Pauline W. Chen

Final Exam is a beautiful, moving piece of non-fiction. Both scholarly and intensely personal, Dr. Chen's first book is a concise but thorough description of her own experiences with death and dying throughout her medical training and the effect it has had on her professional and personal relationships with the dying. Her experiences are largely universal -- her descriptions of her first patient whose death she felt responsible for echoed -- and she backs them up with citations from the medial literature about the exposures trainees have to death and their reactions.

Despite the fact that I am well-versed in the palliative literature and had read many of the articles Dr. Chen cited her personal experiences lend a depth and character to the discussion that is priceless. Dr. Chen's strength is that she is brutally honest. She describes unflinchingly her avoidance of patients that were dying and her regret of being too terse at times. She discusses events that other medical non-fiction would gloss over.

My only grievances with the book is the end-notes. The book is rife with them (at one point there are three end notes corresponding to a single sentence) and they are not marked at all in the main text, although they are designed to refer to particular sentences in the main text. The end notes are written in a different style than the main narrative, and detract from the flow. By and large they fall into three categories: those that are essential to the text and directly related to the main text; those that are essential to the text, but not directly related to the main text and those that are not essential. The first two categories should have been integrated into the narrative and the third should have been eliminated.… (más)

This review originally appeared on my blog www.gimmethatbook.com.

Final Exam was a book I picked up myself from the library. It was on my own personal reading list, which I haven’t been really able to get to these days. This is not a new book; it was published in 2007, but the ideas that Dr Chen speaks of should be relevant and in use today.

The mission of all doctors is to maintain life–by performing surgery, by prescribing medication, by encouraging life changes such as dieting or quitting smoking. But–everyone eventually dies, no matter how brilliant the surgeon was, or how much weight a patient lost. Many doctors gloss over this fact and prefer to focus on living and making a better quality of life.

Who will champion a better quality of death? No, Dr Chen is not going to talk about euthanasia, or discuss funeral services. She is going to bring to the forefront a subject that has been assiduously avoided in human medicine for a long time: death is very much a part of life, and it should not be spoken of in hushed tones or pushed to the back of one’s mind. To truly care for your patients, you must realize that death is truly part of life.

No one wants to consider their own mortality, especially someone who is going to the hospital for an operation. Dr Chen postulates that all doctors can give better care by embracing their own personal feelings and fears about death, and listening to what their patients are telling them, either with words or what their body is saying.

There is a great deal of explicit description in Final Exam: of medical procedures and people struggling to die, those with sickness or those who have developed complications after surgery. Dr Chen starts out with her own personal experience with a cadaver in medical school and brings us all the way to her visceral reaction when a good friend of hers dies.

This book’s message is a powerful one, and not for the faint of heart. I thoroughly applaud Dr Chen for suggesting that doctors make themselves more emotionally available and vulnerable. Too often a patient’s death is couched in a sense of failure, of medicine gone wrong. A delicate balance needs to be attained, and I hope Dr Chen has started a dialogue by writing this book.

I loved this. You can pick up your own copy here.… (más)