The Checklist Manifesto: Atul Gawande

I first read about Dr Atul Gawande as one of this prominent Thinkers of this decade, as selected by the TIME Magazine. So on coming across a book by him at Crossword, Nagpur, it was hard to resist picking it up.

Leafing through a few pages, the matter seemed interesting, so took it home.

Later that evening, as wife prepared dinner, I began to read; and got so much hooked to it, that only put it down after finishing it around 2 AM... and the next day was a Monday.

Nevertheless, it was worth the time.

In this book, Atul Gawande, a surgeon with specialization in endocrine oncology, talks about checklists. He doesn't tell you how to create one, but why one is needed in the first place. The subject matter may seem mundane, but what makes the book exciting is the way in which the author describes how he arrived at the concept of using checklists in a critical field like surgery.

He begins by sharing with us some hair-raising stories of surgeries, in which the patients had a touch and go with death. He describes how The rising complexity and sophistication has made even the best minds sometimes miss out on critical factors. Surgery has become, in his own words, 'too much of an airplane for a single person to fly'.

In a quest to find a solution for a better success rate in surgeries, he meets people from diverse fields to know the secret of their efficiency: a builder, a master chef, a team of Wal-Mart staff that provided on-time relief to victims of Katrina hurricane, a key technical guy at Boeing.... and he discovers that each one of these uses something as basic as a checklist to ensure that things fall in place when they matter the most.

He learns of Keystone Initiative, a programmer started by Peter Provonost to get doctors and all those involved in health care serious about reducing avoidable errors.

Gawande then sets out to try and test his theory, using support of the World Health Organization (WHO). He and his research team involve hospitals from all over the world, New York, London, Delhi, Nairobi... in which the operating teams are required to adhere to a simple checklist during each surgery.

The results, he says, exceeded his own expectations.

It's a thrilling narrative, one that at once fills your mind with awe about complexity of the human body, and admiration for the people who have mastered at least a significant part of it. Gawande spares no one, including himself when he talks about the mistakes and errors that people make, mostly out of carelessness borne out of routine.

If you think checklists are a bore, then this book should make you re-think your position.

And if you are already a checklist enthusiast (like me!), then this book would give you a sense of having got it right in the first place!

[This article has two companion blog posts. Mind Matters  talks about my personal take on checklists, whereas ByteSpace takes a look at checklists from a technical writer's perspective.]

[Movie] 3 Idiots

Shahrukh Khan may be looking for a blockbuster success in My Name is Khan, Salman Khan may have his hands full of controversies, Hritik may have almost disappeared from the face of Bollywood, but ‘aal is well” with the Ace Khan: Aamir Khan.

3 Idiots, produced by Vidhu Vinod Chopra, directed by Rajkumar Hirani (Munnabhai-fame) and starring Aamir, Kareena, Boman Irani, R Madhavan and Sharman Joshi predictably released on 25-December. This is the third of Aamir’s films (after Taare Zameen Par and Ghajini) to be released on 25-December, and if the signs are anything to go by, is slated to be another blockbuster hit.

If Taare Zameen Par was about mind and its problems (dyslexia), Ghajini was about a split mind and an awesome body, 3 Idiots has lots and lots of the nether part, the butt. In any other film, it would have been gross and awful, but Hirani makes it a focal point of laugh riot that ensues.

3 Idiots is indeed a laugh-riot, except some parts where it tries to appeal to our minds… and our hearts.

There is some talk about the film being based upon “Five Point Someone: What You Shouldn’t Do at IIT” by Chetan Bhagat. The movie does have some resemblance: a premier technical institute and its three whacky protagonists, the gorgeous daughter of principal, and a couple of sequences; but to conclude that the whole plot is based on the book would be going too far.

Of the cast, Aamir steals the show naturally. Be it his impish face or his body language, he looks fresh, every bit a college student. Boman Irani, Madhavan and Sharman Joshi suit their roles nicely. Kareena doesn’t have much to do.

