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When I first began writing this, I was tucked into bed at seven p.m., hoping to be asleep soon. As I take my notes from last night and begin to type them into the computer, it is 4:34 a.m., and I've been awake for an hour. The headaches that have been dogging me for months have intensified their barking in the past couple of weeks. Pain and nausea are paired, and the pain in my face simply changes shape when I swallow the Vidodin I was prescribed on Friday. I have been trying other pain medications—and they haven't been working—so strung out from pain, I broke down and accepted the doctor's offer to write a small script for opiates until I can get in for my CT scan, which is scheduled for later this morning. (My history with opiates is not a good one.) The Vicodin has made me feel sleepy and sick—and relieves the grinding ache in my head for only 45 minutes or so.
I could pop these pills every hour, chasing the dragon of relief, but ironically, the Vicodin gives me a headache—it's in a different part of my head—a pressure that feels as if the inside of my skull is a pneumatic piece of rubber dangerously overinflated. I'm not really having a lot of fun with this, but distraction seems my only real coping mechanism. And so, I've been reading and reading. By my count, five books in a month, plus who knows how many magazine articles, online articles, and blog entries.
Each time I've read a book, The Omnivore's Dilemma [2], A Long Way Gone [3], Pretty Birds [4], The Book Thief [5], I have intended to write a review of it and did not. That was the headache that got in the way. Sunday, I bought Final Exam: A Surgeon's Reflections on Mortality by Pauline Chen. [6] I finished it last night. The book was put-downable—I HAD to put it down, allow whatever emotion it had provoked to wash over me, before I would find myself picking it up again, wanting to know more, to allow myself to read something that was giving me access to an entirely different pain. Not my headache. And not something I would simply label heartache. It was, rather, that peculiar vibration that moves through my body when I am reading something that is resonating through me so strongly that I feel something begin to shake, to loosen within me. Resonant reading makes my boundaries less solid because of the recognition of my connection to the writer, my knowledge of the subject. Not smarts knowledge. Visceral knowledge. Gut feeling. The stuff that reminds me of my humanness, the fact that I am a part of something larger than myself.
Pauline Chen is a very successful surgeon if the list of schools where she did her training: Harvard, Northwestern, Yale, National Cancer Institutes, and UCLA are any indication.
As an accomplished surgeon, she could have writtten a deity-like paeon to the number of patients she had saved, the lives restored, the power she would be expected to feel as a member of such an elite profession. This book could have been Narcissus saying, 'Behold what I have done! Look at me!
Instead, what Dr. Chen focuses on is the ways that she has learned to stop failing her patients. Dr. Chen has written an extraordinary meditation on how her profession is ill-equipped to deal with one of the major health issues—helping patients to have good deaths. Despite the fact that humans have a 100 percent mortality rate, even among doctors who see patients die on a regular basis, there is a belief somehow that a patient death is a failure. Profoundly uncomfortable with death, many doctors cannot discuss end-of-life issues with their patients. (The problem is so endemic that even a percentage of oncologists do not tell their cancer patients that they are terminal.)
Why is this? Chen has many potential answers that look at the systems by which m.d.s are trained, and her critiques of those systems are interesting.
But it is in talking about her experiences, surgically stitching together her small encounters with individual patients and the setting in which she saw them, that is where Pauline Chen cracked open my chest.
I'm a terrible book reviewer. I'm so intent on not spoiling anything for readers that I will rarely even quote from the book. Words, for me, are like magic, and I'm always afraid that if I quote too much from the book that that magic sensation—the first time you read great writing and you feel that feeling in your gut that tells you this is great—well, I'll take that away from you if I've already quoted those parts. And so, my book reviews tend to be reflections on what got provoked in me—rage, sadness, happiness—or the epiphany I had, in my effort to convince you that this book is interesting enough that you should go read it.
I read Cynthia Ozick's brilliant exegesis of book reviews in this month's Harper's. And while I have read books whose authors are long dead, I am not sure that I could perform the "who begat who" that Ozick argues is part of a critical reviewer's job in tracing the influences at work in a piece of writing. So, let's just say that I'm not really a book reviewer. I can link a book to the zeitgeist, or tell you how a book made me think about a period in history with which I have some familiarity. With this book, I can say that as someone who has recently experienced the death of someone close to me, many things that Dr. Chen has written about touched those nerves.
I suppose it shouldn't come as a surprise to me that those parts of my flesh are still bruised. Yves' death [7] feels as if it happened years ago, and yet, we just passed the four-month mark. I still think about him, and feel him at the oddest moments.
Reading the book was like having him reading over my shoulder. It was comforting and tear-inducing at the same time. Dr. Chen's book did nothing to frighten me about my own death; in many ways, I've already made my peace with that, mostly because of the gift I was given in November.
Image is Ralph Fabri, "Death and Transfiguration" [8]
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