Monday, March 17, 2008

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

Witnessing so much death and illness plays a large role in the informal curriculum of who physicians eventually become as professionals. During our medical school and residency years physicians are influenced greatly by volume, intensity and often times sporadic support received in caring for dying patients. Thankfully this hit or miss approach is changing, but slowly. The inclusion of palliative care in the curriculum of many medical schools and the growth of palliative care physicians to lead as mentors to students, residents, and other attending physicians in approaching death in a more supportive, helpful and person-centered way.

Dr. Pauline Chen, the author of FINAL EXAM: A Surgeon's Reflections on Mortality, now out in paperback, has been on a book tour, and traveled through Kansas City (Sinclair), Milwaukee (Rosielle) and New Haven (Quinn) hitting a Pallimed trifecta. Of the three of us, I was the only one who did not get to see/meet her in person. But she did agree answering a few questions for us, which you can find in the Pallimed interview. Now on to the book review.

Dr. Chen, a transplant surgeon, penned an excellent book which takes you through her training as she encounters death in medicine's many forms: anatomy lab, Morbidity and Mortality report, , the first code blue, transplantation organ harvest after brain death and others. She writes skillfully about each and the lessons learned without trying to fool the reader into thinking she 'knew it all along.' By allowing us into her thoughts and worries, she graciously allows us to see her foibles, but eventually demonstrates how these lessons have shaped who she is today. In reading this book, I too recalled events from my training long thought forgotten. To be able to witness Dr. Chen's uncynical growth in response to caring for the dying is helpful for both the health care practitioner and for the public as well.

An excellent quote summarizing the effect of medical training:

"Ultimately they will settle at a comfortable equilibrium point, and this act of creating a new moral paradigm - detached concern, secure uncertainty, and humanistic technology - marks an important step in the transformation of the lay medical student into full-fledged professional physician."
While those palliative care practitioners searching for a way to better communicate with surgeons about palliative care issue will not find a panacea in this book, you may find this book might be a good bridge to start discussing how much of surgery really can be palliative.

Dr. Chen's website has a reader guide and posts by Dr. Chen about her book tour. You can purchase the book from Amazon (of course), but I know Rainy Day Books (an independent bookstore in Kansas City) still has a few signed copies if you are interested. (Disclaimer: No kickbacks here!) Be sure to also check out the Pallimed Interview with Dr. Chen.

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