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

3.85  ·  Rating details ·  2,656 Ratings  ·  238 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
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Kindle Edition, 290 pages
Published (first published 2006)
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Sarah
Sep 07, 2011 rated it it was amazing  ·  review of another edition
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
Hanane
Oct 08, 2013 rated it it was amazing  ·  review of another edition
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
Laurel
Jan 06, 2008 rated it liked it  ·  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
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K.
May 27, 2015 rated it it was amazing  ·  review of another edition
Shelves: aging, medicine
Before reading this book, I understood that physicians deal with matters of life or death. Chen highlights the raw truth that physicians have to confront death daily and find ways to address this reality. Yes, physicians save a lot of lives with their state-of-the-art techniques, their experience, their collaboration with others, and even the instincts they draw on in fast-past emerging crises. However, physicians also have to develop an attitude, a manner, a relationship with death.

The book ha
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Louis
Nov 26, 2009 rated it really liked it  ·  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
Pris robichaud
Jan 04, 2009 rated it really liked it  ·  review of another edition

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
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Charles Matthews
Dec 18, 2009 rated it really liked it  ·  review of another edition
Hospital shows – ER, Grey’s Anatomy, House and so on – have inured us to the sight of the moist workings underneath the skin, and inspired us with the drama of dedicated (and usually good-looking) young doctors saving lives. As for death, Luka and McDreamy and Gregory House take it in their stride – on TV it’s just the occasional unfortunate byproduct of so much heroism.

Pauline Chen, a real-life surgeon, has another way of looking at it. Death is one thing medical school doesn’t do a good job in
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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
Aug 24, 2013 rated it really liked it  ·  review of another edition
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
AGC
Jul 04, 2012 rated it it was amazing  ·  review of another edition
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
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Tracey
Mar 17, 2008 rated it really liked it  ·  review of another edition
Recommended to Tracey by: Ginnie Jones
Shelves: libraryread
A thoughtful look at how doctors in general and the author in particular cope with death and dying in their professional lives.

The book begins with Ms. Chen's first-year cadaver studies as an introduction to the clinical side of death. She continues with stories from her training and internship/residency (with her eventual focus on transplant surgery) combined with a more general look at how her profession is slowly beginning to address death and dying issues within their training. Since so muc
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Peter
Jan 26, 2009 rated it really liked it  ·  review of another edition
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
Frank Jude
Feb 16, 2009 rated it liked it  ·  review of another edition
Shelves: medicine
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
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Mike
Jul 27, 2009 rated it liked it  ·  review of another edition
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
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.
Jennifer
3.5 actually. I really wish that Goodreads would let us assign a one half rating as well.
Glenn
Aug 29, 2016 rated it really liked it  ·  review of another edition
Required reading for a course for med school students. A great jumping off point for discussion and reflection.
Jim Gleason
Intrigued by an amazing article by a Dr. Chen in the Virginia Quarterly Review titled: Dead Enough?: The Paradox of Brain Death (search the web using “Chen brain death” to see the article) I couldn’t resist ordering her newly published book, Final Exam. In a most interesting and eloquent writing style, this liver transplant surgeon shares her own experiences through medical training and later as a practicing surgeon with death and dying, and in the telling also takes on issues in medical educati ...more
Joseph
Jul 29, 2017 rated it it was amazing  ·  review of another edition
I enjoyed this book well enough that I finished it in one day. Well written, and I found Pauline a likeable narrator and she kept me engaged throughout, though she does not often go deeper into how events she experienced effected her, and is very superficial about her own life, only revealing aspects that directly relate to death and dying. I would be interested to read more about how her experiences as a surgeon impacted her personal relationships. She is not overly clinical, but the subject ma ...more
Cyndie
As a veterinarian, I found this book interesting particularly because our patients don't live as long and age more quickly. Additionally often the financial resources aren't there to simply do everything medical available for every pet. We find ourselves having to focus on the quality of life and quality of end of life on a regular basis. Often our pet owners mention something to the effect that they wish it was as easy to talk to their physician about those issues as it is to talk to us.
Robin
Jul 07, 2017 rated it really liked it  ·  review of another edition
Pauline Chen's book takes us through her years of medical school, her internships and residences. She also gives us a look at her childhood and family. The discussion through her cases looks at the many difficulties that come with mortality and decisions around level of care. As a nurse I very much appreciated her reflections and how they helped me revisit many areas of my career.
Eleanor Merca
Oct 03, 2017 rated it it was amazing  ·  review of another edition
very humbling to read about a doctor's feelings of inadequacy regarding end-of-life care skills. i wish this was taught in med school ( or was i asleep during that lecture, yet again? darn!) so we wont be so 'lost' . "heavy" topic, but worth reading
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
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Kyle Wendy Skultety (gimmethatbook.com)


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 smoki
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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
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Zack
Sep 01, 2011 rated it liked it  ·  review of another edition
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
Debi Goniwicha
Feb 21, 2017 rated it liked it
Not for seasoned healthcare workers

This is a great book for someone outside the healthcare profession. As someone who has worked in a hospital for 20 years, this is mostly a reiteration of what I see on a daily basis.
Riva
Jan 11, 2014 rated it liked it  ·  review of another edition
Shelves: death-dying
"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
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Becca
Jun 19, 2008 rated it it was amazing  ·  review of another edition
Recommends it for: all medical trainees
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
AWBY
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
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