Atul Gawande

Presenter0:00

Hello, I'm Kirsty Young. Thank you for downloading this podcast of Desert Island Discs from BBC Radio 4. For rights reasons, the music choices are shorter than in the radio broadcast.

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For more information about the programme, please visit bbc.co.uk slash radio four.

Presenter0:34

My castaway this week is the surgeon and author Atil Gawandi.

Presenter0:38

A Harvard professor and practising physician, the titles of his best selling books go a long way to explaining the focus of his work in life.

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Being Mortal, Illness, Medicine, and What Matters in the End. Complications, a Surgeon's Notes on an Imperfect Science. His writing and teaching deftly explore the complex nexus between survival and sensitivity, what it truly means to treat people effectively, and indeed how it might be possible to better manage decline and even have a good death.

Presenter1:09

Born in Brooklyn, then raised in Ohio, he began learning at his mother and indeed his father's knee. Both were doctors, who'd travelled from India to study and then work in the States.

Presenter1:20

His childhood seems almost a blueprint for the brain box offspring of first generation immigrants. When he wasn't reading encyclopedias, cover to cover, he was hanging round hospitals waiting for his parents to finish their long shifts.

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He says we look for medicine to be an orderly field of knowledge and procedure, but it is not.

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It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and, at the same time, lives on the line. So welcome, Atulkawandi. Listeners will be very familiar, Radio Four listeners, with your Wreath lectures which you gave last year.

Presenter1:59

You hold two professorial posts at Harvard Medical School and at the School of Public Health. You've written four best-selling books. You carry out over one hundred and twenty surgeries each and every year. If you were your doctor, what would you say to you about stress and getting more sleep?

Atul Gawande2:19

Well, um, not a lot. In surgery, we tend to think that you haven't worked hard enough. We're always priding ourselves on how little sleep you've managed to get. But in a funny way, I've been always somebody who got my seven hours of sleep a night, and I constantly work at trying to get something done. And if I get something done, then I can feel happy with whatever I didn't get done.

Presenter2:41

And endocrine surgery is is is your your specialism. You once said that you were left agog at the confidence that it took for a person to to wield a scalpel. Each time that you perform surgery, do you yourself still have to sort of marshal your resources to do that?

Atul Gawande2:57

No. I've I've done just in endocrine operations, more than three thousand or so of those, and that's part of the beauty of medicine, is reaching a point where certain things can feel really normal. Sitting in here, not normal.

Atul Gawande3:12

And so now I can walk into an operating room with no phone calls, no emails, a team of people, no drama, no emotion like, you know, you're having a bad day at home. Don't care. We're here. We're focused on one thing. And what's funny is you start developing ideas of what is really appealing that are quite unnatural. Like I have certain ideas about how I should make sure everybody is left underneath their skin. You know, I want my knots to be beautiful. Even though on some level it doesn't matter.

Atul Gawande3:46

But you start developing a kind of aesthetic of what it is that seems like a good job done.

Presenter3:52

You you used the word there a couple of times. You know, I've been thinking and I thought this. Wh where is your thinking time? Do you build in thinking time for all the writing?

Atul Gawande4:00

Yeah.

Presenter4:00

Do?

Atul Gawande4:00

During surgery or during my clinic is not my thinking time. What comes out of those, though, are the things that keep you up at night or that you're puzzling over that you really wonder about, a mistake you made and why that happened and whether it was your fault and not your fault and how to think about that or patients who die. And that becomes my thinking time, is the time around the clinical time. And then the beauty of getting to be a writer is I can ask people to do things that would seem very odd. Like I can ask a patient, could I visit them at home and hear more about what was going on with this thing that didn't quite go right. Or I can interview other surgeons or people in public health to say, you know, tell me a time when it all went wrong for you. And I don't get permission normally to do that, but tell them I'm writing a book or writing for the New Yorker. And people suddenly say, sure.

Presenter4:56

Atil Gwandi, we are here, of course, not just to talk to you, but to listen to your eight choices of music. Tell me about the first one this morning. What is it, and why have you chosen it?

