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Closing the Chart: A Dying Physician Examines Family, Faith, and Medicine
Dr. Steven D. Hsi, a family physician and father of two young sons, was diagnosed in 1995 with a rare coronary disease that caused his death five years later at the age of forty-four. Throughout his ordeals as a patient, including three open-heart surgeries, Dr. Hsi's outlook on the teaching and practice of medicine changed.
In 1997 he began a journal intended for publication after his death. Written with the assistance of newspaper columnist Jim Belshaw and completed posthumously by Hsi's widow, Beth Corbin-Hsi, Dr. Hsi's writings urge his colleagues to become healers, to look at their patients as human beings with spiritual as well as physical lives.
In 1997 he began a journal intended for publication after his death. Written with the assistance of newspaper columnist Jim Belshaw and completed posthumously by Hsi's widow, Beth Corbin-Hsi, Dr. Hsi's writings urge his colleagues to become healers, to look at their patients as human beings with spiritual as well as physical lives.
- GenresMedicine
222 pages, Hardcover
First published January 1, 2004
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Displaying 1 - 19 of 19 reviews
August 16, 2022
“There is a place in our busy lives for what can be learned from spending a little time with a dying patient…. Sick people open a window into their lives and sometimes their souls. Most doctors slam the window shut as quickly as possible. I wish they would not.”
This book was given to me and all of my medical school classmates before we started clinical care in our third year. It was part of a presentation from the author’s widow and brother, the latter of whom would become a cherished professor of my pediatric residency. Unfortunately, I received it at a point when I did not have (or make) time to read anything that was not directly related to medicine. That period lasted for several more years, through the end of my residency. I recently redescovered it, tucked on a bookcase where I keep my medical texts. I decided it was high time, 15 years later, to read it. The story is profoundly moving. It has taught me that, in spite of my pride at practicing medicine in the “kinder, gentler“ vein I was trained in, I can still learn from other people’s experiences with illness and medical care, and improve my value to my patients and their families if I remain willing and open to forming a basic human connection.
This book was given to me and all of my medical school classmates before we started clinical care in our third year. It was part of a presentation from the author’s widow and brother, the latter of whom would become a cherished professor of my pediatric residency. Unfortunately, I received it at a point when I did not have (or make) time to read anything that was not directly related to medicine. That period lasted for several more years, through the end of my residency. I recently redescovered it, tucked on a bookcase where I keep my medical texts. I decided it was high time, 15 years later, to read it. The story is profoundly moving. It has taught me that, in spite of my pride at practicing medicine in the “kinder, gentler“ vein I was trained in, I can still learn from other people’s experiences with illness and medical care, and improve my value to my patients and their families if I remain willing and open to forming a basic human connection.
October 12, 2020
Dr. Hsi wrote this book (along with Belshaw and Corbin-Hsi) for a specific reason - to share his experience as a patient in a way that might affect change among the medical community.
Therefore, the writing points to very specific details of his time in hospitals, traveling for procedures, in exams, etc. He also adds in the emotional toll - often very candidly - his health crisis had on his marriage, on his children, and on his own psyche.
I do not work in the medical community. I found the book helpful to understanding the patient in the center of a chronic and deteriorating condition, what his thoughts were, where he directed his fears, and his frustrations at his own body.
He was clearly a bright and thoughtful person, and this comes through in his writing as well as in his message.
Therefore, the writing points to very specific details of his time in hospitals, traveling for procedures, in exams, etc. He also adds in the emotional toll - often very candidly - his health crisis had on his marriage, on his children, and on his own psyche.
I do not work in the medical community. I found the book helpful to understanding the patient in the center of a chronic and deteriorating condition, what his thoughts were, where he directed his fears, and his frustrations at his own body.
He was clearly a bright and thoughtful person, and this comes through in his writing as well as in his message.
Read
February 7, 2017Great Book - relevant to each of us, as everyone is a patient.
Humanity and interpersonal communication seem to be the theme of this book, especially for the purposes of health communication.
