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A Surgeon’s Reflections on Mortality

A-Final ExamMedical school students, flush with zeal and a passion for saving lives, often forget one fact: the inevitability of death. Pauline W. Chen details her own study of death—from her first cadaver dissection to her first surgery to losing a patient for the first time. Chen, who sees death daily, must reconcile her role as doctor with her close connection to patients who have their own fears about how their lives will end. In most cases, doctors and patients avoid discussing death: it is terrifying, it robs patients of hope, it is seen as failure. One survey found that 25 percent of oncologists did not tell their patients that their disease was incurable. When death is unmentionable, doctors and patients are unprepared when it comes—and Chen examines the resulting psychological toll.
Knopf. 268 pages. $23.95. ISBN: 0307263533

Hartford Courant 4 of 5 Stars
"[Chen] has a gift for turn of phrase and imagery that shows the sensitivity and ‘shared humanity’ at the core of how she wants doctors and their patients to approach death. Reading her book is a visceral experience: You read a chapter and sit in stunned reflection upon your own mortality." Chuck Timlin

New York Times 4 of 5 Stars
"A series of thoughtful, moving essays on the troubled relationship between modern medical practice and the emotional events surrounding death. … Dr. Chen vividly conveys the fears and anxieties of medical training, as well as its pleasures." William Grimes

Rocky Mountain News 4 of 5 Stars
"Chen writes with tenderness and clarity, as if sharing her most intimate thoughts and concerns with a close friend or sister. … Her devotion to patients as well as her honesty about life and death issues make this a compelling read." Verna Noel Jones

San Francisco 4 of 5 Stars
"Chen has a clear and unwavering eye for exposing the reality behind the mythology of medical training that has driven the culture since Samuel Shem’s novel The House of God codified its rules in 1978. … We would all do well to listen to what [Chen] has to say." John Vaughn

Dallas Morning News 3.5 of 5 Stars
"It’s a confession of failings, both her own and her profession’s, but it’s also a chronicle of growth, of coming to terms with the inadequacy all of us feel in the face of mortality, but which doctors are, at least in the popular imagination, supposed to be able to rise above. … [A] candid memoir that’s sometimes disturbing, sometimes gently funny, and always poignant." Charles Matthews

Critical Summary

In her first full-length book, Pauline W. Chen, a liver-transplant specialist, shares her unique perspective and her wealth of experience, having honed her skills at some of the world’s most prestigious medical institutions—including Harvard, Yale, and UCLA. Chen showcased her writing ability as a finalist for a National Magazine Award in 2006 with her essay "Dead Enough? The Paradox of Brain Death," and critics applauded the portraits in Final Exam for their insight and the author’s graceful, lyrical prose. Chen means to take on death directly here, and as a result, there are gut-wrenching scenes—from the physical (detailed descriptions of a cadaver’s anatomy) to the emotional (a mother accidentally hitting her two-year-old boy with her car and his suffering in the ICU while awaiting an organ transplant). Critics compared Chen’s work to that of physicians-cum-memoirists Richard Selzer (Letters to a Young Doctor), Sherwin Nuland (How We Die), and Atul Gawande (Complications: A Surgeon’s Notes on an Imperfect Science). Chen’s auspicious debut fits nicely into this growing body of literature on death and dying.