Pauline W. Chen: A Surgeon's Reflections

Our two jobs

Over the course of the book tour, I have been asked quite a few times how doctors have reacted to Final Exam.

For the most part, my book has been well received by doctors, and that has been immensely gratifying. After all, I feel connected with other doctors. They are my family, the shared DNA being our education and training.

But I was asked more recently if I noticed a difference in how older doctors and younger doctors were responding to my book.

I answered no. My sense was that doctors young and old were responding in the same way.

I’ve thought a lot about that question in the last couple of weeks. I’ve gone so far as to ask other doctors I meet the same question.

Today if I were asked that same question, I think I might answer it a little differently.

There is a difference in the way older doctors – and I mean doctors who are at least a couple of generations ahead of me – have received my book. Like younger doctors, they have talked about how certain narratives resonated with their own experiences. And like younger doctors, they have talked about the need for improving how we educate and train doctors to care for the dying.

But what is different is the stories they tell me. In their reflections, there is a kind of quiet respect of mortality, an acceptance of our profession’s limits.

I heard a story yesterday that really brought this home. I met a woman whose father had practiced surgery from the 1950’s until his death from pancreatic cancer in the 1980’s. He had a very busy practice and on top of his clinical duties was chairman of surgery at two of the local hospitals.

One day, this woman went to visit her father at the hospital. She found him in a patient’s room, sitting at the bedside and reading the Bible aloud to his patient. When he later left the patient’s room, his daughter asked him, “Why were you reading to that patient?”

“She asked me to read from the Bible to her,” her father replied. “And because I could no longer do anything for her medically, I did what I could.”

I grew up, professionally speaking, at a time when therapeutic failures were the exception, rather than the rule. It was hard not to ask oneself, “Isn’t there some other procedure or medication we can use here to help this person?” when you wanted nothing more than to help your patients and in your mind helping meant curing. Liver transplantation, for example, was a “gold standard” of therapy for end-stage liver disease when I was training; easily 80% of liver transplant recipients could expect to live at least another five years.

But back in the 1970’s, for example, only about a quarter of patients who underwent a liver transplant survived even one year. How could the physicians who grew up and practiced in that era not feel a little differently about mortality than my generation of doctors?

In an age when the number of our successful therapeutic options has exploded, it’s difficult to see that sometimes the most therapeutic thing you can do has nothing to do with another drug or operation. Sometimes all we can – and should –do is simply be with our patients, make them comfortable. Sometimes the very best thing we can do as someone’s doctor is to sit at their bedside, take their favorite book, and read aloud.

I think it’s like Dr. Courtney M. Townsend, a legend in surgery and a personal hero, recently told me. “We have two jobs as doctors: to heal and to ease suffering. And if we can’t do the former, my God we better be doing the latter.”

Booksellers

I got a chance the other night to have dinner with some booksellers.

I’ve always loved books. I was one of those kids who begged to be left at the bookstore rather than dragged to the Sears & Roebucks next door and then fussed when it was time to leave. I like to feel a book's weight in my hands, to smell the ink on the pages, and to allow myself to be drawn in by a cover that holds infinite promise.

So for me, a person with a lifelong addiction to books, dinner with booksellers was a chance to mingle with my dealers, up close and personal.

I ended up having a wonderful time. For one, these people were great – fun, interesting, and everything you would expect from people who are devoted to books.

They were also very patient. They did not flinch for a moment when I babbled on and on about fond memories of hours spent wandering among their shelves; or when I divulged that at readings I sometimes get lost in other titles on my way to a podium; or when I told the story about driving around lost one night in a New England town with my twins wailing in the back seat because I absolutely had to get to one of their stores.

But as the dinner went on, I noticed that there was also something deeply familiar about many of them. It was not that I had met them before (I hadn’t, for the most part). Nor was it that there might have been some common friend (again, not so for the most part). Instead, it was that their stories – about running their businesses while taking care of their families – reminded me of my own past.

For a good chunk of my childhood, my parents ran small businesses. They started with a concession stand, selling trinkets; progressed to a small corner grocery store; went on to own an ice cream store; and eventually ended up in the clothing business.

With these booksellers, I found I could share more than my love of books. I could share some of my childhood memories. I recalled our family freezer, filled with tubs of ice cream remainders, flavors that never sold. There were vacations and weekends spent accompanying my father to fairs and flea markets, not because I was any huge help at age 10 but because without my presence, my father would not have been able to step away for even a minute. And there were holidays where my father and mother, working to keep their stores open, would come home exhausted to three children who would then demand some festive celebration.

So when one of the booksellers asked me, “How do you manage to do it all?” I wanted to ask all of them the same.

Now when I go to my readings, I still feel giddy walking into the stores. And I still have a tendency to get lost on the way to the podium. But these days, I also cannot help but also look in admiration at those who are hosting me.