.45%

I just finished Better: A Surgeon's Notes on Performance the other day, and I can easily say it is one of the best books I have ever read. All three sections of the book were masterful; every chapter had a catch to it that made it seem better than any other one before it. What I found to be my favorite part about this book was how Dr. Gawande could take something that seemed so irrelevant and meaningless to any higher purpose and show you just how vital it was. Every anecdote he mentioned took the points he was trying to make and turned them into very real life situations that anyone in the medical field will have to deal with, no matter what you think.

There were times in this book, especially near the end, where it felt like he was talking to me specifically.

For instance, one of the chapters found in the third section, the ingenuity one, was discussing the lethal disease Cystic Fibrosis and how America is dealing with it. Cystic Fibrosis is something that you are born with, and because of the genetics, you can never know if you will get it. It's what's called a recessive gene, which means that the only way you could inherit it is if both of your parents had it and they passed it on to you. This makes it very much more complicated because then most people never find out until the disease has matured in the body. One of the strongest symptoms of it is the accumulation of mucous inside of the lungs, making it increasingly hard to breathe. Until eventually, it kills you. People who find themselves inflicted with this also find themselves in a daily struggle against it. They must endure, at least twice a day, physical pain as someone bangs on their chest and various points across their body trying to force the mucous out of their mouths. Regular doctor appointments, something that would already annoy most people, are something they also have to participate in for the rest of their lives. Along with various medications, etc.

The average lifespan of someone born with CF was about thirty some years. Recently however, this number has gone up because of the aggressive new treatment methods that have spread across the United States. Which is where I go back to what I was saying earlier about Dr. Gawande talking to me. In one clinic where CF is treated, Gawande interviewed on of the doctors, he'd been there for decades, and in the last ten years, not a single victim of CF has died. The oldest patient they had at the time was over sixty years of age. What was his trick, was what Gawande was curious about. The doctor explained how the well being of a patient could be analysed by seeing the percent at which their lungs functioned: 80, 100, 110 (if the person's lung was functioning better than that of someone without CF). In one instance, there was a patient who's lungs were at 99.5%. That didn't cut it for this man, and he continued vigorously treating this patient until lung functionality was 99.95%. 99.5%...99.95%... if I were in his shoes, you better bet that I would have stopped at the former number, and been very proud of myself. But in fact, in order to be successful in medicine, a doctor always has to try until there is absolutely nothing more he can do.

When it comes down to those fractions of percents, .45%, when it comes down to staying up until the wee hours of the morning to deal with a patient, or working double time over the weekends, that is the difference it takes to be a good doctor.