Final Exam: A Surgeon's Reflections on Mortality
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Final Exam: A Surgeon's Reflections on Mortality

3.81 of 5 stars 3.81  ·  rating details  ·  1,490 ratings  ·  196 reviews
A brilliant transplant surgeon brings compassion and narrative drama to the fearful reality that every doctor must face: the inevitability of mortality.

When Pauline Chen began medical school, she dreamed of saving lives. What she could not predict was how much death would be a part of her work. Almost immediately, she found herself wrestling with medicine’s most profound p...more
Kindle Edition, 290 pages
Published (first published 2006)
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Hanane
كتاب رائع جدا، يجمع بين ما هو مفيد ومؤلم، بين التحديات والتجارب الصعبة لطبيبة جراحة منذ مرحلة دراستها إلى حين تخرجها، بين صفحات الكتاب أحسست أني عشت معها جميع الحالات التي وصفتها، وكم كانت مؤلمة تلك التي كانت تنتهي بالموت و الفراق، عندما يعجز الأطباء ويفقدون الأمل في إنقاذ المريض، عندها يكون الرجاء الوحيد هو أن يحظى المريض بنوع الموت الجيد الذي يستحقه٠
Sarah
This is certainly not a feel-good, enjoyable read in the sense of warm fuzzies, but I believe it is something that most people should pick up if they have time. I wanted to include in my review my favorite lines from the book, as Dr. Chen is a very eloquent writer, but I realized quickly I would basically be copying the entire book. She covers some VERY controversial topics such as * how far DO you go with treatment in the face of a horrible prognosis, * why would you stop treatment, * why would...more
Laurel
Jan 17, 2009 Laurel rated it 3 of 5 stars  ·  review of another edition
Recommends it for: doctors?

I was drawn to this book for obvious reasons (death and dying) and was excited to read a book about the medical field that wasn't all fiction-y and soap opera-y. I heard about this in the New York Times, and someone had cited it as one of the best books of 2007. After reading it, I find that title somewhat surprising, unless it was judged on the unique subject matter and not the writing itself.

Pauline Chen is a doctor, not a writer (she described a nurse's eyebrows as "luxuriant"), but nonethel...more
Melissa Lee-tammeus
If I had to pick a surgeon, this author may definitely be the one I would chose. I picked up this book to get a better understanding of the doctors I am dealing with during my internship and I have to say I now have a much deeper respect for medical doctors overall than I did before. The first chapter is all about the trials and tribulations of working with and through a cadaver from head to toe in Gross Anatomy and how that experience defines a doctor's life. I realized right after that chapter...more
Tonsina
Going into the medical field (I'm a Nursing Student) you hear stories about the attitudes of Doctors that have been pervasive throughout the years. Some people have excellent experiences with doctors that interact well, listen and truly try to work with the patient; on the other side are experiences of "Doctor knows best", never questioning and rarely explaining the full situation to the patient. Surgeons are one of the specialties that suffer from this particular stigma. That attitude has final...more
Louis
Dec 27, 2009 Louis rated it 4 of 5 stars  ·  review of another edition
Recommends it for: Those who teach others in a profession.
Not long ago, I was at a Pittsburgh Symphony Concert which had pieces that reflected on death and mortality Pittsburgh Symphony: reflections on death. This is another view of the topic, in this case the final exam is for doctor's, who have to face the fact that their patient is facing death and how dealing with this should be part of the doctor's profession. Pauline Chen, a transplant surgeon, makes the case that (1) providing care in death is not part of a regular doctor's training, (2) it real...more
AGC
I really enjoyed Dr. Chen's reflections and personal experiences about patient care and end-of-life care. A lot of what she addresses relates to patient-centered care for healthcare workers, and how they should interact with patients.

