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I first learned of today's interviewee when I was given his debut book to review for a website I used to write for. In case you can't tell I am fascinated by people who work in science and medicine Well, he writes about medicine, and quite well: if you haven't read Complications: A Surgeon's Notes on an Imperfect Science, maybe you've seen his writing in the New Yorker. He's got a new book out called Better: A Surgeon's Notes on Performance. Oh, and earlier this year he won the MacArthur 'Genius' Grant (the second Zulkey.com interviewee to do so! You guys don't have to thank me) which made it all the more embarrassing when I found out that I had incorrectly plugged in my microphone when I chatted with him on the phone. Fortunately I took notes and fortunately he's also a very nice guy on top of being smart and talented.
The Atul Gawande Interview: Just Under Twenty Questions
When did you begin writing about medicine?
It wasn't until 1996, when I was a surgery trainee. I had some friends who were writers and I was interested in it, even though there was pretty good evidence I wouldn't be good at it. These friends of mine started an internet magazine--being 1996, not many people had browsers so not many people read the magazine at the time. They were going through a rough patch getting writers, so the editors were calling people they knew asking them to write for them, and they asked me.
How and when did you get your first New Yorker piece published?
That internet magazine I wrote for ended up becoming Slate. My first pieces for them were no good, but I was working with all these fantastic editors who were great at telling me what you do well and what you don't do well. it's a lot like what I went through with my surgical training, actually. Each essay got a little better, and eventually I was trying to write two essays a month, short pieces. Then Slate's readership grew a lot, and I learned through the grapevine that a New Yorker editor had been following my essays. I published "No Mistake" with them in 1998, and ended up writing three articles for them that year.
What are some of your least favorite procedures to perform?
Toe amputation, which you have to do a lot when you're in training for some reason. I have no problem working with bowels that have been shot through, with stool or urine though, but I don't know, I just don't like feet.
How did you come to specialize in endocrinology?
Well, I'm a general surgeon, but I do a lot of endocrine surgery. Each hospital has its niche or needs so a general surgeon can find himself doing burn care or trauma or breast cancer. When I was first looking for a job I happened to come at a time when the hospital needed someone who could work on endocrine techniques. I work on a lot of emergencies and breast cancer, various lumps and bumps.
Do you find that doctors' specialties say much about their personalities or is it more nuance (or even simply more practical) than that?
I think it's more random and practical. There is definitely some truth that there are different types of people who go into general medicine or surgery or become psychologists, but otherwise, there isn't a personality type that goes with each specialty necessarily. One of my favorite plastic surgeons, for instance, is a guy who you'd meet and never assume was the 'type' to be a plastic surgeon.
What do you think is one of the most misplaced or perverted ideals, health-wise, that Americans have today?
I think that there is an imbalance between the value we place on thinking about and managing the problems we have versus trying to cure them. Take chronic back pain, for instance: there are plenty of different things that can cause back pain, and in many cases, we can't find the cause at all. There's just not a quick fix for many problems.
What other country's health care systems do you admire?
There's no country that's been able to fix the core problem of health care, which costs ever more. Almost anywhere you point to--France, UK, Canada--in any given moment there are periods where they're doing well and periods where they're absolutely struggling under the cost of health care. I do admire any country that's decided every person should have healthcare. I think for us, the system that works the most consistently well is Medicaid.
Was it difficult to write about your own mistakes as a surgeon and to publish them? Or as a doctor are you put through the ringer so much with your actions being examined that it wasn't that big a deal?
It wasn't that big a deal for me. I think that the systems where you're fallible are the most interesting. I don't write stories or like looking at situations where I already know the answer--then everybody knows the answer. Instead, I'm trying to think through the troubles with genuine confusions and fierce arguments, trying to find some way of grasping the truth of the situation. I like trying to see the complexity of the situation and not trying to paper it over.
Did other doctors express any concern that in your writing, you admit to the human error side of being a doctor?
I was braced for it: the major response though has been the same one I've gotten out of the profession. In fact, those in the field seem to have a kind of recognition, "this is what it's like." I'm not writing it to throw bombs--I wanted to say, I feel reasonably competent at what I do, but don't know how to get great about what I do. I didn't want to point fingers though at the profession or anyone in it.
Have you gotten a very strong reader reaction to your essay "The Score"? As someone who's never been pregnant it didn't exactly make me want to rush out and have a baby anytime soon.
Yes: everybody has their own childbirth story, though. We all kind of know that we're in an unusual time of history right now--childbirth was the number one cause of death for women for as long as we can remember. That's only changed in in a dramatic way in the last couple of generations. We forget that history.
Who are some of your heroes? (in any field?)
There are so many. Virginia Apgar, for one, was a fascinating character. She was this tomboyish woman who was one of the first women to graduate from the Columbia University College of Physicians and Surgeons. I heard once that she flew an airplane under the George Washington Bridge (illegally.) There are so many from other fields, like fantastic surgeons, and writers like Hemingway and Adam Gopnik, who is just amazing at building layers of observation.
Do doctors watch medical TV shows very much (either for entertainment or to pick them apart) or are you guys so sick of that by the time you're off-duty?
When ER came out we all watched it--somehow everybody had time to watch at least some of ER. Those first three seasons, it was great. No one ever had to do paperwork, they all had lives outside the hospital. It had all the drama of the medical experience but got rid of the 90% that's paperwork. Now other people like Scrubs or Grey's Anatomy, but I don't see the same fascination within medicine, partially because those shows had to evolve into soap operas. It's very difficult to convey a mix of science and individual characters and situation.
Why do you think so many children of Asian parents are encouraged to go into medicine?
Well, it's Indians in particular, although it's not that Indians in general always become doctors, because you certainly don't see that when you go to India. In the US, many of the Indians came over in the '60s, had been recruited due to a doctor shortage, and they ended up leaving to come here or the UK, and so what you have now are the children of that generation. You might ask, "why do many Koreans become greengrocers?" It's the family connections. My parents never said explicitly that I should become a doctor, but they sort of expected it. If I became an actor, they'd be puzzled or more likely alarmed. Now there's a new generation with your M. Knight Shymalans and people going into pop music, people making their parents very nervous.
What's been the best thing you've read lately?
I've been reading Cormac McCarthy's The Road right now, and I'm already having nightmares because of it. I've also read Papertrails by Pete Dexter, for the Philadelphia Inquirer, who I'm an enthusiast of.
What do you do with your free time (all five minutes of it?)
In an ideal world: listening to lots of good music, going out with friends, the usual stuff.
What kind of music do you like?
I like everything from alt country to indie rock, like the Decemberists and the Arcade Fire. I had to turn down a book reading so I could go to the Arcade Fire concert.
You're on sabbatical right now, but how have patients reacted to you as you've become more high profile with your writing?
Right now I'm working with a program for the WHO that's going to try to reduce surgical deaths. These days, people google everybody, so it seems like most of my patients have googled me, so a lot of people come in the door knowing that I'm a writer. Because most of them cancer patients, though, that's a one or two sentence conversation, as they very quickly want to know how they're doing.
Since you won the "genius" grant, have you been throwing that around whenever possible? Like in line for Starbucks, "Get out of the way, genius coming through!" or if you're arguing with someone, saying, "Well, I'm ONLY an award-winning genius, but..."
Hah, well these days my wife will say, "Now the genius can go and take out the trash."
How does it feel to be the 180th person interviewed for Zulkey.com?
It feels marvelous!