nature Writing 2000 and the New Yorker essay collection In Sickness and In Health. Gawande lives with his wife and three children in Newton, Massachusetts.
