“What does it take to be good at something in which failure is so easy, so effortless?”

In this quote, Gawande points out that it is difficult to empirically measure how well doctors practice medicine because there are very few advanced metrics for doing so, and treating a patient is often an uphill battle. The potential for failure makes practicing medicine a stressful job, though it has high rewards. Therefore, it is paramount that a doctor pay careful attention to all the minutia of his or her craft. Doctors cannot afford to overlook anything, and they must be vigilant to the point of exhaustion. 

“Betterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only humans ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so one’s life is bound up in others’ and in science and in the messy, complicated connection between the two. It is to live a life of responsibility.” 

Gawande wants to remind his readers that the world is not perfect. Because we are accustomed to living in ordered, structured, and modern societies, it is easy to forget that humans are flawed, and that reality is messy. Thus, doctors must strive to always be better because they are fighting against the chaotic nature of the world. People often forget that doctors are human, and they expect superhuman results in medicine. Gawande stresses that practicing medicine is a human task and that it is limited in ability, like every other human endeavor.