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Seven years ago, Atul Gawande faced a crucial moment in his medical training. The student, who had never operated before, was observing an abdominal procedure when it came time to make the first incision. “The patient was put under, the belly exposed. And then, the nurse handed me the knife,” he recalls with a laugh, reliving the nervous thrill that went through him. “I picked it up and drew it across the skin. It was a lot tougher and springier than I thought it would be, so I had to cut twice.

Still, I was exhilarated,” he said. “There is something about the feeling that you are entering a world that others don’t get to see – and that slightly sickening feeling of sticking a knife into somebody.”

Gawande, 37, who spoke by phone from Brigham and Women’s Hospital in Boston, is in his last year of surgical residency. While he recently overcame his queasiness, he hasn’t lost his sense of wonder.

In “Complications: A Surgeon’s Notes on an Imperfect Science” (Metropolitan Books, 288 pages, $24), a collection of 14 pieces, some of which were originally published in The New Yorker and Slate magazines, Gawande uses real-life scenarios – a burned-out doctor who refuses to quit; a terminal patient who opts for risky surgery, with fatal results – to explore the larger ethical issues that underlie medicine. He asks: How much input should a patient have? How can young doctors gain hands-on experience without endangering lives? And how responsible are these doctors for their mistakes?

The son of two physicians, Gawande attended Oxford on a Rhodes scholarship, then worked in a research laboratory and as an adviser to the Clinton administration on health policy before earning his M.D. in 1995. (“I guess I always knew that I’d eventually come around to it,” he says.) Soon after, Slate editor Jacob Weisberg, a friend, approached him about writing a column on being a doctor. Gawande had never tried journalism before and struggled with it at first, though he says he enjoyed the process. “A lot of the topics I ended up writing about came from experiences that I didn’t understand or that bothered me. They were often things patients ask about and I don’t have answers for, and I wanted to get answers.”

Many readers will blanch at the cases Gawande describes, like the surgeon who biopsied the wrong part of a woman’s breast, delaying her cancer diagnosis by 18 months. Other failures are his own: He once needed to perform an emergency tracheotomy, a procedure he had little experience with, under time pressure. His hesitation, he admits now, nearly cost the patient her life.

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