Dr. His uses his own cardio illness to review the medical profession’s attitude toward patients, and in this case, the way it communicates or doesn’t communicate with them. He does this as an insider now on the outside, but with some pull, “I am a physician, I understand the language spoken by physicians,… (p.89).”
As a medical professional, he learned to treat the disease and not that patient, as “[their] time was much too valuable to be spent bantering with patients,” [p.6], noting that “[n]o doctors asked the questions that needed to be asked: What has this disease done to your life?” [p.6-7].
He noted the “indifference (p.87) that young doctors have toward discussing matters of substance – treatments and outcomes – with the patient, even though it is in the Medical Center’s patient bill of rights or manifesto (p.182).
Upon requesting to speak to the surgeon prior to signing the consent for his second surgery, the response by the chief resident was one of anger and then indifference, “‘Okay,’ he said in a way that made it clear this part of the conversation was over as far as he was concerned (p100).”
One of the communicative means of control and distance physicians keep over and from patients is by naming diseases. The naming gives control to both sides, doctor and patient, as Dr. Hsi noted on p. 19, “If nothing else, identifying [my symptoms – aortic regurgitation] gave me some degree of control.”
Doctors, he noted on p. 72, for example, do not treating those they cannot name, “my cardiologist said doctors who don’t understand something tend to blame the patient for the symptoms. He said he found it common for the physicians to simply think the patient was wrong.”
Furthermore, they blame the patient if they cannot identify a disease responsible for symptoms, “‘We don’t have a problem,’ they tell the patient. ‘You have a problem. We’ve done all the tests. We can’t find anything wrong.’”
He notes that identifying things with lingo permeates through to nurses and even patient advocates, “in terms of efficiency and precision, an argument can be made for the use of jargon in any field, but efficiency is not improved when used as a device to cancel our the ‘bother’ of treating patients as whole human beings rather than a disparate collection of broken parts (p.104).”
To the cardio-thoracic surgeon known as “God,” “I was a valve,” Hsi noted. “But once the surgery was over, it seemed ‘God’ had moved on to the next case (p.134).”
He did find a doctor there, the cardiologist, who examined him prior to his departure from the Medical Center after his second surgery. “”[She was] everything a patient could ask for in a doctor. She asked questions: How are you doing? How is your family? What has this done to you?”
A corollary to the hierarchy of medical professionals is that the lower on the totem pole, the more the staff person connects with the patient.
• “[W]e remained mute in the presence of the physician (p.46).”
• The cardio-thoracic surgeon known as “God” “…showed little interest in nay of the events that led up to my arrival at the Medical Center… (p.105).”
• At the time of his second surgery with “God,” the cardio-thoracic surgeon ‘s “…demeanor was markedly different from the first surgery, when he caem into [Hsi’s] room and delivered a canned performance made memorable only by its rote, mechanical nature. When he left the room this time, [Hsi] was struck at how these few minutes of communication changed everything for me, the patient. My mood was elevated, I was elated (p.180).”
• During the visit to his hospital room by two cardiologists just prior to his third surgery, “[N]either cardiologist spoke to [his wife, a surgical nurse], neither acknowledged her, neither so much as introduced himself to her.”
• When Hsi was having trouble breathing while intubated after the second surgery, his wife practically was disdained by the doctors. “…Beth knew why. She gently made a suggestion. The two surgery residents not so gently blew her off (p.181).”
• “Nurses work hard to empathize with the patients (p. 33).”
• “When the patient census is low, nurses get to do what they went into nursing to do – comfort and care for the sick. They have the time to answer anxious questions and explain what they are doing (p.88).”
• “I once spoke to medical students who argued that the physician shouldn’t get too close to the patient. They had heard this in some vague place, spoken by some vague person (p.74).”
Dr. Hsi changed his manner of working as a physician, as a result of being a patient.
• “I don’t believe doctors talk to patients about [the patient having no control over anything] (p.33)”
• “I swore to never again take lightly a patient’s complaint about side effects (p. 20).”
• “Our [his physician brother’s and his] conversation eventually changed the way I practiced medicine. For the first time in my life, I had let my guard down. I had talked openly of vulnerability and weakness and fear (p.43).”
