Atul Gawande on C-sections

by F.

Atul Gawande has an excellent piece in The New Yorker this week. This is a perfect example of excellent science writing, starting off with a human story:

At 5 A.M. on a cool Boston morning not long ago, Elizabeth Rourke—thick black-brown hair, pale Irish skin, and forty-one weeks pregnant—reached over and woke her husband, Chris.

“I’m having contractions,” she said.
“Are you sure?” he asked.
“I’m sure.”

She was a week past her due date, and the pain was deep and viselike, nothing like the occasional spasms she’d been feeling. It seemed to come out of her lower back and wrap around and seize her whole abdomen. The first spasm woke her out of a sound sleep. Then came a second. And a third.

She was carrying their first child. So far, the pregnancy had gone well, aside from the exhaustion and nausea of the first trimester, when all she felt like doing was lying on the couch watching “Law & Order” reruns (“I can’t look at Sam Waterston anymore without feeling kind of ill,” she says). An internist who had just finished her residency, she had landed a job at Massachusetts General Hospital a few months before and had managed to work until this day. Rourke and her husband sat up in bed, timing the contractions by the clock on the bedside table. They were seven minutes apart, and they stayed that way for a while.

From here the piece cross-cuts between Rourke’s story and the history of obstetric procedure, including the Apgar Score, which is used to gauge the success of birthing procedures.

This is great storytelling. There is classic drama (“Someone wants something badly and is having trouble getting it”) as Rourke tries give birth the natural way, without an epidural, and during the telling of Rourke’s tale, our hope (“I hope the baby is OK”) and fear (“Oh my God, so many things can go wrong”) are stoked by learning the history of obstetric procedures and all the ways doctors have tried to turn a dangerous process (for both the mother and the child) into a safe one.

Entirely compelling, mostly because the piece dramatizes facts: there are human stories amidst the description of obstetrical procedures, which gives the reader a reason to care about the procedures (“Will they use that on Rourke?”) Brilliant.

The whole piece in on-line. I ran this whole article through a “readability analyzer,” just to see what would come out. Here are the results:

Readability grades:

Kincaid: 7.8
ARI: 8.7
Coleman-Liau: 11.2
Flesch Index: 69.2
Fog Index: 11.1
Lix: 38.4 = school year 6
SMOG-Grading: 10.4

Sentence info:

39370 characters
8581 words, average length 4.59 characters = 1.42 syllables
505 sentences, average length 17.0 words
44% (224) short sentences (at most 12 words)
12% (64) long sentences (at least 27 words)
77 paragraphs, average length 6.6 sentences
1% (7) questions
46% (236) passive sentences
longest sent 76 wds at sent 133;
shortest sent 2 wds at sent 151

Word usage:

verb types:
to be (302) auxiliary (95)
types as % of total:
conjunctions 6 (474)
pronouns 8 (654)
prepositions 12 (990)
nominalizations 1 (114)

Sentence beginnings:

pronoun (133)
interrogative pronoun (14)
article (84)
subordinating conjunction (17)
conjunction (39)
preposition (42)

Gawande is a MacArthur genius grant recipient, former Rhodes Scholar, and a professor of surgery at Harvard Medical School. This article, according to the Fog Index number suggests that the writing is about High-School level, which feels right. Newsweek and Time generally, I’m told, have an FI number of 11 or so (as here). The take-away: good writing is easy reading.

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