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Book Review: In Shock

Friday, August 2, 2019  
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Book Review: In Shock by Rana Awdish

I had been hearing rumblings about the book In Shock by Dr. Rana Awdish, for a few months, so I finally ordered it online late one night while studying for Step2. I kept thinking if I read one more textbook, my eyes might finally fall out. It was one of the few books I read for fun since starting medical school, so I was excited. The book follows the author, Dr. Rana Awdish, a pulmonologist and the medical director of the Pulmonary Hypertension Program at Henry Ford Hospital, through her pregnancy and subsequent journey as a patient. She strikes an incredible balance between being a patient and physician, while intimately commenting on physician culture and the medical system as a whole.

She is brought close to the brink of death, which provides her with a unique perspective on being a patient and imminent mortality. She feels trapped in the intensive care unit that she was so comfortable in for work. She feels trapped in a body that has betrayed her; what should have been a normal pregnancy is complicated by a near-death experience and critical illness, then subsequent recovery. Between the stories of her hospital stay, she weaves in moments of burnout she has experienced herself and watched her colleagues and classmates experience. Many of these were especially poignant. One of my favorite included a passage of stories that residents told in a debriefing session. She described the often too familiar feeling of hopelessness that comes in medicine. One that stuck with me in particular was one of a seven year old saying goodbye to his mother because she would not be able to receive a liver transplant. The seven year old asked the resident if they could make their mom well again. It was made especially heartbreaking because the resident had a child the same age. She discussed how in these situations and in these "de-briefings," people rushed to get these stories off their chest, and the group did not often respond to the stories, but they provided support through just listening. In medicine, there are few moments for these "de-briefings" or few places doing this.

She eventually becomes pregnant again; and again, she had medical woes. Her uterus was very thin from her previous pregnancy and surgery, which as the baby grew, stretched the uterus perilously thin. She was admitted to the hospital perinatal ward. There was an interesting experience where she almost fired one of the obstetricians taking care of her for a night. She explained her reasoning, and it was interesting to hear the perspective of a doctor as a patient. After her pregnancy, she has many more abdominal surgeries, and recurring medical issues related to strictures in her bile ducts. She is overwhelmed often with abdominal pain. This leads her to often miscalculate if it is time to go to the hospital or if it is time to stay at home. It brought into focus an important point: She was given more autonomy as a patient because of her position as a physician. She could advocate for herself when she did not believe her conditions were not being treated appropriately. On the other hand, a patient without medical knowledge might not be afforded this luxury. She provides a great juxtaposition of issues within the medical care. In the end, she jokes that she has had all the types of shock.

She also discusses her current life. She presents on her case as a physician and patient. She especially highlights that she could hear everything being said, when the doctors thought she was not able to, like "she's circling the drain."

I found this an incredible and emotional read. It led me to reflect on patients I had experienced and my times in the hospital. While I often felt that when looking back, I did not live up to the examples of good communication but this book gave me tools to look forward with to reassess how I handle communication with patients. There were many incredibly poignant moments in her treatment, and it is a fantastically written, easy read. I truly believe that most people should read this book. It sheds light on how we fail patients and how we fail ourselves in medicine. I will leave you with one of my favorite passages.

"We disembody doctors and expect them to somehow transcend that handicap and be present in their bodies, empathetic and connected. Physicians who have had to learn to disengage from their own emotions to function naturally divert their gaze around the emotions in the room… Because in the face of pain and suffering, pour presence alone feels puny and weak and not at all like the powerful version of ourselves we'd envisioned when we signed up to be healers of disease. Yet if we can disclose our weaknesses and even our failures, there can be forgiveness and grace. Even when we are breaking, we are already in the process of healing and coming together, healing to become stronger."

by Alyssa Brown