Product Description

A brilliant young transplant surgeon brings moral intensity and narrative drama to the most powerful and vexing questions of medicine and the human condition.

When Pauline Chen began medical school twenty years ago, she dreamed of saving lives. What she did not count on was how much death would be a part of her work. Almost immediately, Chen found herself wrestling with medicine’s most profound paradox, that a profession premised on caring for the ill also systematically depersonalizes dying. Final Exam follows Chen over the course of her education, training, and practice as she grapples at strikingly close range with the problem of mortality, and struggles to reconcile the lessons of her training with her innate knowledge of shared humanity, and to separate her ideas about healing from her fierce desire to cure.

From her first dissection of a cadaver in gross anatomy to the moment she first puts a scalpel to a living person; from the first time she witnesses someone flatlining in the emergency room to the first time she pronounces a patient dead, Chen is struck by her own mortal fears: there was a dying friend she could not call; a young patient’s tortured death she could not forget; even the sense of shared kinship with a corpse she could not cast aside when asked to saw its pelvis in two. Gradually, as she confronts the ways in which her fears have incapacitated her, she begins to reject what she has been taught about suppressing her feelings for her patients, and she begins to carve out a new role for herself as a physician and as human being. Chen’s transfixing and beautiful rumination on how doctors negotiate the ineluctable fact of death becomes, in the end, a brilliant questioning of how we should live.

Moving and provocative, motored equally by clinical expertise and extraordinary personal grace, this is a piercing and compassionate journey into the heart of a world that is hidden and yet touches all of our lives. A superb addition to the best medical literature of our time.

Product Details

• Amazon Sales Rank: #177531 in Books
• Published on: 2007-01-09
• Released on: 2007-01-09
• Original language: English
• Number of items: 1
• Binding: Hardcover
• 288 pages

Features

• ISBN13: 9780307263537
• Condition: NEW
• Notes: Brand New from Publisher. No Remainder Mark.

From Publishers Weekly
Like most physicians, Chen, a transplant surgeon and former UCLA faculty member, entered medicine in order to save lives. But as a medical student in the 1980s, she discovered that she had to face death repeatedly and "found disturbing inconsistencies" as she learned from teachers and colleagues "to suspend or suppress any shared human feelings for my dying patients." Chen writes with immaculately honed prose and moral passion as she recounts her quest to overcome "lessons in denial and depersonalization," vividly evoking the paradoxes of end-of-life care in an age of life-preserving treatments. Chen charts her personal and professional rites of passage in dealing with mortality, from her first dissection of a human cadaver, through the first time she pronounces a patient dead, to having to officially took responsibility for the accidental death of a patient in her care. Focusing on the enormous moral and psychological pressures on doctors and on the need for greater empathy in hospital end-of-life care, Chen also reports on signs of change within the profession, stemming from both criticisms of training and institutions and from physicians' initiatives to bring a greater sense of shared humanity to their work. Announced first printing of 75,000. (Jan. 17)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist
There is a vast popular literature about physician ineptitude with dying and death, whose doctor authors often cite their own cases to make points. Chen takes the logical next step by recounting only her immediate experience with dying and dead persons and what she learned from it. She starts with her first dead "patient," the woman she dissected in anatomy class. She continues with the many, many deaths she witnessed as an intern and resident and later. She poses them against the backdrop of being encouraged to disengage emotionally from patients and to opt always for prolonging life. She recounts, with pain, her own failures to "be there" for dying patients and their loved ones. She notes recent medical education reforms aimed at helping physicians accept death and prepare patients and loved ones for it. She recalls, with wonder, good physician dealings with death--those of doctors she learned from and, finally, her own. A graceful, precise, and empathetic writer enthralled by her work, Chen imparts much about medical schooling and surgery, too. Ray Olson
Copyright © American Library Association. All rights reserved

Review
“Dr. Chen, a surgeon specializing in liver transplants, is her own patient in Final Exam, a series of thoughtful, moving essays on the troubled relationship between modern medical practice and the emotional events surrounding death. . . . Dr. Chen vividly conveys the fears and anxieties of medical training, as well as its pleasures. . . . Her most hopeful argument is herself: a doctor open to confronting her own fears and doubts, and willing to prepare her patients for the final exam.”
—The New York Times

“Chen writes with immaculately honed prose and moral passion as she recounts her quest to overcome ‘lessons in denial and depersonalization,’ vividly evoking the paradoxes of end-of-life care in an age of life-preserving treatments.”
—Publishers Weekly

“Chen has a clear and unwavering eye for exposing the reality behind the mythology of medical training. . . . We would all do well to listen to what she has to say.”
—San Francisco Chronicle