• “It remains remarkable to me that no healthcare provider ever asked how we were coping with the burden imposed by the complicated care I required (p.64).”
Humanity and interpersonal communication seem to be the theme of this book, especially for the purposes of health communication.
Dr. His uses his own cardio illness to review the medical profession’s attitude toward patients, and in this case, the way it communicates or doesn’t communicate with them. He does this as an insider now on the outside, but with some pull, “I am a physician, I understand the language spoken by physicians,… (p.89).”
As a medical professional, he learned to treat the disease and not that patient, as “[their] time was much too valuable to be spent bantering with patients,” [p.6], noting that “[n]o doctors asked the questions that needed to be asked: What has this disease done to your life?” [p.6-7].
He noted the “indifference (p.87) that young doctors have toward discussing matters of substance – treatments and outcomes – with the patient, even though it is in the Medical Center’s patient bill of rights or manifesto (p.182).
Upon requesting to speak to the surgeon prior to signing the consent for his second surgery, the response by the chief resident was one of anger and then indifference, “‘Okay,’ he said in a way that made it clear this part of the conversation was over as far as he was concerned (p100).”
One of the communicative means of control and distance physicians keep over and from patients is by naming diseases. The naming gives control to both sides, doctor and patient, as Dr. Hsi noted on p. 19, “If nothing else, identifying [my symptoms – aortic regurgitation] gave me some degree of control.”
Doctors, he noted on p. 72, for example, do not treating those they cannot name, “my cardiologist said doctors who don’t understand something tend to blame the patient for the symptoms. He said he found it common for the physicians to simply think the patient was wrong.”
Furthermore, they blame the patient if they cannot identify a disease responsible for symptoms, “‘We don’t have a problem,’ they tell the patient. ‘You have a problem. We’ve done all the tests. We can’t find anything wrong.’”
He notes that identifying things with lingo permeates through to nurses and even patient advocates, “in terms of efficiency and precision, an argument can be made for the use of jargon in any field, but efficiency is not improved when used as a device to cancel our the ‘bother’ of treating patients as whole human beings rather than a disparate collection of broken parts (p.104).”
To the cardio-thoracic surgeon known as “God,” “I was a valve,” Hsi noted. “But once the surgery was over, it seemed ‘God’ had moved on to the next case (p.134).”
He did find a doctor there, the cardiologist, who examined him prior to his departure from the Medical Center after his second surgery. “”[She was] everything a patient could ask for in a doctor. She asked questions: How are you doing? How is your family? What has this done to you?”
A corollary to the hierarchy of medical professionals is that the lower on the totem pole, the more the staff person connects with the patient.
• “[W]e remained mute in the presence of the physician (p.46).”
• The cardio-thoracic surgeon known as “God” “…showed little interest in nay of the events that led up to my arrival at the Medical Center… (p.105).”
• At the time of his second surgery with “God,” the cardio-thoracic surgeon ‘s “…demeanor was markedly different from the first surgery, when he caem into [Hsi’s] room and delivered a canned performance made memorable only by its rote, mechanical nature. When he left the room this time, [Hsi] was struck at how these few minutes of communication changed everything for me, the patient. My mood was elevated, I was elated (p.180).”
• During the visit to his hospital room by two cardiologists just prior to his third surgery, “[N]either cardiologist spoke to [his wife, a surgical nurse], neither acknowledged her, neither so much as introduced himself to her.”
• When Hsi was having trouble breathing while intubated after the second surgery, his wife practically was disdained by the doctors. “…Beth knew why. She gently made a suggestion. The two surgery residents not so gently blew her off (p.181).”
• “Nurses work hard to empathize with the patients (p. 33).”
• “When the patient census is low, nurses get to do what they went into nursing to do – comfort and care for the sick. They have the time to answer anxious questions and explain what they are doing (p.88).”
• “I once spoke to medical students who argued that the physician shouldn’t get too close to the patient. They had heard this in some vague place, spoken by some vague person (p.74).”
Dr. Hsi changed his manner of working as a physician, as a result of being a patient.
• “I don’t believe doctors talk to patients about [the patient having no control over anything] (p.33)”
• “I swore to never again take lightly a patient’s complaint about side effects (p. 20).”
