Upgrade to the Flash 9 viewer for enhanced content, including the ability to browse & search through your favorite titles.
Click here to learn more!
Written by 
- Format: Hardcover, 288 pages
- Publisher: Knopf
- On Sale: January 9, 2007
- Price: $23.95
- ISBN: 978-0-307-26353-7 (0-307-26353-3)
about this book
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.
“Chen’s introspection provides a model for a creative method that we should seek to integrate into our system of medical education. The self-awareness that results from reflection on difficult encounters with patients should be transformed into an educational tool to develop and explore professional identity in medical schools. This process of self-reflection should be formally incorporated into medical education so that it can occur among a group of supportive peers. Our educational system needs to create a formal infrastructure for self-reflection and dialogue. Through this process, we may come closer to developing the sensitivity and character that we would all want in the physicians who care for our families and ourselves.” —Lisa Soleymani Lehmann (Harvard Medical School), The Journal of Clinical Investigation
“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
“As Chen so eloquently argues, a 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. Any book that calls a spade a spade on these touchy topics deserves high kudos for candor and compassion. In particular, I commend Final Exam to every medical student and young physician.” –Claire Panosian Dunavan (Professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA.), Los Angeles Times