Atul Gawande5:05

Uh Love Struck Baby uh by Steve Rivaughn. I chose it um because it was my first date with my wife. When we ultimately put our record collections together, I had 700 vinyl albums, she had 400 vinyl albums, and we only overlap by ten.

Atul Gawande5:23

in the whole mix. Her whole history was basically the blues and rock and roll and Steve Rayvon was kind of a modern version of that. And I actually was able to get third row seats for this fantastic concert. And I was wrinkling my nose and saying, is this really very good? And she was having the time of her life. And so I was happy. I subsequently saw him several times before he died.

Speaker 45:48

Well I'm love struggling baby I must confess Life without you diamond just a silent best Thinking about you baby gave me such a thrill I gotta have you baby can't get a feel I love you baby and I know just what to do

Speaker 46:05

I still remember, you let it be said The way you make me feel take a food to forget I saw a ton of bricks a dead man watching too little, baby I never forget Every time I see you make me feel so fine Heart beating crazy, my blood run a wild

Presenter6:22

That was Stevie Ray Vaughan and Love Struck Baby Atul Gawandi. Here in the UK we've benefited from one of your big ideas. It was something called the Preoperation Checklist or Preoperative Checklist, and this has been adopted by NHS Trusts here.

Atul Gawande6:32

Precision.

Presenter6:36

It it's going through the the key details of surgery and the safety surrounding it. Did you have an aha moment to come up with that?

Atul Gawande6:45

So first of all, the aha moment, there were many, and what it is, was basically bringing to the operating room the kind of pre-takeoff checklist your pilots use when you get on an airplane. So we were asking people to follow along a few basic steps that we did the research to identify what are the most common failures, and there were failures around unsafe anesthesia and blood loss and team communication. And the checklist was 19 items under two minutes before the anesthesia, before the incision, and before the patient left the room. Some simple things, you know, pretty dumb-sounding things like, do I have the right patient on the table? Do I know what their medical issues are and allergies are? Have I got the blood ready if we need the blood? But then the others are really about communication. Has everybody in the room introduced themselves by name? Has the surgeon briefed the team on how much blood loss to expect? Anything non-routine you should be aware of? Has the anesthesiologist briefed the team on the medical concerns about the patient? Has the nurse said what their plans are for the instruments? And it seems really mundane. One of the rules that I've discovered is there's no mistake too dumb for us to make.

Atul Gawande7:57

And deploying this two-minute checklist, including St. Mary's in London, in Toronto General Hospital, but also rural Tanzania in Delhi, eight cities, we had a nearly 50% reduction in death. So we published in 2009. I wrote my book about it in 2010. And most of the Western world has adopted this.

Presenter8:16

And so you listed places there that it's been taken up around the world, but I noticed you didn't list the USA as a

Atul Gawande8:21

Oh, well, that was an initial pilot study. So now I would say we're in at least 100 million of the world's 300 million operations. But to own it, to actually be in the huddle and say, this is what I'm concerned about, and really communicate with the team and make sure everybody else is communicating, I think that's done only a part of the time, and that's the key to the success.

Presenter8:43

We have all come across, or at least anecdotally are familiar, with, you know, the bow tied cardiologist as God of his own domain, you know, who seems to to rule across everything with such confidence and certainty. How do you think individual physicians should guard against being corrupted by their own power?

Atul Gawande8:51

You know, who seems

Atul Gawande9:02

Well, I don't think that these are easily solvable problems by the individual physician. In other words, the amount of knowledge that you have to absorb to keep up, the range of skills that you're required to execute, are beyond the capacity of any individual. And therefore, what system you're part of and the extent to which you're also influencing a good system to get better and not in a system that is poor to begin with.

