The Checklist Manifesto: How To Get Things Right

by Atul Gawande

What I couldn’t work out, though, was how the country’s strict gender divide was negotiated in its operating rooms. I remember sitting outside a restaurant the day I arrived, studying the people passing by. Men and women were virtually always separated. Most women covered their hair. I got to know one of the surgery residents, a young man in his late twenties who was my guide for the visit. We even went out to see a movie together. When I learned he had a girlfriend of two years, a graduate student, I asked him how long it was before he got to see her hair. “I never have,” he said. “C’mon. Never?” “Never.” He’d seen a few strands. He knew she had dark brown hair. But even in the more modern dating relationship of a partly Westernized, highly educated couple, that was it. In the operating rooms, all the surgeons were men. Most of the nurses were women. The anesthetists split half and half. Given the hierarchies, I wondered whether the kind of teamwork envisioned by the checklist was even possible. The women wore their head scarves in the operating rooms. Most avoided eye contact with men. I slowly learned, however, that not all was what it seemed. The staff didn’t hesitate to discard the formalities when necessary. I saw a gallbladder operation in which the surgeon inadvertently contaminated his glove while adjusting the operating lights. He hadn’t noticed. But the nurse had.