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Final Exam: A Surgeon's Reflections on Mortality [Englisch] [Gebundene Ausgabe]

Pauline W. Chen

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Gebundene Ausgabe, 9. Januar 2007 --  
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9. Januar 2007
A brilliant young transplant surgeon brings moral intensity and narrative drama to the most powerful and vexing questions of medicine and the human condition.

When Pauline Chen began medical school twenty years ago, she dreamed of saving lives. What she did not count on was how much death would be a part of her work. Almost immediately, Chen 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, training, and practice as she grapples at strikingly close range with the problem of mortality, and struggles to reconcile the lessons of her training with her innate knowledge of shared humanity, and to separate her ideas about healing from her fierce desire to cure.

From her first dissection of a cadaver in gross anatomy to the moment she first puts a scalpel to a living person; from the first time she witnesses someone flatlining in the emergency room to the first time she pronounces a patient dead, Chen is struck by her own mortal fears: there was a dying friend she could not call; a young patient’s tortured death she could not forget; even the sense of shared kinship with a corpse she could not cast aside when asked to saw its pelvis in two. Gradually, as she confronts the ways in which her fears have incapacitated her, she begins to reject what she has been taught about suppressing her feelings for her patients, and she begins to carve out a new role for herself as a physician and as human being. Chen’s transfixing and beautiful rumination on how doctors negotiate the ineluctable fact of death becomes, in the end, a brilliant questioning of how we should live.

Moving and provocative, motored equally by clinical expertise and extraordinary personal grace, 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.


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“Dr. Chen, a surgeon specializing in liver transplants, is her own patient in Final Exam, 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. . . . Her most hopeful argument is herself: a doctor open to confronting her own fears and doubts, and willing to prepare her patients for the final exam.”
The New York Times

“Chen writes with immaculately honed prose and moral passion as she recounts her quest to overcome ‘lessons in denial and depersonalization,’ vividly evoking the paradoxes of end-of-life care in an age of life-preserving treatments.”
Publishers Weekly

“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

“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.”
Los Angeles Times

Final Exam is a revealing and heartfelt book. Pauline Chen takes us where few do—inside the feeling of practicing surgery, with its doubts, failures, and triumphs. 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. . . . We would all do well to listen to what she has to say.”
San Francisco Chronicle

“Chen in this fresh and honest memoir engages and educates on many levels. . . . [She] deserves high kudos for candor and compassion.”
Los Angeles Times Book Review

“Chen . . . uses words with a sugeon’s precision, courageously confonting difficult subject matter with stunning results. She aces this ‘Final Exam.’”
New York Post

“Restrained but impassioned prose.”

“[A] compassionate, compelling memoir.”

“Truly engaging.”
Time Out Chicago

“A graceful, precise, and empathetic writer enthralled by her work, Chen imparts much about medical schooling and surgery, too.”

“This well-written, thoughtful, and engaging books is highly recommended.”
Library Journal

“Chen writes with tenderness and clarity, as if sharing her most intimate thoughts and concerns with a close friend or sister. . . . Chen’s deep compassion and humanity shine in this narrative. Her devotion to patients as well as her honesty about life and death issues makes this a compelling read.”
Rocky Mountain News

“This is an affecting, convincing look at the questions of death from a physician’s point of view–presented with honesty.”
Desert Morning News

“Remarkable . . . a strongly written memoir filled with emotion.”
Columbus Dispatch

“A fascinating, compelling work.”
Journal Inquirer

Über den Autor und weitere Mitwirkende

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.

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Die hilfreichsten Kundenrezensionen auf (beta) 4.5 von 5 Sternen  61 Rezensionen
38 von 38 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen How Many Physicians Would Pass The Exam? 17. Februar 2007
Von H. F. Corbin - Veröffentlicht auf
Format:Gebundene Ausgabe|Verifizierter Kauf
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 von 32 Kunden fanden die folgende Rezension hilfreich
4.0 von 5 Sternen Caring For the Ill and Personalizing Their Dying 4. März 2007
Von prisrob - Veröffentlicht auf
Format:Gebundene Ausgabe|Verifizierter Kauf
"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 von 32 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Great read 17. Januar 2007
Von Googie Aldredge - Veröffentlicht auf
Format:Gebundene Ausgabe
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 von 16 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Physician, Heal Thyself 24. Mai 2007
Von Charles S. Houser - Veröffentlicht auf
Format:Gebundene Ausgabe
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 von 34 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Humbling! 25. Januar 2007
Von Loyd E. Eskildson - Veröffentlicht auf
Format:Gebundene Ausgabe
"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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