Atul Gawande, MD, a general surgeon at Boston’s Brigham and Women’s Hospital and assistant professor at Harvard Medical School and School of Public Health, wrote an exhaustive essay about intensive care for his widely referenced Annals of Medicine column in The New Yorker this past December.

For every drowned and pulseless child rescued by intensive care, there are many more who don’t make it—and not just because their bodies are too far gone. Machines break down; a team can’t get moving fast enough; a simple step is forgotten. Such cases don’t get written up in The Annals of Thoracic Surgery, but they are the norm. Intensive-care medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered.

On any given day in the United States, some ninety thousand people are in intensive care. Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an I.C.U. from the inside. Wide swaths of medicine now depend on the lifesupport systems that I.C.U.s provide: care for premature infants; victims of trauma, strokes, and heart attacks; patients who have had surgery on their brain, heart, lungs, or major blood vessels. Critical care has become an increasingly large portion of what hospitals do. Fifty years ago, I.C.U.s barely existed. Today, in my hospital, a hundred and fifty-five of our almost seven hundred patients are, as I write this, in intensive care. The average stay of an I.C.U. patient is four days, and the survival rate is eighty-six per cent. Going into an I.C.U., being put on a mechanical ventilator, having tubes and wires run into and out of you, is not a sentence of death. But the days will be the most precarious of your life.

On April 24, Gawande comes to the Y to discuss his bestselling new book, BETTER: A Surgeon’s Notes on Performance. With riveting accounts of medical failure and triumph, he provides keen insight into how success is achieved in the complex and risk-filled medical profession.

[Atul Gawande, MD on BETTER: 4/24/08]