The pathetic fact is that I don't go to doctors enough myself. I'm almost a year overdue for my teeth cleaning (that isn't too gross to mention, is it?), and then there's this lump in my back that I really should get examined. And I will. I will. But where's the time? And you can never get an appointment for when you really need one. ...
The patient, by the way, did just fine—I and his attending surgeon did a carotid endarterectomy, one of those Roto-Rooter jobs to clean out a blockage in the main artery to the right side of his brain. It's an operation that tends to make me nervous. You do it to prevent the plaque in the artery from breaking off and causing a stroke, which had a 10 percent chance of occurring in this guy over the next five years. But cleaning out the blockage has (in our hands) about a 2 percent incidence of stroke during surgery itself. You take a big risk now to avert a big risk later, and that makes logical sense. Still, waiting for patients to wake up after the operation is always a little, well, pregnant. He was a little wobbly for an hour or two in recovery. But then he was himself again—able to stick out his tongue straight and talk without slurring and move with full strength—and maybe even a little improved for what we did.
So now, I'm dying to ask you how cooking, or more precisely the origin of cooking, affected how we human beings evolved. Maybe, though, we have to wait for the story to come out. Which is when? And how long will this take you (has this taken you)? A couple days? A couple weeks? This could not have been assigned. So how much of your time do you have to spend on this versus reporting on the latest research that Science and Nature and the New England Journal have lined up to come out on Thursday? Have you got someone working on one of those stories now? Though I am myself in the medical writing as well as medicalizing business, I've not been in the medical reporting business. And I've had only the vaguest inkling of how set and controlled the reporting of "breakthroughs" actually is.
But maybe I should get back to the news. Regarding the rather interesting contradiction between Bush's stand on cloning and his stand on the death penalty, the contradiction may not be so deep after all. I think Bush and a lot of others would say the biggest reason they're for the death penalty is not so one death would serve to deter others from killing people. (The evidence is pretty unconvincing on this point, anyway.) Instead, they think people like Timothy McVeigh and Osama Bin Laden and lots of other less spectacular killers should be killed because it's just. Now, if the process of figuring out who really deserves it is shot full of errors, the way the panel in Illinois has found it to be, that's enough to get even conservatives questioning what we're doing. For once, there may be common ground between right and left here. But only if evidence really matters in politics. I take what is happening in Illinois as a positive sign.
What's happening in Israel and the Palestinian territories, however, is another matter. Let us take for granted that when suicide bombers are raining down upon your land and people, you are in the right to fight back to stop them. U.S. News two weeks ago had a jarring report, however, noting that the "kill ratio" in Israel has remained a persistent 3-1 going back apparently months. That is to say, no matter how fiercely Israel fights back, one Israeli is killed for every three Palestinians killed.
But maybe Sharon and Arafat do not see this as a linear process. At some tipping point, perhaps they think, so many of the other side are killed that their backs will be broken, they will be cowed without a need for compromise and discussion. If so, however, it is not evidence that they are relying upon.
Atul Gawande, a surgical resident in Boston, is a staff writer on medicine for The New Yorker and author of the new book Complications: A Surgeon's Notes on an Imperfect Science.