There's always the dilemma: keep fighting and pressing for more treatment? Or quit the expensive treatments, which could be more detrimental than ameliorating for a patient at his/her end, and focus on the quality of life and palliative care? So it's up to the physi...more
Peter
This is a book everyone should read. It's not easy - she deals with the difficult issues of death and with her own and our mortality. Her perspective is that of a physician dealing with dying on a daily basis. But it is also an issue that sooner or later we all deal with related to our loved ones and eventually ourselves. The vivid clinical descriptions made me stop in places to take a few deep breaths before continuing, but they served the purpose of focusing my attention and making reading a d...more
Mike
Thought this would be a good book to read as the health care debate unfolds in the US. I highly recommend the book to anyone in the medical professions, but think there are more appropriate treatises on death and mortality for other audiences. Mary Roach's Stiff: The Curious Life of Human Cadavers offers a more lighthearted glimpse into that which awaits us all. For a philosophical and psychological examination of mortality, Ernest Becker's The Denial of Death is indispensable and potentially li...more
Frank Jude
The subtitle of this book says it all: "A Surgeon's Reflections on Mortality." Pauline Chen is a transplant surgeon with an apparently uncommon sense of reflective thinking. While reading this book, I was moved by the realization of how much suffering -- both the buried, denied suffering of medical staff, and the often confused, scared suffering of dying patients -- is caused by western medicine's framing of death as defeat!

Chen makes the case that only when doctors face their own mortality, wi...more
Andrew
Having known doctors as relatives and friends of the family, I know they're not like a lot of humans. In being extremely good at one thing -- taking people apart and putting them back together -- they can fail at interacting with them emotionally. It's called bedside manner, and some have it, some lose it, and some never had it in the first place.

This collection of a star liver surgeon's meditations on dying pivots exactly on that difficulty -- how do you cure people without forgetting they're p...more
Ili
Pauline Chen discusses how terrible doctors are at dealing with mortality and death. We are surrounded by it, and yet we have the worst coping mechanisms. Ignoring death, not talking about it, and dehumanizing our patients are just some of the solutions.

The most striking passages dealt with how patients "stop existing" once medical treatment becomes futile. People need caring and love most of all when their illness becomes incurable, and yet we ignore them. A very strong drive exists within for...more
Stacie Nishimoto
short stories and case studies full of compassion, eloquence, and candor. if you care about people at all and suffering even a little, this book will appeal to you, altering a perception of medicine and mortality forever. I defy anyone to come away uninspired.
Heather
I liked it because she, a doctor in the field discusses the lack of human emotion, compassion , that patients ARE humans and that human bodies have souls seems to not exist or we do not see often in medical field. I am shocked that she is so truthful even about her own dehumanizing, arrogant and racist practices shared by many doctors. (Minus our own few stellar Drs. we have found and kept or have been lucky in emergency situations!) Most of the book is pretty sad and I felt disgusted by the med...more
Carey
My biggest complaint with this book is that the author can't seem to decide who her target audience is. There are large sections that read like something you might find in a medical journal or textbook. The language is peppered with medical terminology and jargon that, as a lay person, didn't allow me to fully engage in the narrative. The sections where she recounts specific episodes with her patients were interesting, but the transitions between the two sections were awkward and clumsy.

Chen's "...more
Jennifer
3.5 actually. I really wish that Goodreads would let us assign a one half rating as well.
Riva
"It is nearly impossible as we go about our daily duties to talk about our lives as finite. Nonetheless, it is only by taking on these discussions that we can ensure our patients---and our loved ones---a good death, however each person may define that." (xv)

A friend of mine is writing a PhD dissertation on the concept and discourse of 'a good death.' In hospice, we let patients - and their families - define it for themselves, as Dr. Pauline Chen suggests in the quotation above.

In medicine, howev...more
Lindsay
"For doctors, care at the end of life is, as this book's title implies, our final exam."
Dr. Pauline Chen composed a series of nine reflections from her experiences in medical school, internship, and residency. Through these stories and reflections, Dr. Chen comments and criticizes how she as a doctor was taught to deal with death of a patient, how to interact with the patient's family, but most importantly, what to do when you know your patient is going to die in a day/week/month and there is si...more
Pris robichaud

Caring For the Ill and Personalizing Their Dying, 4 Mar 2007


"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...more
Jessica
Great book topic, but the author is clearly a surgeon rather than storyteller. Dr. Atul Gawande is a better author on these sorts of topics. That said, this book had great glimpses into the surgeon's training and dealings with death. There is an interesting section on gross anatomy (dissecting humans) and another excellent section on the stupidity of the surgeon's long training hours:

pg 86 - 87
At 4:30, after the operation was essentially done, the attending surgeon left my close friend Susan, al...more
Cindy
I love memoirs about medical school and doctors going through their years of training. This one, however, doesn't rank very high on my list.