Atul Gawande9:31

That's a fundamental thing. You know, we discovered more than 4,000 different medical and surgical procedures during the last century. We've discovered more than 6,000 drugs, and we have an uncounted number of preventive solutions. And our job is to deploy that capability town by town to every person alive. Groups of people working together are far better than having the smartest, most experienced, most trained, and hardest working individual in the system. If they aren't part of a whole group of people who are all pulling in the same direction, communicating with the same consciousness of what a good outcome is, you don't get anywhere. It's why I worked on something that's seemingly mundane as a checklist. That checklist could take incredible experts, but also perfectly ordinary people, and have a 50% reduction in death across eight cities. That's bigger than any pill, any procedure, or the very smartest person.

Presenter10:24

I hope it's called the Gowandi procedure or something, is it? I hope you at least get a credit in the title on that one.

Atul Gawande10:30

No, no, no, no, no. There are many, so many more people involved. I got lucky enough to be, you know, telling the story and.

Presenter10:34

No.

Atul Gawande10:36

and chairing the WHO Commission, but that's a very different thing.

Presenter10:40

Time now for your second piece of music at Olga Wandic. Tell us what we're going to hear now.

Atul Gawande10:43

So this is Sir Duke by Steve Ree Wonder. And this was my first single that I bought. It was a 45 that I had purchased when I was about 10 or 11 years old. And I basically listened non-stop to top 40 radio and that was all. And this was my opening out into music, which I came to care a great deal about.

Speaker 411:03

Music is a world within itself with a language we all understand.

Speaker 411:12

With an equal opportunity, for all to sing, dance, and clap their hands.

Speaker 411:20

Well just because the record has a roof, don't make it in the group But you can tell right away

Speaker 411:30

They can feel it all

Presenter11:33

That was Stevie Wonder Answered You Can Play to Atil Gawandi because it was the first record you ever bought.

Presenter11:38

Your father had arrived in New York City then from India in nineteen sixty three? Sixty two, yeah. Sixty two for his residency training. I mean, it seems to me he really em embraced Western culture. You say he he gave up vegetarianism and discovered dating. What sort of life had he left behind?

Atul Gawande11:43

62, yeah.

Atul Gawande11:55

So he was from a small farming village. He was one of 13 brothers and sisters. There was no high school in his village. And his mother died of malaria when he was 10 years old. And he watched her die. And he felt powerless. And he had this sense, I'm not really sure where he got it, that there was an answer out in the world for what could have been done for her. And in fact, there was a treatment discovered at that time that could have been of huge help to her. And it wasn't there. I don't know how he decided to become a doctor, given that he didn't know any, never met one. But from that point on, he knew he wanted to be a doctor. He moved to another village with a relative where they had a high school so he could complete high school and then went on to college and medical school in a big city far away. My mother, on the other hand, came from a completely different background. She was from a family that ran temples in Ahmedabad, in Gujarat. And my mother was one of three sisters and one brother. And her eldest sister discovered that the way to not get married off by your parents was to stay in school as long as possible. And so her eldest sister became a physician and managed to avoid being married off. So she made her sisters do that. So my mother got her training and was offered a chance to do her training after medical school in New York. My parents were set up on a date. They don't even speak the same Indian language. So they met speaking English from the very beginning and then married.

Presenter13:26

And he knew and your mother knew that they were never going back. Did they they knew that they wanted to make uh their life in the West?

Atul Gawande13:33

Not quite. They had made a plan to head back to Nagpur and that he would practice surgery and my mother would practice pediatrics. And it's a public health story because I was vaccinated with a smallpox vaccine and had a bad reaction to it. I developed an encephalitis, which is a inflammation of the brain, and was very sick. And then I was not allowed to travel because you have to have a series of vaccines to be allowed to travel. So my first time to get to travel abroad was not until the eradication of smallpox. So the global ability to eradicate this disease had a very direct effect on us in that, you know, I would ultimately go into public health as part of what I do.

Presenter14:10

Time for some more music, Atokwandi. Tell me about this. Your third of the morning.

