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.”

Comments

[Horace Jeffery Hodges]

I haven't read your book yet, but I read a very postive review in the International Herald Tribune of one of the local Korean English dailies.

But I'm only incidentally writing because of your book. I have a different reason. I knew Morse Hamilton. He was my creative writing professor when I was a freshman and sophomore at Baylor University. Because a fellow literature major from Baylor contacted me recently, I was thinking about people whom I had known there, and I thought of Morse and decided to write a blog in his memory.

In doing so, I discovered that he was your teacher ... at Phillips Exeter Academy, was it? Anyway, a comment from the Baylor student who had contacted me led me -- via Google -- to your blog.

If you're interested in a memory of Morse, see my blog entry for March 12, 2007.

Jeffery Hodges

* * *

[Horace Jeffery Hodges]

That should read:

"I read a very postive review in the International Herald Tribune OR one of the local Korean English dailies."

I need to proofread more carefully.

Jeffery Hodges

* * *

[Viola Chen]

Dear Pauline,

It was very wonderful to hear you read from your book and to listen to your experiences with mortality and medicine last Friday afternoon at UVA. I feel very fortunate to have had the opportunity of meeting you and would like to know if you would be kind enough to be my mentor. Please feel free to email me if you're interested--I promise I won't take up too much of your time.

Thank you very much for coming down to Charlottesville--your story was really inspiring.

[Tim]

Dear Dr. Chen,

Thank you for having the courage and drive to write your book. As a layperson, it was simply inspiring to read. I'm going to suggest that our G.P. read it if he has not already done so.

As neither a literary critic nor medical professional, I can offer only some impression as a general reader for whatever they may be worth. Your skill as a writer also reflects your skill as a surgeon. About 3/4 through the book, it occurred how your advocacy for a more epathic approach to curative and palliative care was deftly interwoven with compelling patient anecdotes, all honestly cast within the larger framework of personal biography.

All the best.

Tim Baker

[Randy Susan Meyers]

Dear Dr. Chen,

Thank you for your book. I picked it up as a writer, for research, and it helped me understand the experience of being a doctor far deeper than any memoir I have read before. On a personal level, I read your book only a month after losing my mother and father-in-law. Your book, your writing of your experiences, helped me come to peace in a manner unlike any other books or conversations I have had since these deaths. Your ability to place death smack in the middle of the (obvious) cycle of life allowed me to begin letting go of residual guilt. Your honesty as a doctor helped me to understand (and perhaps even forgive) the doctors who were unhelpful and hurtful, those who avoided our questions during the week my family and I spent in a Neuro-ICU. We impart god-like qualities onto our doctors and then forget they have the same discomfort (perhaps more considering the work they must do for us) with death, as do we. Again, thank you for writing this book. You did a magnificent job. Randy Susan Meyers

[Nicole Kangas]

Dear Dr. Chen,
I just wanted to say how much I liked your book. I am not a doctor, but the daughter of one, and I find it hard to express how much the book helped me to understand my father. He's not much of a talker, and this felt like insight.
Not only that, but I have struggled for the last few years with the guilt that I should've followed in my father's footsteps and this actually helped me to sort some of that out. Not resolve it, but at least narrow down some of my reasons why and why not.

[Joseph J. Neuschatz M.D.]

Dear Dr. Chen,

Even the word TERROR ends in OR.

May I send you "terrO.R." for possible review ?

I sincerely hope my novel is fiction.

BEST,

JJN

[Yi Liu]

Doctor JJN's comment was confusing on first sight. This is what he means:

http://www.google.com/search?source=ig&hl=en&q=ISBN-10%3A+160145015X&btnG=Google+Search