Final Exam: A Surgeon's Reflections on Mortality

Final Exam: A Surgeon's Reflections on Mortality

A brilliant transplant surgeon brings compassion and narrative drama to the fearful reality that every doctor must face: the inevitability of mortality. “Uncommonly moving ... A revealing and heartfelt book." —Atul Gawande, #1 New York bestselling author of Being Mortal 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 paradox—that a profession premised on caring for the ill also systematically depersonalizes dying. Final Exam follows Chen over the course of her education and practice as she struggles to reconcile the lessons of her training with her innate sense of empathy and humanity. A superb addition to the best medical literature of our time. “Incandescent ... The real power of her book lies in her stories. Balanced and perfect, each one seeks out the reader’s heart like a guided missile, and explodes.” — The New York Times   “ Final Exam is a revealing and heartfelt book. Pauline Chen takes us where few do.... 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 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   “In graceful, lucid prose, [Chen] narrates key events through which medical students and trainees first encounter death and, ultimately, depersonalize it.... Fresh and honest.” — Los Angeles Times Book Review 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. Chapter 1Resurrectionist My very first patient had been dead for over a year before I laid hands on her.It was the mid-1980s, and I had at last made the transition from premedical to full-fledged medical student. That late summer from the window of my dormitory room, I could see the vastness of Lake Michigan dotted with sailboats and the grunting, glistening runners loping along its Chicago shores. Despite this placid view, I rarely looked out my window. I was far too preoccupied with what lay ahead: my classmates and I were about to begin the dissection of a human cadaver.Prior to that September, the only time I had seen a dead person was at the funeral of my Agong, my maternal grandfather. Agong had grown up on a farm in the backwaters of Taiwan at the turn of the last century. He barely finished high school, but by the time he was middle-aged, Agong owned a jewelry store in one of Taipei’s most fashionable districts and had raised five college-educated children. While he grew up speaking Taiwanese, Agong had taught himself Mandarin Chinese and Japanese, languages and dialects as different as German, English, and French.Agong loved my mother, his firstborn child, and lavished her with that gift of nearly blind parental adoration. As her firstborn child, I was in a special position to receive some of those rays of love. Unfortunately though, with my American upbringing I understood Taiwanese but spoke only “Chinglish,” a pidgin amalgamation of English and Mandarin Chinese. Moreover, Agong and I had been separated by half a world until he moved permanently to the United States when I was in high school. So while I loved my grandfather, our relationship always remained rather formal.Agong died in the fall of my sophomore year in college. One weekend, my parents mentioned to me on the phone that he was doing worse and might possibly “not make it.” A week later they called again to tell me that he had passed away.My mother was grief-stricken. She became consumed by guilt and remorse, feelings that I would later learn often plague relatives of the recently dead. For my part, while I did mourn Agong’s death, I was unsure how to cope with this phase of life or with my mother’s overwhelming grief. I had not been witness to his actual dying, and seeing my grandfather alive during one visit and lying dead in a casket the next made his death unreal to me. The funeral was not particularly long, but the parade of mourners dressed in black and my