Amid the “filleting” and “sawing” apart of arms, legs and pelvises going on all over during her first year of medical school, Pauline Chen — author of the memoir “Final Exam: A Surgeon’s Reflections on Mortality” and a former Yale-New Haven Hospital resident — begins to understand that she must “learn to separate [her] emotional self from [her] scientific self” if she is ever to “overcome death.” But it is also while dissecting a cadaver that Chen realizes the futility of such a project: No matter how hard she tries, she cannot distance herself completely.
What makes “Final Exam” such a success is Chen’s second realization: She will never be able to divide herself in two. Her repeated attempts to put herself back together — to reconcile her emotional and scientific selves — allow “Final Exam” to transcend mere narrative recounting and approach revelation.
The book is not powerful merely because it is an exploration of a world that remains — we hope — hidden for many of us. Although Chen shares the haunting and unforgettable stories of patients who are forced to confront death — the woman who allowed her breast cancer to progress so far that it began to eat its way through her skin; the young boy who must live with a plastic patch over his abdomen because of the incessant infections that plague his body — it is the effect these stories have on Chen herself that move us most, as readers.
Chen is able to chart the topography of her mental state just as well as she is able to diagnose disease in her patients. When a college professor writes to ask advice about some “suspicious looking nodules” on her liver, Chen’s mind begins to spin out of control. “I tried to stop my racing thoughts,” she writes, “but there was no button to push and nowhere else to look. I saw the tumor devouring her liver, then spitting out voracious offspring that would eat away at her intestines and lungs. I saw the rocky cancer oozing the malignant fluid that would cause her belly to swell. I saw an end that I knew I could not prevent.”
As lyrically as it is delivered, the message is one of simple helplessness. After years of training and practice, Chen realizes that there will always be cases over which she has no control, no matter how close she is to the patient and no matter how hard she tries. As long as she continues to try to save lives, she will be forced to live with death.
Chen’s deep understanding of this paradox in the medical profession does not leave her powerless, however. Instead, she focuses the end of her book on putting power back in the hands of physicians and readers alike. “Our professional fear and aversion to dying is the most difficult — and most fundamentally human — obstacle in changing end-of-life care,” she writes of the medical profession, but her directive is issued just as much at normal men and women faced with the deaths of friends and family.
Chen’s solution is to privilege the crisis that confronted her early in her medical career. “The 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. And when we are finally capable of that, we will have become true healers.”
It is towards this new paradigm of healing that Chen wants us to move, and with her injunction as a model, the apparently daunting task starts to seem easier.