Atul Gawande14:14

This is Def Leppard's photograph. At the end of high school, I went with three other friends, all local friends, all of us kind of local rejects in a certain way, on spring break in Florida. It's a 23-hour drive, and I had the car, being the kid of the two doctors in town who had money. And we had a tape deck, and I managed to bring only two albums. So one was Pink Floyd the Wall, and the other was Def Leopard's Pyromaniac, and they were on constant rotation for 23 straight hours. And, you know, it is completely inseparable from sitting in that car and stopping at fast food joints along the way.

Speaker 415:00

Got a photograph, picture of Boston, you're too much. You're the only one I wanna touch.

Presenter15:27

That was some of Def Leppard and photographed there. I should tell listeners at Agawandi. There was a broad smile across your face as you began listening to that. You said that y you were, you know, on this road trip, you and your friends, you you described yourselves there as, you know, local rejects. That's interesting. What was this part of the kind of encyclopedia reading kind of were you too brainy for your own good?

Atul Gawande15:45

I think each of us had our own stories. I mean, I was never a complete reject in the sense of being a shutout. But, you know, I didn't get dates in school. And some of that I'd like to blame on my being an Indian in a, you know, a largely white community. But a lot of it had to be chalked up to, you know, I still had my peach fuzz mustache and hadn't learned how to get rid of that. I was constantly trying to figure out, you know, if I'm not the immigrant, what does it mean for me to be the local guy? And I would have fights like my mother, the pediatrician, would not let me have a gun. And virtually all of my friends had guns. They all had motorcycles. She would not let me have a motorcycle. And then also, you know, I was pretty geeky. I knew I was going to go off to graduate school. As I got to college, I went to Stanford in California, and it was like the world opened up to me. So my parents were my source of what was, you know, really stimulating and interesting. And I got to college and I discovered everything from politics to literature. And I couldn't get enough of everything. And so I actually came to Oxford after college for two years. I did politics, philosophy, and economics. You were a Rhodes Scholar. I was a Rhodes Scholar. And I was not at all headed down the medical path. I went into politics for a while and then eventually circled back.

Presenter15:45

Cookie.

Presenter16:56

Well, let me just ask you about going into politics. As I understand it, by the age of twenty six you were running a policy unit inside Clinton's White House and you were in charge of seventy five people within that health policy unit. That sounds ridiculous.

Atul Gawande17:10

Right. One of the things about American politics is you can see insanely young people doing things you can't imagine.

Presenter17:17

How did you know how to run seventy five people in a policy unit?

Atul Gawande17:20

Well, I mean, the the terrible story is that I didn't know how to run seventy five people. Um I didn't do a great job. You know, I would do I would micromanage in ways that don't work well. You know, I had multiple people resigning from my team because I would redo the work and it wasn't necessarily the best way to build a team.

Presenter17:35

Uh did you choose to leave? Did you have to leave? How did it end?

Atul Gawande17:38

Oh, well, it ended in part because the the policy went down in flames. So had the option to stay on for welfare reform, but decided I also didn't love working with my future beholden to a politician. I didn't want to be staff. And so I decided that even though it meant starting over again, that I would go back to medical school.

Presenter17:59

Time for some more music. What are we going to hear now, Azhel?

Atul Gawande18:02

Oh, this is interesting.

Presenter18:02

Uh

Atul Gawande18:03

So, this is a favorite punk band out of LA called X and their one hit song, Hungry Wolf. And I bring it on because when I got to college, I went up to the city, went up to San Francisco, and just went into the first place I could walk into to see a real live concert. And it was X. They were amazing, and it just completely switched me on to a whole range of music. And I felt like my mind was opening in every dimension, including what kind of music I would be listening to.

Speaker 418:47

Single thing I'm bullied

Speaker 418:50

I wanted to go strong

Speaker 418:54

Happy break the road, awake, and who follows me?

Presenter19:05

That was X and Hungry Wolf. Um for a man of your generation, Atilgawanda, you met your wife quite young. When did you and your seven hundred vinyl albums meet Kathleen?

Atul Gawande19:15

We met when we were eighteen and, you know, I'd really had very little dating experience, but I had lots of experience asking girls out on dates.

Atul Gawande19:24

And so she was one of the few who said yes.