First of all, Dr. Chen is not a very good storyteller. And while she doesn't present herself in a very flattering light through most of the book, she also doesn't show herself as a very sympathetic character.



She makes enlightened statements about how end-of-life care should be handled differently than it usually is by medical professionals here in the 21st...more
Kim
The author, a surgeon, writes about death from a doctor's point of view, which is to say, a point of view completely uncomfortable with death. She recognizes this, and has spent the past few decades of her practice moving toward a place where she can truly be with people at the end of their life, rather than seeing death as a failure of her attempts to cure them. She touches on the policy and educational changes in the medical community to better address end of life and palliative care issues, a...more
John
I liked it. I think it's a good topic and decent book for future and probably also current doctors and nurses.

This part about a benefit of residents working insane hours interested me:

pg 86 - 87
At 4:30, after the operation was essentially done, the attending surgeon left my close friend Susan, also a surgical fellow, and me to finish closing up the patient's skin. Together she and I had been up for over forty-eight hours. To hurry us along and prevent us from falling over, the sympathetic nurses...more
Stacy
A Dr. admits how the medical field doesn't take care of dying people very well--very much appreciated that someone comes clean about this :). After witnessing what my grandmother went through being shuffled from hospitals (3) to nursing homes (2) with poor consistency in paperwork and finally getting relief with hospice, I'm glad that this book is out there. Dying is not fun to watch or be around, but it's a fact of life. I was more at peace with my grandmother's death than her suffering through...more
Becca
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 l...more
yamami
الكتاب عبارة عن مُذكرات طبيبة جراحة .. تبدأ مذكراتها كـ طالبة في كليّة الطب ، تَسرد انطباعاتها وأحاسيسها لأصعب ما يواجه طلاب الطب ( غُرف التشريح ) .
الخوف الذي يطغى على كل شيء عندما يُطلب من الإنسان أن يسحب جثة هامدة وباردة تفوح برائحة مادة الفورمالديهايد -المادة المستعملة في حفظ الجثث- ، تلك الرائحة الزنخة والحادة التي تلتصق بالملابس كأنها بقايا الموت الذي يملأ غرف التشريح ..

ومن ثم كـ طبيبة متدربة تتحدث عن مُشاهداتها لحالات الموت السريري/ الإنعاش المُستميت / الموت !!
الموت الذي يَهزم محاولة الأطب...more
Anna
I listened to the audiobook, which was read by the author. While the topic of how doctors deal with death among their patients was interesting, I found that the author (a seasoned surgeon) was often very clinical and lacked the emotion that I thought she was trying to portray with how doctors needed to be more empathetic and link to their own feelings and less apathetic when dealing with dying patients. Her discussion of how the medical community has dealt with this and tried to incorporate more...more
Nanci
Library Journal says: "Numerous articles and books have shown that many physicians do not know how to treat terminally ill patients appropriately and humanely. Some physicians, in fact, use extreme and futile medical interventions to treat dying patients, with little regard to their costs, the pain and suffering they cause, or even the patients' own wishes. Chen, a young Asian American transplant surgeon, further addresses this profound paradox of medicine?a profession premised on caring for the...more
Zack
This book is exactly what the title describes: it's a transplant surgeon's reflections on mortality. Pauline Chen discusses a number of events and patients she's encountered, mostly from med school through her post-residency transplant surgery fellowship, and how each of them in some way has shaped or is emblematic of her own feelings about death. She identifies fear of death and reluctance to discuss it as a significant and pervasive problem in medicine, and doesn't fail to hold herself account...more
Laetitia Wu
As a medical student, at first I felt Dr. Chen to be overly sentimental in dealing with many issues in work. I wondered how she reconciled such candid sensitivity with the harsh grittiness of daily life throughout her career. As I read on however, it only became more apparent that it is my own inadequacies in understanding the ‘humane’ that are being reflected, my inability to grasp empathy and compassion, the very qualities (or lack of) that this book is about, and which Dr. Chen wanted to call...more
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