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Final Exam: A Surgeon's Reflections on Mortality 1st Edition

4.5 out of 5 stars 96 customer reviews
ISBN-13: 978-0307263537
ISBN-10: 0307263533
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Editorial Reviews

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)
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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
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Product Details

  • Hardcover: 288 pages
  • Publisher: Knopf; 1 edition (January 9, 2007)
  • Language: English
  • ISBN-10: 0307263533
  • ISBN-13: 978-0307263537
  • Product Dimensions: 4.9 x 1.3 x 7.6 inches
  • Shipping Weight: 13.6 ounces
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (96 customer reviews)
  • Amazon Best Sellers Rank: #210,010 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By Foster Corbin TOP 1000 REVIEWERVINE VOICE on February 17, 2007
Format: Hardcover Verified Purchase
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.
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Format: Hardcover Verified Purchase
"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.
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Format: Hardcover
This book is really compelling, Dr. Chen brings you into her world and her work with clarity and a terrific knack for storytelling.

Her love of medicine and her genuine appreciation for her patients as people, not just interesting problems, is extremely touching.

Ultimately, she asks questions that dont just apply to medicine, but to society as a whole. How can our secularized society and our culture do a better job of facing death and caring for the dying?
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Format: Hardcover
Towards the end of FINAL EXAM, author Pauline Chen describes harvesting organs from a brain-dead patient who bore a strong physical resemblance to herself. Soon afterward she began to write stories, mostly about her experiences with patients. When she took a creative writing class, her teacher was clearly impressed by the authentic quality of what Chen had to relate and told her, "Pauline, you have to write these stories." This book is the the completion and gathering of those stories.

FINAL EXAM is an account of Chen's evolving understanding of what she could and couldn't accomplish as a physician and surgeon. She begins with a description of her "relationship" with the cadaver she was assigned in medical school and goes on to describe a number of patients who died under her care. It is gratifying that she seemed to learn something from each experience and was able to use these experiences to strengthen her skills as a caregiver. Also important to these stories are Chen's descriptions of her relationships with her medical colleagues (including nurses, interns, and medical students) and of the bonds she was able to forge in spite of the impossible schedule and stresses that are unavoidable in that profession. Each story is powerful and moving. And each story made me think about the kind of care I want to receive (and demand) as the end of my life approaches. This is a wise and gentle book. Chen's vision and power of expression come mightily close to the poetry found in S. Nuland's masterpiece, HOW WE DIE, a work Chen is familiar with and quotes from. One can only hope that many doctors will read her reflections and absorb their important message.
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