Atul Gawande

I've spent the weekend at ALA, which has been fabulous. This morning I went to Atul Gawande's sunrise presentation (fortunately not exactly at sunrise).

I first encountered Gawande's work two years ago when I read Complications, which gave me lots to think about and, in concert with some of my rhetoric readings, changed my ideas about human logic, reason, and intuition.

Today he talked about his latest book, The Checklist Manifesto. Here's the short version of his fascinating presentation: About half of deaths that occur in surgery are preventable. He was on a WHO committee looking for ways to prevent those preventable deaths, and they thought of airpline flights, which like surgery are extremely complicated procedures but that nearly always work. So he went to the Boeing Checklist Factory (he said the Boeing guys didn't like it when he called them that) and asked them to train him in the art of checklisting. Then he made a checklist for surgery that included things like have an extra bag of blood around and some antibiotics and also things like make sure everyone in the room knows everyone else's name and also knows why you're doing the surgery. Then they sent the checklist to a bunch of pilot hospitals around the world, from the best research hospitals to struggling refugee hospitals.

At first everyone looked at the list and said, We already do all this. But it turns out that when they measured it, even though everyone meant to do all those steps every time, 2 out of 3 times they forgot a step. So the checklist made a big difference, and they saw a huge reduction in the number of complications. So at the end of the study he asked the doctors, Are you all going to keep using the checklist? Only 80% said yes--the others said it was a waste of time. But 93% of them said they would want someone doing surgery on them to use a checklist.

So, Gawande said, Why is that if we had a medicine that would drastically decrease fatalities everyone would prescribe it, but when we have a piece of paper that does exactly the same thing, not everyone is willing to use it?

He theorized that the problem is our idea of being experts and heroes. We think heroes act all by themselves, like superman. But in real life, they have to work in concert with other people, especially as we face increasingly complex problems. So he said the checklist itself is merely a representation of a set of values, chief among which is humility: recognition that we are fallible humans and even our experts need checking. He said the checklist also embodies ambition: the hope that we really can combat extremely complicated problems like diseases and that we really can strive for perfection every time.

The presentation reminded me very much of Paul Woodruff's excellent book Reverence. The basic premise is that, ironically, when people begin thinking they are gods, they begin acting like beasts. Instead, people are at their best when they have a sense of reverence: a glimpse of being part of something larger than themselves.

First Day

Just completed my first day as an editorial assistant at A K Peters. It was a good day with good people, and I think I’m going to learn a lot here. I expect to get good experience with the entire publishing process and gain a broad perspective of editing. I also expect I'll learn a lot more discipline doing the nitty gritty hands-on of editing.

The day started with 3 meetings:

1. Editorial meeting, where we discussed all the projects currently in editing and made assignments. I was assigned to my first three projects.
2. Company meeting, where every department discussed status updates on their work. Because the company is so small, I got to hear from acquisitions, production, design, marketing, and sales, which was fascinating. I’m looking forward to learning through experience about every stage of publishing.
3. Covers meeting, where we discussed some cover possibilities for a new publication. No surprise, this was much more subdued than the Candlewick covers meeting I attended.

I spent most of the rest of the day starting to learn LaTex (“tech”), the math-oriented typesetting program we use, which involves quite a bit of coding. It will take some work, but I think I’ll really like having so much direct control over the text, as I did while editing in WordPerfect for a professor years ago.

Camber and I celebrated the day with dinner at Not Your Average Joe’s where we had a delicious dinner that made up for the terrible one she had at Joe’s American Food during her first week at A K Peters.