Atul Gawande19:28

And so that to me was love. And then, you know, for whatever reason, never let go. And we had to grow up together. You know, she went abroad her junior year to Paris and to Florence. And I visited her over Christmas. And I was like, what is this French food? And I made her eat out at McDonald's and Burger King every night. And she did not dump me.

Presenter19:49

You said to me that your parents were were liberal, and yet I'm wondering, did they have any expectation that it would be nice if you met a a young Indian girl, and maybe somebody who understands the Hindu traditions, that's where you you know, was there any of that floating around?

Atul Gawande20:05

You know, there was some family aspects to that, but my parents were really great about it. They were upset that I was dating anybody. They were worried my grades would go down. But she came to visit for the first time over a holiday. And at the time, one of my cousins was having an arranged marriage, and we were hosting everybody coming in from all over the world. So she not only was visiting the family, she was visiting the entire family. There were 150 Indians, about 30 of them staying over at our house. There's never been any issue. And I think reflective of my parents in a certain way that they are traditional in certain ways, but they were the local presidents of the Rotary. They were extremely involved in the community. And they'd always raised us with an expectation, my sister and I, that we're going to give back, that we're lucky, and that we really look on the world as one big place.

Presenter20:58

What about for you with Kathleen's fam beautiful Irish name, Kathleen? I mean, you know, were they expecting this young Indian doctor to come in and sweep their daughter off her feet?

Atul Gawande21:02

Yeah.

Atul Gawande21:06

Oh, and I worried about that too. But it was instantly obvious that there was none whatsoever on that side. By Christmas that next year, her grandmother had knitted me a stocking to go over their mantle, fully expecting that I would be there for many more Christmases to come.

Presenter21:22

Do you still have the stocking?

Atul Gawande21:23

still very much have that stocking.

Presenter21:25

Time for some more music then. Tell me about this. We're we're gonna hear your fifth disc.

Atul Gawande21:29

Ah yes, this song helps reflect the art of making an operating room playlist because you are bringing people into an operating room, making them listen to your music, and those people will range from age 18 to over 65. I have become known for my playlist, so people come in who want my playlist. And part of it is the trick of recognizing that you want music that everybody's going to love. And this particular song is on virtually every playlist that I put together for a day in the operating room. This is Tom Petty's American Girl.

Speaker 422:05

He couldn't help thinking that there was a little bird life

Speaker 422:12

After all, it was a great big world.

Speaker 422:17

With lots of places to run to

Speaker 422:20

Yeah, big shit at the thigh

Speaker 422:23

Try and cheat.

Speaker 422:25

That one I'm promised to let's go and keep

Speaker 422:30

Oh yeah, alright.

Speaker 422:34

Take it easy, baby

Speaker 422:36

My glass ain't not nice She was

Speaker 422:40

An American girl.

Presenter22:43

That was Tom Petty and American Girl. Um there is not a wasted word in your prose, Atul Gawandi. Uh one of your earliest pieces of published writing was in The New Yorker. Um it was called When Doctors Make Mistakes.

Presenter22:58

Did you have any qualms about sharing the mistakes of your colleagues for everybody to read?

Atul Gawande23:05

I did. You know, I tend to go into the writing what I'm writing about from a different mentality than when I realize it's going to be published. That probably helps. So I start in just thinking, this is a problem that I'm interested in. It's keeping me up at night. How do I understand it? And one of the first pieces I wrote was about a patient that I made a mistake in, and they nearly died. And a lot of mistakes in medicine are blamed on the individual, and I bore real responsibility for it. But it was a case where I was asked to do an operation as a second-year resident that I really was not equipped to do. I'd never done it before. I'd practiced once on a goat.

Speaker 223:14

So

Atul Gawande23:45

And it went badly, as you might expect. Now, there are a variety of reasons. It was an emergency situation, but I really wanted to explore it. But you can imagine then how the hospital would feel about it as I'm exploring all of the natures of the failure. Not only my failure, but their failure. My attitude in the writing, and I hope it always comes across, is that I'm trying to think about what does it mean for me to be good as a doctor and for our patients. And they got that message. I had a couple complaints, but for the most part, really surprisingly supportive.

