Heart surgeon Dr. Donald Effler once said that to be great, a surgeon must have “a driving ego”, “a passion for perfectionism.”  In A mistake, Dr Elizabeth Taylor is an exceptional surgeon with both these traits, but as a woman these attributes, seen as great in a man, are seen as aberrations by her superiors, her colleagues and her junior staff.

A mistake is about fallibility and culpability.  Humans have developed so far beyond simple mistakes that lead to predictable outcomes, in fact when one of these does happen in the book, I was hoping that Shuker had made a mistake himself and that the awful predictable consequences weren’t going to happen, but in such a meticulously written novel I knew that wasn’t the case – simple mistakes have simple causes and the mistakes can be forgiven, or not.

With the development of complex medical interventions, complex engineering, and complex human relationships, the scope for “complicated problems, and complex problems” expands, “And then there’s just chaos.”  Woven throughout A mistake is the story of the tiny ignored potential that led to the catastrophic launch of the space shuttle Challenger in 1986, where five astronauts, one payload specialist and one civilian school teacher died.  Elizabeth refers to it as “The most beautiful story of error.”

Integral to the story is a new monitoring system soon to be imposed on hospitals, where surgeons are named, and the outcomes of their surgeries made public.  This is supposed to urge surgeons to achieve better outcomes, but of course it could also lead them to turn down operations where the chances of a good outcome are slim or lead them to re-categorise deaths.  And the new system ignores the fact that complex problems require complex solutions, and multiple actors.  Throughout the novel, Elizabeth is writing a response to criticism of an article she and a colleague have submitted to a prestigious medical journal, pointing out these dangers.

A mistake starts with a graphic description of a young woman, Lisa, being operated on, the operation being carried out with the deceptive nonchalance of experts carrying out their speciality.  Elizabeth is sleep deprived and constipated, but in her element, her preferences creating the atmosphere in the theatre.  We know something is going to go wrong, and when it does Elizabeth is superb at managing the problem.  All would have continued as usual, if the young woman hadn’t died early the next morning.

Shuker is wonderfully hands off in ‘telling’ Elizabeth Taylor, the reader is left to piece together her history, and decide when she is being ironic, when she is presenting her beliefs.  Elizabeth goes for a hair-raising drive at one point, is that her ‘controlling the universe’ gene, or a death wish?  She gives outrageous advice to female colleagues who want to succeed, is she being ironic or is that what she has had to do to advance?  It is a very effective device, and doesn’t mean Elizabeth isn’t nuanced.

Although regretting the young woman’s death, Elizabeth apparently feels no culpability for it, placing the cause as the original sepsis the woman presented with.  But when she is sitting on the loo going over her reaction to the crisis, who is it who considers:  “While a kilometre away in the morgue the wound did not heal and the body did not recognise itself, nor gather itself to itself, nor rise again”?  And when she gets an advanced copy of the new software, she plots her outcomes and watches the ‘dot’ that is her move from mid-stream to out in space as she includes and omits Lisa’s surgery … repeatedly.

The mistake in the operation was that of Richard, Elizabeth’s registrar.  But mistakes are complex and operations the work of teams, and Elizabeth led the team.  When Elizabeth discovers a complaint has been made and an enquiry started, she is clear that the responsibility is hers.  She considers her response to the mistake was effective, it was a controlled response, never chaotic.  She sees her job as not only being the lead agent, but also fixing the errors of her team – nicely paralleled with her inability to live with a tiny flaw in her house, in the only wall that she hadn’t gibbed herself.

When the fallout from Lisa’s death leads to another tragic death, Elizabeth is offered absolution of sorts, but it is an ‘out’ of playing the system, and Elizabeth has never been able to play the system – never able to stop from speaking out at meetings, in conferences – a fact that puts her off-side with colleagues of both genders and all levels.

A mistake is an insightful look at the pressures on medical professionals – pressures which are hugely heightened for women.  It looks at the idealised reality of medical monitoring systems as opposed to the complexity of the world.  And it exposes the conundrum of expecting our surgeons to be cautious and keep us safe whilst also allowing them to be cavalier enough to cut us open.  I thought this was a great book, read it and see what you think.