Cutting to the Core

A year or so after encountering her 83rd organ donor, Chen finished her training and finally had a bit of time for herself. She signed up for a couple of writing classes. Fictional variations on her medical experiences poured forth.

One day, one of her writing teachers asked to talk with her. The teacher had seen that there was something Chen needed to get out, something to do with the human reactions to death and dying that doctors learn to suppress -- and she thought it would work best in nonfiction form.

"Pauline, you have to write these stories," she said.

So Chen wrote them: draft after draft, story after story. Too often, she felt "like I was just skimming on the surface." What she needed to confront came down to a single painful question: "Why do you keep thinking about these people?"

Why did she keep thinking about the elderly couple she calls Juliette and Joseph -- most names in her book have been changed for privacy reasons -- whom she'd met while in medical school at Northwestern? Juliette had checked into the hospital with pneumonia. As it became more certain that she would never leave, Chen noticed, the doctors supervising her care began to ignore her.

She also noticed how relieved she felt that it wasn't her job to tell Joseph his wife was dying.

Why did she keep thinking about Bobby, the patient with whom she'd promised to discuss the options for end-of-life care, and about the tearful, angry nurse who told her what her failure to do so had meant?

"He was dying, Pauline. He had cancer everywhere," the nurse said. But instead of sending him home or even just leaving him in peace, doctors "poked him and prodded him and thumped on his chest." She poked Chen's own chest for emphasis as she spoke. "That is how Bobby died."

And what about her earliest intimate confrontation with death -- the one for which she and her fellow medical students had been so thoroughly unprepared?

Dissecting a human body taught her "the concise and efficient beauty of human anatomy, the pleasure of using my hands as an extension of my mind," Chen writes. It helped her decide to be a surgeon. Yet this initiation rite also served a more problematic function.

It taught her and her peers to separate their emotional selves from their scientific selves. They learned to suppress their fear of death by viewing "this dead human body not as 'one of us' but as 'one of them.' "

It wasn't easy. Chen recalls one student who dealt with his dissection anxiety by launching into an elaborate air guitar routine at the beginning of each session. It didn't work and he soon dropped out of school. She herself balked at using an electric saw on her cadaver's pelvis. The student who ended up wielding the saw stayed silent the rest of the afternoon.