Speaker 424:03

Uh

Speaker 224:03

Yeah.

Speaker 424:03

It has

Presenter24:19

And it is your belief then that clear thinking, that clarity and truth, will in the end bring better practice? Because, you know, we we so much act on instinct.

Atul Gawande24:29

The clarity comes from taking the stories and experiences of individuals seriously, and it works on two levels. It's the emotional level. It's why I tell stories. It's understanding what this experience meant to people in the course of their lives. And understanding, you know, what does the data, what does the science, what does the understanding of the systems in place tell you about what's possible? I think the expectation of the public is not that people in medicine or in other fields are perfect, but it is that we're all aiming for perfection. And that willingness to be transparent about the experiences and the stories of what goes on when people come into our hands, that I think is really fundamental.

Presenter25:10

Let's have some more music, Atulkawandi.

Atul Gawande25:15

So this one is Frankie Goes to Hollywood, Two Tribes. And I chose it in part because it's a kind of funny story. As I was starting to court my now wife, I had started dressing very cool and I had a friend and we went off to a concert and she watched me go off and it was to go see Frankie Goes to Hollywood. We had gelled up our hair and I'd bought some fake leather pants and I had a kind of ripstop Michael Jackson red fake leather shirt. And we went to the concert and of course the average person in the room was a 15 year old girl.

Atul Gawande25:50

And then we were there kind of, you know, rocking out. It was a great show. And I came home and Kathleen said, was your fly down the whole time?

Speaker 226:15

When you hear the air attack warning, you and your family must take cover.

Speaker 426:34

We're too tough, no more one is all too bad.

Presenter26:39

That was Frankie Goes to Hollywood and Two Tribes, and I'm still toying with the image of you in your leather pants and that red shirt. So, Atul Gawandi, your most recent book then is Being Mortal, Illness Medicine, and What Matters in the End. And I wonder, as you came to the end of writing it, what occurs to you about what matters in the end?

Atul Gawande26:57

The key thing that I discovered, and I interviewed more than 200 patients and family members about their experiences with terminal illnesses or severe infirmities, was that we do not recognize that people have goals in their life, priorities, besides just living longer. The second thing that I discovered was that the most reliable way to find out what people's priorities are is to ask them, and we don't ask. Even for people

Atul Gawande27:23

Within weeks of death, we don't ask. There's tremendous suffering when you have your clinicians and the system all assuming the most important thing to you is survival at all costs. And, you know, my father, as he was coming to the end of his, he had a brain tumor, his most important thing was social interaction. Can I talk to my friends and family? Can I be at the dinner table and actually still have this wonderful social existence that is the reason he wanted to be alive? And when the treatment started to sacrifice that, our recognizing that that was what was important led us to stop the things that took that away from him and let him be a person rather than a patient. And for me, being a person rather than a patient is: can I communicate with you? Can I still be in the world of ideas to some extent? And I'm able to have that kind of interaction. I'd be willing to go through a lot to keep that going.

Presenter28:19

Time for some more music, then. Tell me about

Presenter28:21

Your seventh of the morning I saw Gwandi. What are we going to listen to now?

Atul Gawande28:25

So there's a kind of an odd story to this. I don't know if it's possible to tell, but I am obsessed by music. And if I could have been a rock and roller, I'd have given up all this stuff to have. To make music. Yeah, to make music and have a band and to have really done it. And one of my favorite bands is Weezer. They're very popular in the United States. And out of the blue, Rivers Cuomo, the lead singer and the songwriter, contacted me to let me know that he'd read my book about checklists and had constructed his own songwriting checklist about how he constructs hit songs, how to reshape the songs when he's come up with good songs and what he does in the production process and all that kind of thing. And it was amazing to me. But most of all, it was just such a thrill to see the kind of things I'm doing start to offer connection in some way to people who are just being incredibly creative.