Though the songs haven’t exactly been a rage, the one song that stays with you is “Behti hawa sa tha wo…”. The lyrics of “Give me some sunshine” are fantastic. “Zoobi Doobi” is wonderfully retro.

The movie is a full 3-hr long run, but credit goes to the director for not making it seem lengthy. Still, a couple of sequences could have been completely chopped off, in order to make the product a bit more compact and effective.

But mostly, the movie is full paisa wasool stuff. On a scale of 1-10 (where 10 is the best), I would rate 3 Idiots at 7, plus an extra 0.5 thrown in for some awesome cinematographic shots of Ladakh and Simla.

The Lost Symbol

After the stupendous success of  The Da Vinci Code, Dan Brown has again come up trumps with another bestseller in “The Lost Symbol.” The novel broke all the sales records on the day it was published (15th September 2009), and continues to be at the top (or near the top) of bestseller lists.

Robert Langdon features as the male protagonist for the third time ( he was seen earlier in Angels and Demons and The Da Vinci Code, aided by a researcher in ‘noetic sciences’ (admittedly I heard of this term the first time I read the book), Katherine. Dan Brown’s penchant for power centers and secret societies continues. Angels & Demons had CERN-Vatican and Illuminati; The Da Vinci Code had The Church and Priory of Sion; Deception Point had NASA; and Digital Fortress had NSA. The Lost Symbol features Freemasons and the narrative takes place in the heart of Washington, D.C : the US Capitol Building itself.

Antagonist is a lone figure, but a unique one at that.

So, what works in the novel?

Definitely the trademark Dan Brownian blend of fact and fiction and fast paced plot. At the end of every chapter (they are short and many); you are on the edge to know what happens next. Brown presents the all-so-familiar artifacts (the Capitol building, the Smithsonian Museum) and objects (the dollar currency) in such a startling manner that one keeps on reading out of sheer curiosity and amazement.

What doesn’t work?

The plot, though interesting in specifics, is a bit repetitive overall. Also, dialogs could have been better. At times they seem too artificial and a bit overdramatic.

Overall…

It’s definitely worth a read. The book succeeds in arousing our curiosity about Freemasons and also makes us think about the potential of humand mind and body.

Personally, I enjoyed Angels and Demons the most, closely followed by The Da Vinci Code, with the  Digital Fortress trailing a short distance behind. I would place The Lost Symbol a notch above Digital Fortress, because it ends so beautifully, on a positive note.

The Selfish Gene

I had purchased “The Selfish Gene” by Richard Dawkins sometime around May-2009, yet never came around to reading for almost 3 to 4 months. Reason: It was hidden out of sight in a drawer full of other papers. One day, while ransacking the drawer for something else, I came across the book… And once I began reading it, could hardly stop cursing myself for not having read it earlier.

The Selfish Gene carries forward Darwin’s theory of evolution. The central idea of the book is: it is the gene -- and not the species -- on which the natural selection works. The author describes at length how the genes ‘try’ their best to propagate themselves through the generations, and how this leads to the ‘survival of the fittest’. He puts forward the concept of an “evolutionary stable strategy’ and introduces quite a few new terms (such as ‘memes’) and phrases (the ‘selfish’ gene, to begin with!)

The book is enlightening in some ways, and disturbing in more than a few ways. It is enlightening, because it tells us a number of fascinating facts about our lives; it is disturbing, because it makes cringe about some of our thoughts and behaviours that seems all too normal so far.

Language is lucid, and author has taken pains to ensure that it doesn’t become boring. Richard Dawkins can be compared to Dan Brown in that he has a superb writing style, one that compels reader to read one chapter after the other.

A note of caution: this is a book that demands your absolute concentration; it is not something you read on a heavy stomach with eyes drooping, on way to an afternoon siesta. To be able to digest this book, it is advisable that you brush up a bit what you learnt about Gregor Mendel’s theory of genetics. It would also help if you know a bit about DNA, and genes.

