Atul Gawande on the Secrets of a Puzzle-Filled Career

; Atul Gawande, MD, MPH


December 06, 2013

In This Article

Writing Books

Dr. Topol: Do you prefer to write a full-length book or one of these intriguing pieces in the New Yorker?

Dr. Gawande: I'm in the middle of a book right now, and it's painful enough that I think I really like the New Yorker pieces because I get them done in about 3 months. I'm a surgeon; I like getting it done. I've been at work on this book for 2.5 years. It's in second draft now, so it's coming close enough that I know we should be able to have it out next year.

The writing that I like best, and also the research that I like best, is work that feels cool but it lasts. It has a sense that 5 years from now, maybe 10 years from now, it might still be remembered and have value. What I think I like best about the books I've written is that they have lasted, and it feels like they might have the greatest longevity if I can get them right.

Dr. Topol: Your first book was Complications: A Surgeon's Notes on an Imperfect Science. Did you know that there would be an audience to read about the nitty-gritty of the medical-surgical world?

Dr. Gawande: No. The New Yorker exposed me to the idea that there would be a readership, but I didn't exactly know how many would follow along, and I still thought of it as something I did as a hobby. I would have been embarrassed to call myself a writer at that time, even though I had been on staff about 6 years at that point. I felt like Malcolm Gladwell and Adam Gopnik and others; they were the real writers, and because I had this view into gross situations, then I had an unfair advantage.

When the book came out, we were going to call it a victory if 10,000 copies were sold. So I was flabbergasted when the publisher kept going back for reprints, and the New York Times Book Review gave it a good review. It completely shifted my thinking. It was one of the most memorable moments of my life.

I was about to go into what turned out to be a 9-hour vascular case as a fourth-year resident when I got a call from the National Book Award Committee that they had selected my book as a finalist for the National Book Award. I didn't feel that I could say anything; no one in the room would have been all that interested. We had a case to do. But I just remember suddenly realizing that this isn't a hobby. This now has to be part of what I do. If they took my writing seriously, I needed to take it seriously as well.

Frustrated Rock Singer

Dr. Topol: That's fantastic. Now, I know that you're not just a writer, because I see on Twitter that you like music and have Sunday playlists.

Dr. Gawande: Well, I'm a frustrated unsuccessful rock singer, a rock music guy. I had little bands when I was in college. When I got to Oxford I recorded a bunch of music and did a couple of shows there and figured out pretty quickly that I was not going to be a rock musician. So I rely on my kids, who are really great musicians, to hopefully fulfill that part of my life. But I still love music, go to a lot of shows, keep up with a lot of folks, have gotten to know people in various bands that I just follow religiously.

Dr. Topol: So it isn't just a Sunday afternoon on Twitter playlist?

Dr. Gawande: No. I love connecting to people who are deeply creative, and musicians and certain kinds of scientists really fall into that category. Certainly writers do. Long before I was writing, I found myself around a lot of people like that and was just attracted to trying to know how they do what they do.

Dr. Topol: Speaking of connecting to a lot of people, what do you think about Twitter?

Dr. Gawande: I was very resistant. My publisher had been pushing me to get on Twitter, go on Facebook, and I didn't see the point. And then I saw a Twitter feed of someone who is posting their favorite quotes from books they read, and I thought, "Wow -- I love seeing what he's doing." I realized that you could use it not to tell about the coffee you had that morning or other things, but instead to reflect your own personality and that it's an art form. All art is defined by constraints: Shakespeare working with the sonnet form, people working with the novel form, and Twitter -- how do you work with 140 characters?

And there are fascinating ones. I follow one guy who writes short stories in 140 characters.

Dr. Topol: It's amazing.

Dr. Gawande: I follow science people who show me interesting things. I get my news on there, and then I get people who are annoyed with the kind of tweeting I do, which is partly "let me tell you what's interesting that's going on in healthcare policy" and about science and medicine, but it's also just music. I spent 1 week where I had been on a David Foster Wallace reading binge and was putting up my favorite quotes from my reading for a straight week, so Twitter is just another form of expression. To me it's a cocktail party that is nonstop. You can dip into the cocktail party whenever you want and talk to whomever you want at this party. And if you don't like that particular person, just move on to the next.

Dr. Topol: That's a good way to put it. Not that many physicians are on Twitter overall. I've been trying to encourage it because, as you say, there's a lot of valuable material you can get to.


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