A Surgeon's Reflections on Mortality
Knopf, Hardcover, 9780307263537, 288pp.
Publication Date: January 9, 2007
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.
Pauline W. Chen attended Harvard University and the Feinberg School of Medicine at Northwestern University and completed her surgical training at Yale University, the National Cancer Institute (National Institutes of Health), and UCLA, where she was most recently a member of the faculty. In 1999, she was named the UCLA Outstanding Physician of the Year. Dr. Chen’s first nationally published piece, “Dead Enough? The Paradox of Brain Death,” appeared in the fall 2005 issue of The Virginia Quarterly Review and was a finalist for a 2006 National Magazine Award. She is also the 2005 cowinner of the Staige D. Blackford Prize for Nonfiction and was a finalist for the 2002 James Kirkwood Prize in Creative Writing. She lives near Boston with her husband and children.
“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.”
“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 levels. . . . [She] deserves high kudos for candor and compassion.”
—Los Angeles Times Book Review
“Chen . . . uses words with a sugeon’s precision, courageously confonting difficult subject matter with stunning results. She aces this ‘Final Exam.’”
—New York Post
“Restrained but impassioned prose.”
“[A] compassionate, compelling memoir.”
—Time Out Chicago
“A graceful, precise, and empathetic writer enthralled by her work, Chen imparts much about medical schooling and surgery, too.”
“This well-written, thoughtful, and engaging books is highly recommended.”
“Chen writes with tenderness and clarity, as if sharing her most intimate thoughts and concerns with a close friend or sister. . . . Chen’s deep compassion and humanity shine in this narrative. Her devotion to patients as well as her honesty about life and death issues makes this a compelling read.”
—Rocky Mountain News
“This is an affecting, convincing look at the questions of death from a physician’s point of view–presented with honesty.”
—Desert Morning News
“Remarkable . . . a strongly written memoir filled with emotion.”
“A fascinating, compelling work.”