The book could have done with some illustrations and diagrams. There are almost none. Hence it can be intimidating for a beginner to wade through pages and pages of dense text, which is loaded with terms from biology and genetics that are not exactly a common usage.

If you look forward to reading something that will not only tickle your grey cells, but pinch and prod them to think hard, then this is a book you ought to take up.

After finishing with The Selfish Gene, I have now taken up “The Blind Watchmaker” and look forward to a tryst with “The Extended Phenotype”.

Goa: How to visit, When to visit, What to see

Whenever I introduce myself – rather modestly – as “The Great G from Goa”, people usually tend to notice only the last part: Goa. Even though the world has become flat and UK, US, Australia have become backyards for frequent-travelers; Goa still remains a favourite tourist destination for most of Indians, and foreigners as well.

As a Goan, I often have to answer a barrage of questions from potential travelers to Goa. Rather than answering same questions over and again, I decided to put up this article to provide at some basic information. Needless to say, the would-be travelers are advised to make their own inquiries before setting out on the journey.

So here we go!

When to visit:
Goa can be visited any time of the year, but tourist season begins in October and continues up to the onset of monsoon in first week of June. The week from 25-December to 3-January is the peak season.
Goa receives about 100-120 inches of rainfall from June to September. This is the off-season and you can actually enjoy low tariff at hotels. However, the incessant rains and muddy beaches would rather restrict your plans.
If you have some time to spare, traveling by Konkan Railway from Mumbai to Goa, especially during rainy season, can be an experience to remember. The entire route is full of lush green forest cover, and has scores of long tunnels and high bridges to keep you enthralled all the way.

How to visit:
Goa enjoys excellent connectivity by road, rail and air with almost all major cities in India. Goa has three national highways: NH4A, NH17 and NH17A. NH17 connects Mumbai and Goa. Konkan Railway project runs through the state. All the airlines operate flights from the Dabolim airport, the only airport in Goa.
About a decade back, Damania Shipping operated a Catamaran ship service between Mumbai & Goa but it was stopped when Konkan railway became operational.

Accommodation:
Goa has a complete range of lodging facilities: right from five-star hotels like Cidade de Goa, Marriott, Taj and Park Hyat to Holiday Homes run by tourism department to low-cost living rooms. But if you really want to freak out, then shacks (i.e. bamboo huts raised on poles) on beaches is the option to go for!

How much time:
This entirely depends on how much time you have at your disposal. The least you should plan for is 3 days: 1 day each for North Goa & South Goa, and one day for shopping and relaxing on a beach. If you have more time, keep 2 days for North Goa, 2 days for South Goa, and 1 day for shopping/beach. That’s sufficient on all accounts.

Travel:
Goa Tourism Dept arranges bus tours that cover North Goa and South Goa in one day each. Most of the major hotels have their own sight-seeing tours. Apart from these, there are independent tour-organisers.
One of the best ways to see Goa is to hire bikes from one of the many rental services in Panjim, the capital city and set out to explore the state on your own, with the aid of a map.
Most of the roads are in a good condition, with ample road signs.

What to see:
Beaches: Goa – the land of Sun, sea and sand! The state is gifted with 110 km of west coast which contains about two dozen major and smaller beaches. Miramar, Calangute & Baga (near Panjim), Colva, Benaulim (near Margao), are the major ones, and hence more congested. There are some less frequently visited ones like Harmal near Pernem (North Goa) and Palolem near Canacona (South Goa).

Dona Paula, situated just a few kilometers from Miramar beach provides a breath-taking view of sea. One can enjoy water-sports here. There is a romantic/tragic story associated with the small hill-top from where tourists watch sunset.

For the ones who like peace & quiet, Morjim beach in North Goa is the place to try. The beach is at 'sangam' of the Zuari river with Arabian sea, and is a paradise for swimmers. Of late, this beach has become famous as breeding place for the rare Olive Ridley turtles.

Churches: The state was under Portuguese rule for more than 450 years. Catholicism is the more dominant of the Christian sects here. There are practically hundreds of beautiful churches all over the state, but the most famous are in Old Goa, where mummified body of St. Francis Xavier is preserved. It is taken for public view once in a decade.

