“Death is the moment when evening passes into night. I know. There is no surprise, and it often comes after a long sickness that is worse than death. When I died, I died of many things: the failing systems; the weakening of age; the exhaustion of the long war against dying. Finally, I succumbed to the lack of ethics in a California hospital, killed by filth and neglect.”
Atul Gawande • The New Yorker • March 2001
On the decline of the American autopsy and the fallibility of modern medicine.
“I felt her abdomen. It could be anything, I thought: food poisoning, a virus, appendicitis, a urinary-tract infection, an ovarian cyst, a pregnancy. Her abdomen was soft, without distension, and there was an area of particular tenderness in the lower right quadrant. When I pressed there, I felt her muscles harden reflexively beneath my fingers. On the pelvic exam, her ovaries felt normal. I ordered some lab tests. Her white-blood-cell count came back elevated. Her urinalysis was normal. A pregnancy test was negative. I ordered an abdominal CT scan.
“I am sure I can figure out what's wrong with her, but, if you think about it, that's a curious faith. I have never seen this woman before in my life, and yet I presume that she is like the others I've examined. Is it true? None of my other patients, admittedly, were forty-nine-year-old women who had had hepatitis and a drug habit, had recently been to the zoo and eaten a Fenway frank, and had come in with two days of mild lower-right-quadrant pain. Yet I still believe. Every day, we take people to surgery and open their abdomens, and, broadly speaking, we know what we will find: not eels or tiny chattering machines or a pool of blue liquid but coils of bowel, a liver to one side, a stomach to the other, a bladder down below. There are, of course, differences—an adhesion in one patient, an infection in another—but we have catalogued and sorted them by the thousands, making a statistical profile of mankind.”