“By sharing stories of her own maturation into a healer as well as a technically skilled doctor, Chen in this fresh and honest memoir engages and educates on many levels.”
—Los Angeles Times

“Final Exam is a revealing and heartfelt book. Pauline Chen takes us where few do—inside the feeling of practicing surgery, with its doubts, failures, and triumphs. Her tales are also uncommonly moving, most especially when contemplating death and our difficulties as doctors and patients in coming to grips with it.”
—Atul Gawande, author of Complications: A Surgeon’s Notes on an Imperfect Science

“Chen has a clear and unwavering eye. . . . We would all do well to listen to what she has to say.”
—San Francisco Chronicle

“Chen in this fresh and honest memoir engages and educates on many level...

Customer Reviews

a heartfelt account of how medical profession deals with death and dying
I read this book in one sitting! I HIGHLY recommend this fantastic read to anyone considering going to medical school, everyone IN medical school, and middle-aged readers who find themselves faced with the challenge of caring for aging parents.

Chen's stories, told in a humble and genuinely caring voice, reveal the fascinating--and at times disturbing--realm of end of life care in the emergency rooms and operating rooms of American hospitals. Through her heartfelt accounts, beginning with her first dissection of a human cadaver in med school anatomy lab, through her practice at UCLA as one of the nation's top liver transplant surgeons, Chen tackles the difficult issues of caring for the dying candidly and honestly, often citing her own failures as a young doctor before making certain realizations about how to overcome the depersonalization of death required in medical school. There are also exiting scenes, such as her vivid description of tearing down the Californis coast in a helicopter at 3:00 in the morning to harvest a fresh liver from a child just recently run over by his mother's SUV. The stories are gripping and moving, heart-rending yet touching.

Chen's writing is fabulous: caring and empathetic, yet clear and precise. The little book is easy to read. It should be required reading for first year medical students and premeds, since it not only is about death and dying and how to improve end of life care, but also offers a candid look inside med school life and the gritty, messy, day-to-day grind of busy teaching hospitals.

Overall, a solid 5 stars, get this book today.

-Dan
(biology student)

How Many Physicians Would Pass The Exam?
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.

Caring For the Ill and Personalizing Their Dying
"I think it's like Dr. Courtney M. Townsend, a legend in surgery and a personal hero, recently told me. "We have two jobs as doctors: to heal and to ease suffering. And if we can't do the former, my God we better be doing the latter." Pauline Chen

A few years ago I was part of a poetry group of medical providers. We shared poetry written by or for medical providers that described our work. Most of these poems as it turned it were about the dying, the dead or end-of-life. Our professions had a need to share our profound feelings. Since that time Palliative Care has become a recognized service in many hospitals and communities. Our patients need us and we need each other to share our grief.

Pauline Chen discovered once she was house staff that pronouncing a patient's death was part of her job, the first 'code blue', the first agonizing long death on an intensive care unit, and the day to day life and death of her patients were taking a toll. She was taught it seems to hide her feelings, but then they would not go away and what was she to do? She had an eye-opening experience with a physician who stayed with his patient while he was dying and she realized 'this is what my job is all about." As a transplant physician, Pauline Chen realized that her life and death immersion in very ill patients brought her closer to death than life. As she stated, "zeal to cure is no excuse for failing to communicate prognoses honestly or for sidestepping ongoing dialogue with patients and families as medical events deteriorate." She gives us many examples of her patient experiences and how other physicians reacted to their patient's deaths. As she so eloquently says, " That honor of worrying-of caring, of easing suffering, of being present- may be our most important task, not only as friends but as physicians, too."

"Exercising personal autonomy around one's death is no simple matter today -- especially in settings of ever-more sophisticated and fragmented medical care. As Pauline W. Chen points out in "Final Exam: A Surgeon's Reflections on Mortality," the medical profession bears a good measure of responsibility for this dilemma. But "Final Exam" is neither an angry rant nor a bloodless treatise about medicine's failings. By sharing stories of her own maturation into a healer as well as a technically skilled doctor, Chen in this fresh and honest memoir engages and educates on many levels. At the same time, the author's principal goal -- to hold herself and fellow physicians accountable for providing better end-of-life care -- is ever in view." Claire Dunavan

My role in my profession is to help my patients with their living through their dying. This would not be possible without my team mates and colleagues. My best friend, with whom I share each patient death, found this book and told me about it. Thank you. Pauline Chen has written a book that should be read by all medical providers. It is indeed a good thing to be compassionate and to be there, physically and emotionally with our patients. Highly Recommended. prisrob 3-04-07