When it comes to confronting death, doctors are as much at a loss as the rest of us. They are in the business of saving lives, not ending them. By instinct and by training, they avoid what Pauline W. Chen calls “the final exam,” the emotional challenges posed by terminally ill patients. Death represents failure. It asks unanswerable questions. Perhaps most vexingly, it threatens to crack the hard professional shell of detachment that medical training puts in place. In modern American medicine, death is everywhere and nowhere at the same time.
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. She recalls episodes from her own medical training, and cases in which she was involved, to dramatize her misgivings about the “lessons in denial and depersonalization” that help doctors achieve a high level of technical competence but can also prevent them from expressing empathy or confronting their own fears about death.
In the current system, she writes, “few of us ever adequately learn how to care for patients at the end of life.” Among other things, “Final Exam” is a crash course in the specifics of human mortality. Dr. Chen begins with her first dead body, the dissecting-room cadaver that she disassembles over a period of many weeks, sometimes sawing and flaying, at other times gently separating minute muscle fibers and veins, as she learns to itemize every muscle and bone.