Mesmerized by the OR
Dr. Topol: Then you went back and finished med school. You also were at Harvard School of Public Health and got a degree there as well. And then you did your surgical residency. You're obviously an accomplished surgeon, but when did you get into the writing side?
Dr. Gawande: I never thought surgery was going to be what I was going to do. I went through medical school thinking that I would so something like internal medicine, combine a career where I have a clinic on the side but mostly do public policy, trying to understand how you make health systems better. Then I got into an operating room and I fell in love with it and it was a real problem.
Dr. Topol: You were mesmerized by the operating room?
Dr. Gawande: Weirdly enough, I thought surgeons were like politicians. Surgeons are grappling with having limited information and knowledge, imperfect science, but have a necessity to act in the face of both imperfection in their own abilities and imperfect knowledge in the world. I saw a lot of the same incredible range of characters and people [in politics and the operating room]. I have sometimes said that my favorite New Yorker cartoon, because it described me, was a picture of a headstone in which the inscription read, "He kept his options open." I was the guy who kept his options open.
I wanted to be more like surgeons and more like the politicians I admired who could make decisions, live with the consequences, and learn from the consequences.
Becoming a Writer
Dr. Topol: You got transfixed by surgery but you also got into writing.
Dr. Gawande: I diverted myself. When I was practicing surgery I had no ability to keep my work in policy going. A friend of mine started an Internet magazine, Slate.com. But in 1996 no one was writing for an Internet magazine, so he would ask his friends, "Would you write something for me?" I demurred for a while but then I realized that it was an opportunity to stay involved in writing about policy. And that's what I started doing. You'd call it a blog today, but every couple of weeks I'd have a new article and I'd start learning. My first articles were terrible.
But it was beautiful because I could learn on the job, and just like doing 30 gallbladder surgeries in a row, I did 30 columns in a row but with fantastic editors, people like [founder] Michael Kinsley, Jacob Weisberg, and a couple of other folks who are just fantastic, who would tell me, "This is what you're doing well, and this is what you're not doing well. Work on this." I remember a series of columns where I'd work on how to make it more visual. How do I not put the boring stuff up front but be able to convey the ideas? How do you tell a story? And so, gradually over that time, I learned how to do at least short-form work.
Dr. Topol: You got pretty good at that. Now, when did the New Yorker discover you?
Dr. Gawande: By the end of that period I was getting, like, 300,000 hits for a given article. One of the people following along was a New Yorker editor who asked if I would like to try something longer for them. So, in 1998, I wrote my first piece for the New Yorker. I really enjoyed it, even though it was incredibly painful. It went through 22 revisions and then had to go through their grueling fact-checking process.
Dr. Topol: A little tougher than Slate.
Dr. Gawande: Yes. I thought, "Hey, this will take 2 months [to get published]." It ended up being almost a year before that final piece was something they were happy with. But I learned a ton and then I wrote 3 articles that year. After the 3 articles they asked if I'd switch over and join the staff. I was in my third-year residency at that point.
They worked it out so that I could both do surgery and write, and it was fantastic. It was amazing to have that foot in the door.
Dr. Topol: Was that a life changer for you?
Dr. Gawande: Absolutely. There have been multiple life changers along the way. I've gotten really, really lucky. The life changers have been where I've gotten to be paired with people who could open up my perception of what you could do as a doctor, what was possible for you, and then offer a helping hand to say that this is how you do it well. The New Yorker has really been about my relationship with my editor there, a guy named Henry Finder, who is just tremendous. He's just a tremendous brain, sharpens your thinking and gets you understanding how to write better and better.