Final Exam: A Surgeon's Reflections on Mortality

Pauline Chen is a surgeon who does liver transplants. She is also a fine writer as FINAL EXAM - A SURGEON'S REFLECTIONS ON MORTALITY proves so well. She writes with both passion and humility about the contradiction she sees in the field of medicine: that doctors, who witness death so often that it should almost become routine essentially are no better at dealing with the end of life than their patients are. (She actually uses the word "dysfunctional" to describe many physicians' attitudes toward death.) She believes there are many reasons for this phenomenon. Doctors are trained to be healers; that is why most of them went to medical school. To lose a patient to death somehow is an admission of failure. Many physicians will continue aggressive but useless therapy for a dying patient to pacify the patient's family. Sometimes they fear litigation or they may continue treatment-- we can only hope occasionally-- for financial gain. But whatever the reasons, they are not good enough. The patient loses, but the physician loses as well the chance to do-- what Chen would call-- "something more than cure" and "nurture our [physicians'] best humanistic tendencies."Dr. Chen discusses candidly her first experience with death, when she was a sophomore in college, of her maternal grandfaather. Then in medical school she spent 12 weeks with a cadaver: "My very first patient had beeen dead for over a year before I laid hands on her." She writes about her first patient to die and her inability to contact a dying friend. She confronts her fears about her own mortality when she is about to harvest organs (a procedure she had done eighty-two times previously) from an automobile accident victim and discovers that the donor is a brain-dead thirty-five-year old Asian American woman: "For a moment I saw a reflection of my own life and I felt as if I were pulling apart my own flesh."This beautifully written book reminded me of another fine book by another physician, Abraham Verghese's MY OWN COUNTRY, an account of his treating the first patients-- most of whom would certainly die horrible deaths-- with HIV/AIDS at the local VA hospital in Johnson City, Tennessee in the 1980's. Both these books should be required reading for medical students.When I finished Dr. Chen's "reflections," I thought of (1) how fortunate her patients are to have a surgeon so sensitive and so human and (2) wondered how many physicians would take time out from their busy schedules to read her wise words.

I am one of those people who is always the patient ... and I am one of those complicated patients where things don't typically go as planned. I am probably not one of a surgeon's easiest patients as I tend to test their mettle. That being said, I have had surgeries where surgeons have removed various organs from my neck (thyroid) down to my abdomen (gallbladder and hyster.) All of them have been complicated by one thing or another.I have asked myself more than once: "How do surgeon's do it?" How do they get to that almost God-like place where they hold life in the balance for a period of time and we, the patient, put our utmost trust in them? It's quite amazing if you think about it.The one aspect that is not often addressed or talked about is that of death. How does a doctor distance themselves enough emotionally so that they can continue to do their job? How do they get through the first time that they are actually responsible for a patient's death? These are tough questions that require a special journey for doctors. Dr. Chen's book outlines this journey from med student to a fully-fledged practicing physician specialist. She shares the shift that has taken place in medical studies that teach young doctors how to deal with death in a healthy way that includes palliative care. The journey is fascinating and touching.As a patient, I always wonder. This book helped to pull the curtain back just a little bit more. Thank you Dr. Chen!

Starting with her earliest medical training in anatomy with dissection of cadavers, Pauline Chen takes us on a journey into the sacred territory of the human body, and challenges the medical profession's failure to train physicians in the care of the dying. This book should be required for anyone training for the medical profession. As we follow her personal journey to becoming a surgeon specializing in liver transplants, she respectfully acknowledges the "so much that is right" about medical training, but reveals the dilemma of medicine's lack of preparation for the inevitability of death. Her authentic personal narrative offers the challenge to change how the dying should be treated in the professional medical world, in a way that invites soul-searching rather than offering any formulaic responses.I am not a medical professional, so I was particularly grateful for her "inside the human body" perspectives that amplified my awareness of the wonder and sacredness of the body's deliberate design to succumb to death in a passage as meaningful as birth.Beautifully written, humbly offered, moving beyond words. Thank you, Dr. Chen.

I highly recommend this book! Dr. Chen's authentic writing, part memior and part thesis, explains the training medical students undergo. She discusses how this training, the culture of medicine and other factors have failed to prepare doctors to communicate with patients and family members about death and dying.Dr. Chen's book reminded me of the doctor who told a friend to 'put your affairs in order' when she woke up after surgery. That surgeon's total failure to convey news that an expected benign tumor was advanced stage cancer emotionally gutted his groggy patient. Final Exam sheds light on how this highly recommended surgeon could so spectacularly fail to communicate with compassion.This book is well written and an easy read for the layman. As I finished this book, I recalled the debates about what 'the doctor said' whenever my family had dealt with a terminal diagnosis. I had chalked it up to a mix of stress and different communication styles yet Dr. Chen reminds us that the doctor's ability to communicate is essential.

This author is very genuine and she describes each of her stories and reflections in painstaking detail. Her narrative is such that you almost forget she is a doctor by displacing her medical career from the human emotion everyone else shares. You really connect with the patients in the times when it goes awfully wrong. I used to think most deaths arise from such difficult, untreatable injuries/illnesses. But death happens to all of us and can appear in the most subtle and unsurprising processes.It doesn't matter if you're interested in medicine, or interested in mortality. This is a non-fiction literature that is simply refreshing and enlightening, and should be read by all.

A very compelling book, and a discussion that needs to be had. I enjoyed this very much, and would recommend it to anyone.