Education_of_a_Knife

Education_of_a_Knife - Warning Concerning Copyright...

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Warning Concerning Copyright Restrictions The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship, or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be liable for copyright infringement. This institution reserves the right to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of copyright law. Printing note: If you do not want to print this page, select pages 2 to the end on the print dialog screen. Mann Library fax: 607 255-0318 www.mannlib.cornell.edu
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Metropolitan Books Henry Holt and Company, New York
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Metropolitan Books Henry Holt and Company, LLC Publishers since 1866 115 West 18th Street New York, New York 10011 Metropolitan Books™ is a registered trademark of Henry Holt and Company, LLC. Copyright © 2002 by Atul Gawande All rights reserved. Distributed in Canada by H. B. Fenn and Company Ltd. Several of these pieces have appeared, in slightly different form, in The New Yorker and Slate. Library of Congress Cataloging-in-Publication Data Gawande, Atul. Complications : a young surgeon's notes on an imperfect science /Atul Gawande.— 1st ed. p. cm. Includes bibliographical references and index. ISBN 0-8050-6319-6 (hbk.) 1. Surgeons—United States—Biography. 2. Surgery—Anecdotes. I. Title. RD27.35.G39 A3 2002 617'.092—dc2i [B] 2001055884 Henry Holt books are available for special promotions and premiums. For details contact: Director, Special Markets. First Edition 2002 Designed by Fritz Metsch Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 FOR KATHLEEN
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Education of a Knife Ihe patient needed a central line. "Here's your chance," S., the chief resident, said. I had never done one before. "Get set up and then page me when you're ready to start." It was my fourth week in surgical training. The pockets of my short white coat bulged with patient printouts, laminated cards with instructions for doing CPR and using the dictation system, two surgi- cal handbooks, a stethoscope, wound-dressing supplies, meal tickets, a penlight, scissors, and about a buck in loose change. As I headed up the stairs to the patient's floor, I rattled. This will be good, I tried to tell myself: my first real procedure. My patient—fiftyish, stout, taciturn—was recovering from abdomi- nal surgery he'd had about a week before. His bowel function hadn't yet returned, leaving him unable to eat. I explained to him that he needed intravenous nutrition and that this required a "special line" that would go into his chest. I said that I would put the line in him while he was in his bed, and that it would involve my laying him out flat, numbing up a spot on his chest with local anesthetic, and then threading the line in. I did not say that the line was eight inches long
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