• “Our [his physician brother’s and his] conversation eventually changed the way I practiced medicine. For the first time in my life, I had let my guard down. I had talked openly of vulnerability and weakness and fear (p.43).”
• “It remains remarkable to me that no healthcare provider ever asked how we were coping with the burden imposed by the complicated care I required (p.64).”
April 21, 2025
I knew the Hsi family when they lived in Clovis, NM and I read the obituary of his mother who lived to be 95 years old. His mother was my math tutor in the Ninth grade. I had not known what had happened to the family as I left Clovis years ago but I read that he had written a book about his experiences as a doctor dealing with a chronic heart disease and facing death as his heart failed. An honest depiction of dying slowly while living and how life changed as he became weaker physically but his faith increased as he drew nearer to death - a whole life experience in the realms of medical care.
March 21, 2020
This book was very sad. But it was interesting to hear about being diagnosed with a terminal disease and how the disease progressed from a physician perspective. I was especially struck by the time he traveled for a procedure and didn't feel like he could ask the operating physician any questions. I see this every day that I work as a bedside nurse. I try to improve communication between my patient and physicians after hearing from Dr. Hsi's experience as both.
May 30, 2017
Excellent book. All healthcare providers should read. A humbling account of how even the most educated and plugged in medical folks can be rendered helpless and uninformed by health necessities, ego, and the Medical Machine,.
February 21, 2019
This is difficult to read for it’s heartbreaking content, but it’s very interesting and goes quickly. I appreciate books that give you a glimpse into the places you never want to be, and leave you feeling grateful for the little things.
September 10, 2021
Medical services that can go wrong and do harm. A doctor's experience.
July 27, 2024
Ugly cried
August 6, 2024
Such a touching story
September 5, 2010
Dr. Steven Hsi is a family practice doctor in Albuquerque, who is in excellent physical condition and has a happy life, with a successful clinical practice, a loving wife and two beautiful sons. He ignores subtle (and not so subtle) signs of his impending illness, which he attributes to middle age and lack of conditioning, and his sense of invincibility, a trait shared by far too many doctors, keeps him from taking his symptoms seriously. After an episode of severe chest pain his wife, an ICU nurse, listens to his heart and hears a new murmur, which Hsi also hears and can no longer ignore. On that day he is transformed from a healthy adult to a seriously ill patient, a change that is difficult for the average person but seemingly more difficult for Hsi, a fiercely independent doctor who is almost always in charge at work and, to a lesser extent, at home.
Hsi poignantly relates his experiences as a patient and what this illness does to himself, his sense of well being, and his family. He undergoes three major cardiac surgeries, nearly dies on several occasions due to medical mistakes, and experiences medical care that is sometimes caring but more often indifferent and even hostile. However, his faith in God is strengthened throughout the ordeal, as the members of his church, his family, and his loving and dedicated wife provide the support that the medical community fails to give him.
Unfortunately, Dr. Hsi becomes progressively sicker, and died suddenly but not surprisingly at the age of 44, on his way home to celebrate his son's 11th birthday.
Closing the Chart is an insightful look at the failure of the American healthcare system to provide adequate medical care and spiritual support for seriously ill patients and their families. Hsi provides valuable lessons for doctors, nurses and other healthcare professionals to provide better care for their sickest patients, and to families who must take on the burden of caring for a sick family member. However, this was a very depressing and disturbing story, and I was deeply saddened after reading it, despite knowing that the book was written posthumously, so I would recommend it only guardedly.
Hsi poignantly relates his experiences as a patient and what this illness does to himself, his sense of well being, and his family. He undergoes three major cardiac surgeries, nearly dies on several occasions due to medical mistakes, and experiences medical care that is sometimes caring but more often indifferent and even hostile. However, his faith in God is strengthened throughout the ordeal, as the members of his church, his family, and his loving and dedicated wife provide the support that the medical community fails to give him.
Unfortunately, Dr. Hsi becomes progressively sicker, and died suddenly but not surprisingly at the age of 44, on his way home to celebrate his son's 11th birthday.
