Final Exam: A Surgeon's Reflections on Mortality

Final Exam is a beautiful, moving piece of non-fiction. Both scholarly and intensely personal, Dr. Chen's first book is a concise but thorough description of her own experiences with death and dying throughout her medical training and the effect it has had on her professional and personal relationships with the dying. Her experiences are largely universal – her descriptions of her first patient whose death she felt responsible for echoed – and she backs them up with citations from the medial literature about the exposures trainees have to death and their reactions.

Despite the fact that I am well-versed in the palliative literature and had read many of the articles Dr. Chen cited her personal experiences lend a depth and character to the discussion that is priceless. Dr. Chen's strength is that she is brutally honest. She describes unflinchingly her avoidance of patients that were dying and her regret of being too terse at times. She discusses events that other medical non-fiction would gloss over.

My only grievances with the book is the end-notes. The book is rife with them (at one point there are three end notes corresponding to a single sentence) and they are not marked at all in the main text, although they are designed to refer to particular sentences in the main text. The end notes are written in a different style than the main narrative, and detract from the flow. By and large they fall into three categories: those that are essential to the text and directly related to the main text; those that are essential to the text, but not directly related to the main text and those that are not essential. The first two categories should have been integrated into the narrative and the third should have been eliminated.

I love how vulnerable Pauline Chen gets in her memoir about the realities of being a doctor. Though I will never come close to what she has seen in my life, I appreciate hearing about her experiences taking care of her patients with her amazing bedside manner and how she copes with death and loss.