Complications: A Surgeon’s Notes on an Imperfect Science

In “Education of a Knife,” Gawande introduces the idea of the learning curve in medicine, how—like all workers with a trade—surgeons accumulate skill and experience through practice. That this practicing is done on humans, however, creates a central tension in medicine: “You can’t train novices without compromising patient care” (30).

In a series of personal stories, Gawande tracks his ability over time to perform a single procedure: putting a central line in a patient’s chest, which allows a patient to receive food or medicine intravenously through a tube. The first story takes place in Gawande’s fourth week of training, when the chief resident shows him this procedure and then asks him to replicate it on a patient. He is nervous and inexperienced, and he grows frustrated as he fails on multiple tries with multiple patients, often causing discomfort or pain to the patient and requiring bailing out by a superior. Gawande eventually succeeds with a particularly challenging case, and his success helps him build confidence. By the end of the essay, Gawande is in his seventh year of training and installs a central line almost without thinking. The essay culminates with him assigning the task to a fearful young resident, turning from student to teacher and completing his own character arc within the essay.