Final Exam: A Surgeon's Reflections on Mortality (edition 2007)

This books shows the humanity of working in the medical profession. From the start of medical school to her current position, Pauline Chen, really helps express why the medical system is the way it is, those who try to correct it. The medical profession is made up of humans in a rigid, non perfect system. We as patients should provide assistance to nudge doctors who want to do the right thing to go ahead. And be a poke for those who do not want to bother. ( )

This book did not help me with the feeling that Doctors Are Bad because they are vainglorious snots who are best avoided. I really understand the patient with advanced breast cancer who got no medical intervention until her breast was actually rotting away. I usually feel that whatever doctor I deal with is more interested in getting payment than in delivering care, more interested in getting out of the exam room than in answering questions, etc.

Granted, I am more prejudiced against doctors than most people: my family has three doctors, and every one of them is an awful person in one way or another. I once worked for a doctor who hated people in general and loved to torment her support staff in particular. (Thank God that one wasn't a surgeon. The thought of a knife in her hand still gives me the willies). My problem is mostly that these people really seem to feel their grand Doctorhood puts them on a level far. far above little me. These are the sort of person who can hear "Stop, I am not comfortable with this discussion," and say indignantly, "I am a Doctor, I will discuss whatever I wish." No, sometimes you are a family member who ought to know when to use some manners.

But enough about this reader's doctor dislike. I did not read this book carefully but rather in a feverish haze of illness. Why did I read a book I probably wouldn't like while I was sick? Because it was on top of the TBR pile and I liked the feeling of being able to cross it off my list. I admit I probably missed a lot.

I was struck by the amount of loving detail about the author's first cadaver, who was probably her most memorable patient. This part of the book was very touching. Especially when compared to the patient-avoidance techniques Dr. Chen developed later in her career.

Was the cadaver her favorite patient because it didn't talk back, and no difficult conversations had to occur on its behalf? Or is this a story about how the practice of modern medicine turns starry-eyed idealistic little People Helpers into dog-tired drones servicing the insurance industry more than the patient population?

Doctor Chen ended up saving her precious professional time by developing the back-out-of-the-room technique to cut off tiresome and tedious patient questions, and who figured that she could just skip all those difficult conversations with patients and families about death because somebody else would probably do it, so she wasn't really lying and she wasn't really shirking her responsibilities. Ugh. How horrible to feel that this woman paid more attention and gave better care to her first cadaver than to some of the sick people who ended up cluttering her busy schedule.

Why is it that doctors are in love with their mastery of technology, but avoid pain management? One would think that a terminal case could have all the drugs they wanted, but no. It is common to suffer moderate to severe pain at the end, because pain makes doctors uncomfortable. I think about that paradigm when I think that dying peacefully in the back yard will be much more dignified than going to hospital.

Behind the glamour of surgery lies heartache for patients and surgeons.

Death, Dying, Medicine, Non-Fiction ( )

A fascinating look at how doctors deal with death and dying, from the first cadaver they dissect, to the patients that they are unable to save. Dr. Chen proposes that doctors need to take a more intimate and caring role in dealing with dying patients and their families. ( )