Temples: My home town Ponda (pronounced Fonda) is ringed by all the major temples of Goa: Shantadurga, Manguesh, Mahalasa, Kamaxi, and Ramnath. The temples are managed by mahajans (priests) rather than government trusts, the main reason they are well-looked after as a personal property.

One good thing about temples in Goa is that you can spend considerable time having darshan of the deity, rather than being shooed away in a matter of seconds.
The big temples have huge chandeliers and glass lamps hung from the ceiling and when lit, they cast a beautiful sight. One can only imagine how the scene must have been when there was no electricity.
Dudhsagar waterfall: Deep in the Sahyadri ranges on eastern border of Goa, one can see the Dudhsagar waterfalls while traveling by train. The falls are at their best during the rainy season.

Apart from these, there are minor attractions like two wildlife sanctuaries.
Last few years, one major tourist attraction that is coming up in a major way is plantations such as Ela Pharma.
For the more adventurous, Tambdi Surla temple is recommended. It is small temple of Hemadpanthi architecture, built in 13th century. Folklore has it that a king cobra wraps itself around the Shiv-ling every night.

Calangute beach has Subodh Kerkar's art complex which is worth a visit.
The trip aboard Santa Monica cruise boat across river Mandovi is an experience to remember. There is a band and food and drinks are free (needless to say, included in the boat fare).

Food:
Goa is a paradise for fish-lovers (i.e. people who relish fish as their food!). There are lots of varieties of prawns, pomfrets, sardines, oysters and lobsters. Traditional Goan plate consists mainly of fish-curry, pickle and rice, washed down by the very refreshing solkadhii!
(Photo courtsey: Joel's Flickr album)
Fresh cashew nuts are available in many varieties, roasted/salted/ with husk/spiced.
Liquor, esp. beer is quite cheap. You can get good wine. FeNii (fermented cashew juice with a very high alcoholic content) is the local favourite. Mama Costa is a good place to try it out.

What to enjoy/buy:
T-shirts marked Goa and bamboo hats are available at very low prices on all major beaches and are quite a craze. Artifacts made from sea-shells, coral etc are good as souvenirs or gift items.
There is a midnight bazaar at Arapora… highly recommended for those who can make it.

All the major beaches have one or the other water sport: Motor Boat Rides, Parasailing, Water Scooter Rides, Water Skiing, and Windsurfing. Parasailing is a bit costly, but then the experience is truly out of this earth!

Recommended websites:
Official site of the state tourism board: www.goatourism.org/
Goa Tourism Development Corporation: www.goa-tourism.com/

People/Language etc.:
Goa is one of the most peaceful states in India. People have a susegad (laid-back) attitude towards life. There was a time when shops opened at 10 in morning and you would find hardly any shop open after 8 pm. Of course, things are changing, with malls and multiplexes sprouting up in all the major towns.
Goa has two state-languages: Konkani & Marathi. People can easily converse in either of these two, and are generally good in Hindi as well as English.

Though Goa is better known as a tourist destination, this tiny state, with a population of just 1.8 million has given India some of its best scientists (Dr. Raghunath Mashelkar, former Director General of CSIR and Dr Anil Kakodkar, Director of BARC), singers (the Mangeshkar family, Pdt Jitendra Abhisheki, Kishori Amonkar, Prabhakar Karekar, Remo Fernandes), artists (Mario Miranda), fashion designers (Wendell Rodricks), sportspersons (Leander Paes, Bruno Coutinho), Writers (Manoharrai Sardessai), Business leaders (Victor Menezes, Sumant Mulgaonkar), and so on.. Due to limited opportunities for high-end careers in the state, most of the Goan youth is spread all over the India & world.

Concluding Remarks:
The most important thing to remember is Goa is more about chilling out and relaxing, rather than rushing from one spot to another.

I extend you a warm welcome to my home-state, and hope that you have a good time!