shocking and gory as the medical world is portrayed on television,
it seldom comes close to reality, a lesson that Pauline W. Chen
regurgitates in FINAL EXAM as she describes her academic (and
continuing) education in the most difficult of all lessons: dealing
I'm no psychologist, but sometimes I wonder if doctors go into the
profession because of a God complex, where they wield such awesome
power; patients defer to their wisdom and put their fates
completely into their hands. Then comes the inevitable day when the
physician loses her first patient, whether due to something she did
or didn't do, or because nature has taken its course. It must be
quite a blow to the ego.
Then the transformation occurs.
The doctor can go one of two ways. She can either steel herself
against death or learn from it and become a more compassionate
Chen, who attended Harvard University and the Feinberg School of
Medicine at Northwestern University, paints a compelling picture,
but one that is not for the squeamish. She discusses her first
interaction with a corpse as she and her fellow med students
learned anatomy through dissection. The respect and "relationship"
that developed is touching, as Chen realizes this former life force
had a history, a family, hopes and dreams, just as she does.
Over the course of her studies and through her residency, Chen
learns that her work is not parceled out as neatly as television
shows such as "ER" and "Grey's Anatomy." The victims do not lie in
bed neatly as doctors and nurses struggle to keep them alive. They
slide around, bleed, moan and cry out.
There is no part of Chen's story that isn't saturated with sadness,
even as she is learning. Every new character is destined to die.
How will Chen respond? Will she reach out to the dying man and his
family? Will she try to hide until the end has come and avoid it
For all the emotion, Chen does not come down on one side or the
other on the technology that is available to keep the patient
going. Indeed, most of the people she discusses have decided to go
out on their own terms.
What must one feel upon being given that death sentence? How does a
doctor ever get used to passing down that sentence, when nothing
else can be done? "[T]he words emerge," Chen writes in a chapter
titled "Sorry to inform you" "so softly that I see everyone leaning
in as I speak. 'I wonder,' I hear myself saying to these people,
'if you have thought of what you want at the end of life?'"
Taking a very cynical stance, as lofty as the author's intentions
are, FINAL EXAM reminds me of a line from "I'm a Loser": "Is it for
her or myself that I cry?"
Reviewed by Ron Kaplan on January 21, 2011
Final Exam: A Surgeon's Reflections on Mortality