Cutting to the Core

Medical training taught Pauline Chen to separate her emotional self from her scientific self. In writing
Medical training taught Pauline Chen to separate her emotional self from her scientific self. In writing "Final Exam," she cut through the detachment. (By Michael Williamson -- The Washington Post)
By Bob Thompson
Washington Post Staff Writer
Monday, January 29, 2007

By the time she got to her 83rd organ donor, during her fellowship in liver transplant surgery at UCLA, Pauline Chen was so accustomed to the procurement routine that she felt she could perform the operation one-handed or in her sleep.

There would be the brain-dead donor awaiting her team's arrival: heart still pumping, chest still rising and falling, hooked up to life support machinery. Chen and her colleagues would open the donor's body as if operating on a patient still fully alive. They would call for the machines to be disconnected only at the last moment, so the organs they were harvesting would be as fresh as possible.

Like most doctors, Chen, then 35, had seen a lot of death. Paradoxically, this had only reinforced the illusion of personal immortality that helps medical professionals -- and the rest of us, for that matter -- get through the days and years.

The 83rd donor shattered that illusion.

She was a 35-year-old Asian American woman who looked so much like the doctor now operating on her -- as Chen writes in her new book, "Final Exam: A Surgeon's Reflections on Mortality" -- that opening her body "felt as if I were pulling apart my own flesh."

Finishing the operation, exhausted and sleep-deprived, Chen found herself assaulted by "an unbearable, unspeakable grief" that she didn't fully understand.

Writing about it would help, but she didn't know that at the time.

Chen is over 40 now, though she doesn't look it. Slim and dark-haired, she speaks in a soft voice you sometimes have to strain to hear. Over breakfast at a restaurant in Union Station, she talks about how she came to write her book, what it did for her -- and what she hopes it can do for others.

The early word on "Final Exam," published this month by Knopf, has been favorable. Writing in the New York Times, William Grimes described it as "a series of thoughtful, moving essays on the troubled relationship between modern medical practice and the emotional events surrounding death" -- not to mention "a crash course in the specifics of human mortality."

Chen grew up in Windsor, Conn. Her parents had emigrated from Taiwan, and when she was 7, she traveled there with her mother and sister to be with her grandfather, who had a brain tumor. The family waited together during his operation, and when the surgeon came out and said "I got it all," Chen thought: Being a doctor is something I might want to do.

She has an even earlier memory, though, of wanting to learn how to write letters and words "because I had these stories that I had to write down."

At Harvard, she got hooked on medical anthropology and decided on medical school. During the long years of training that culminated in her UCLA fellowship, she wrote a little fiction and "some journal-like entries." But with time-starved interns and residents needing to grab sleep and food every chance they got -- "see a doughnut, eat a doughnut," they were advised -- writing regularly wasn't an option.


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