Speaker 228:37

Perhaps it

Speaker 429:22

Our hearts are dim, but our minds are free to fly where they will Your beauty has faded, you're a broken shell It's only the weak that fall for your spell

Speaker 429:39

You can't control me, no more clear path to run Pow to run, path to run

Speaker 429:47

Can't control me, no more clear patchy light

Presenter29:53

That's Weezer and Cleopatra. Tell me, Atul Gwandi, you're a surgeon and a professor, as we know. You've been a lab scientist, a public health researcher, a student of philosophy and ethics, a health policy advisor to government. You are the son of two doctors. You're married. You have children yourself. Of all of these things that you have managed to fit in so far, wh which has been the most demanding of you?

Atul Gawande30:17

You know

Atul Gawande30:19

To me, they're all inseparable. And so it's hard for me to figure it out. They're all demanding at different phases. But what I would say is when I met my mother-in-law for the first time, I was dating her daughter, and I was 19 years old. She asked me, what did I want to be when I grew up? And I said, and I was half joking, a professional dilettante.

Atul Gawande30:41

You know, I d I love the idea of just getting to be curious and dabble in lots of places. And probably the biggest stress is the fact that I don't want to give up any of it. And I don't want to give up my seven hours of sleep either. So, you know, it's living with the fact that I'm a sponge. I love being engaged as widely as possible.

Presenter30:58

Which is why you may, I think, have a problem when I cast you away to this lonely desert island, because there'll be no pager going off for surgery. There'll be um well, maybe books to write. How will you be with no structure around you, no company, no problems to solve?

Atul Gawande31:14

I think the hardest part for me would be no company. As soon as you have company, there are problems to solve.

Presenter31:20

Can you imagine what the best part would be of being cast away?

Atul Gawande31:23

Hmm.

Atul Gawande31:24

I think the best part would probably be that I would calm my mind down.

Atul Gawande31:30

It is constantly over running and overflowing with ideas, observations, things that I wish I had time to knit together and explain and describe. It would be, you know, the first place where I wasn't trying a gazillion things at once.

Presenter31:43

And what do you do in real life about that?

Atul Gawande31:45

Um I have a whiskey, not infrequently, and I do meditate. But probably the most important thing is just sitting down and writing, just even stream of consciousness writing. I think that's an important way that I step back and recognize when I'm overflowing my boundaries and letting my enthusiasm get the better of me.

Presenter32:02

Time then for your eighth disc. Tell me about this. What are we going to hear?

Atul Gawande32:05

I described earlier the art of the operating room playlist, and this is a Radiohead song. I play this in the operating room, and I'm not distracted. I'm sure everybody will sit there and listen to this and think, how can he operate during this? But it's part of the vibe of the operating room, and I'm a devotee of Radiohead. I've not gotten to see them live yet, but I will.

Speaker 432:29

I do not

Speaker 432:32

Understand

Speaker 432:35

What is it?

Speaker 432:38

I don't wanna

Speaker 432:44

Check for all

Speaker 432:50

Once again

Speaker 432:52

Do you feel

Presenter33:01

Radio Head and Body Snatchers. So it's time now for me to give you the book, Sattle. You get the Bible, you get the complete works of Shakespeare, and you get to take one other book along with you, your choice. What will it be?

Atul Gawande33:13

It would almost certainly be Tolstoy. I'd probably take the death of Ivan Illich.

Presenter33:17

Okay. It's yours.

Atul Gawande33:17

Yeah.

Atul Gawande33:20

Just a pen and a journal. I almost always write longhand first. Okay.

Presenter33:24

Okay, that's yours then. And if you were to save just one of these eight discs from the waves, which one would it be?

Atul Gawande33:31

I wish it were hard, but it's not at all for me. Radiohead, no question about it.

Presenter33:35

Body snatchers it is then. Ato Gawandi, thank you very much for letting us hear your desertimon discs.

Atul Gawande33:40

Thank you. It was great to be here.

Presenter34:22

You've been listening to a download from the BBC. You'll find more information on the Radio 4 website, bbc.co.uk slash Radio 4.