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Final Exam: A Surgeon's Reflections on Mortality [Audiobook] [Audio CD]

Pauline Chen
5.0 out of 5 stars  See all reviews (1 customer review)

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Book Description

Jan 2007
When Pauline Chen started medical school, she dreamt of saving lives. She had never considered how much death would be part of her work. A brilliant young transplant surgeon asks how is it that medicine is a profession based on caring for the ill yet it depersonalises the dying? Over the course of her medical education and training Pauline Chen struggles to reconcile its lessons with her own fear of mortality and the separation of healing from her desire to cure. From her first dissection of a cadaver in an anatomy class to the first time she uses a scalpel on a living person; from her first experience of witnessing someone flatlining in the emergency room to the first time she has to pronounce a patient dead Pauline Chen confronts how her medical training taught her to suppress her feelings for her patients. Chen finds that her fears of mortality have incapacitated her, she cannot call a dying friend, she cannot forget the tortured death of a young patient. Rejecting her training Pauline Chen begins to create a new role for herself as a doctor who shares her patients humanity. Moving and provocative, inspired by the author s clinical expertise and extraordinary personal spirit, 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.
--This text refers to the Hardcover edition.

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Product details

  • Audio CD
  • Publisher: Phoenix Books (Jan 2007)
  • Language: English
  • ISBN-10: 1597771384
  • ISBN-13: 978-1597771382
  • Product Dimensions: 13.1 x 14.8 x 2.6 cm
  • Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)

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"Do doctors neglect death and the dying, choosing instead... on flogging the last bit of life back into patients?..." -- 'British Medical Journal'

"For me , Pauline Chen's beautifully-written Final Exam: a surgeon's reflections on mortality was fascinating." -- Virginia Ironside, 'The Independent'

"At her best when she writes of individual cases: one turns the page to find out what happened next." -- Dr Theodore Dalrymple, 'Sunday Telegraph' --This text refers to the Hardcover edition.

About the Author

Pauline Chen attended Harvard University and completed her surgical training at Yale University. --This text refers to the Hardcover edition.

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1 of 1 people found the following review helpful
5.0 out of 5 stars Great book 18 Dec 2010
By tht
I bought this more than 2 years ago and it's been on my shelf since. It's a very good introduction to the surgery aspect of medicine if you're thinking about going into it and covers all the morality aspects that books like 'Trust me I'm a junior doctor' etc seem to gloss over. It's also very interesting just as something to read, and very heartfelt. Strongly recommend it.
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Amazon.com: 4.5 out of 5 stars  61 reviews
38 of 38 people found the following review helpful
5.0 out of 5 stars How Many Physicians Would Pass The Exam? 17 Feb 2007
By H. F. Corbin - Published on Amazon.com
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. She confronts her fears about her own mortality when she is about to harvest organs (a procedure she had done eighty-two times previously) from an automobile accident victim and discovers that the donor is a brain-dead thirty-five-year old Asian American woman: "For a moment I saw a reflection of my own life and I felt as if I were pulling apart my own flesh."

This beautifully written book reminded me of another fine book by another physician, Abraham Verghese's MY OWN COUNTRY, an account of his treating the first patients-- most of whom would certainly die horrible deaths-- with HIV/AIDS at the local VA hospital in Johnson City, Tennessee in the 1980's. Both these books should be required reading for medical students.

When I finished Dr. Chen's "reflections," I thought of (1) how fortunate her patients are to have a surgeon so sensitive and so human and (2) wondered how many physicians would take time out from their busy schedules to read her wise words.
31 of 32 people found the following review helpful
4.0 out of 5 stars Caring For the Ill and Personalizing Their Dying 4 Mar 2007
By prisrob - Published on Amazon.com
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. As she so eloquently says, " That honor of worrying-of caring, of easing suffering, of being present- may be our most important task, not only as friends but as physicians, too."

"Exercising personal autonomy around one's death is no simple matter today -- especially in settings of ever-more sophisticated and fragmented medical care. As Pauline W. Chen points out in "Final Exam: A Surgeon's Reflections on Mortality," the medical profession bears a good measure of responsibility for this dilemma. But "Final Exam" is neither an angry rant nor a bloodless treatise about medicine's failings. 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. At the same time, the author's principal goal -- to hold herself and fellow physicians accountable for providing better end-of-life care -- is ever in view." Claire Dunavan

My role in my profession is to help my patients with their living through their dying. This would not be possible without my team mates and colleagues. My best friend, with whom I share each patient death, found this book and told me about it. Thank you. Pauline Chen has written a book that should be read by all medical providers. It is indeed a good thing to be compassionate and to be there, physically and emotionally with our patients. Highly Recommended. prisrob 3-04-07
30 of 32 people found the following review helpful
5.0 out of 5 stars Great read 17 Jan 2007
By Googie Aldredge - Published on Amazon.com
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?
16 of 16 people found the following review helpful
5.0 out of 5 stars Physician, Heal Thyself 24 May 2007
By Charles S. Houser - Published on Amazon.com
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.
30 of 34 people found the following review helpful
5.0 out of 5 stars Humbling! 25 Jan 2007
By Loyd E. Eskildson - Published on Amazon.com
"Final Exam" is humbling in at least two dimensions - producing greater respect for physicians (their knowledge and skill - both practicing medicine and handling grief and death), and reminding the reader that he/she is not immortal, and has over a 90% chance of dying from a prolonged illness - with plenty of time to reflect.

Care at the end of life provides the theme for "Final Exam," and Dr. Chen takes us through her earliest lessons on death in medical school (her cadaver dissection - imagining the person in real life and covering up emotions with black humor, first resuscitation scene - failed, but wondering if she could do as well, and her first pronouncement of death). Then its on to professional medical practice experiences - eg. evading difficult discussions with patients and family, trying to avoid long-term terminally ill dying on one's shift and incurring subsequent paperwork, seeing the devotion of a spouse to his/her long-term partner, ramping up treatment in terminal cases - even though it made little medical sense (accounts for about 22% of all medical expenditures and usually simply prolonged patient and family suffering; avoiding lawsuits is a major reason, unclarity regarding who is the physician is another). Finally, it's on to Dr. Chen's experiences as a transplant surgeon - removing organs from those declared "brain dead" and then deliberately ending their lives, followed by hopefully bringing life to the donor-organ recipient.
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