Closing the Chart is an insightful look at the failure of the American healthcare system to provide adequate medical care and spiritual support for seriously ill patients and their families. Hsi provides valuable lessons for doctors, nurses and other healthcare professionals to provide better care for their sickest patients, and to families who must take on the burden of caring for a sick family member. However, this was a very depressing and disturbing story, and I was deeply saddened after reading it, despite knowing that the book was written posthumously, so I would recommend it only guardedly.
February 23, 2014
Part autobiography, pathography and biography, this book touches on some of the short-comings of modern medicine...failure to recognize the person and not just the disease. Though it was written in the 90s, unfortunately, not that much has changed. Quotes:
"The simple truth of the matter is that we cannot separate the patient from his environment. The patient's world and his illness are woven together. Hw we respond to the threads that make up a patient's life affects recovery. We need to ask about family; we need to include loved ones in discussions about care. When we walkd into an examining room or a hospital room, we need to be awre that in all likelihood, the patient will not be asking questions, no matter how diligent we may think we have been in encouraging it."
"Healing, especially after a life-threatening crisis, is more than simply dealing witht he physical aspect of trying to get something fixed and getting on with it. It deals witht he whole meaning of life and what happens at death or when one is dying. It deals with spirituality, the psychological turmoil, the relatioinships you have with friends and family."
"Physicians erect great barriers to appear less vulnerable and it prevents us from reaching our own spiritual selves. The idea of humanity is very much tied in with vulnerability. To be truly human, to be part of the community, we have to recognize our helplessness in a lot of things and our dependence on other things and other people."
"Steve often spoke of the difference between a physician and a healer. He felt strongly that healers had to be part of the community they served, no isolated from it, regardless of who erected the barriers, patients or doctors themselves. He believed a healer had to deal with all of the patient's life-family, spiritual, medical."
I will be recommending this book to students and residents.
"The simple truth of the matter is that we cannot separate the patient from his environment. The patient's world and his illness are woven together. Hw we respond to the threads that make up a patient's life affects recovery. We need to ask about family; we need to include loved ones in discussions about care. When we walkd into an examining room or a hospital room, we need to be awre that in all likelihood, the patient will not be asking questions, no matter how diligent we may think we have been in encouraging it."
"Healing, especially after a life-threatening crisis, is more than simply dealing witht he physical aspect of trying to get something fixed and getting on with it. It deals witht he whole meaning of life and what happens at death or when one is dying. It deals with spirituality, the psychological turmoil, the relatioinships you have with friends and family."
"Physicians erect great barriers to appear less vulnerable and it prevents us from reaching our own spiritual selves. The idea of humanity is very much tied in with vulnerability. To be truly human, to be part of the community, we have to recognize our helplessness in a lot of things and our dependence on other things and other people."
"Steve often spoke of the difference between a physician and a healer. He felt strongly that healers had to be part of the community they served, no isolated from it, regardless of who erected the barriers, patients or doctors themselves. He believed a healer had to deal with all of the patient's life-family, spiritual, medical."
I will be recommending this book to students and residents.
February 18, 2018
A deeply intimate series of confessions from a physician whose fatal illness changes how he views his role with his patients. I wish they made us read more of these books in medical school and somehow could test us on the things that matter to patients and their families, many of the psychosocial and spiritual issues.
Instead I can only supplement my education in my personal time, on top of the 14+ hours a day spent memorizing medical school science material. I hope that neither me nor my colleagues will have to go through what this doctor did in facing death to realize how they can best serve their patients and meet them at their deepest needs rather than just viewing patients as an organ to be fixed or a disease to be treated. We have such an honorable opportunity to truly help patients and make a difference in their lives at the most vulnerable moments in their lives, but I worry that our training and the culture of medicine will make us miss the point, and turn us away from the people and doctors we wished to be.
Instead I can only supplement my education in my personal time, on top of the 14+ hours a day spent memorizing medical school science material. I hope that neither me nor my colleagues will have to go through what this doctor did in facing death to realize how they can best serve their patients and meet them at their deepest needs rather than just viewing patients as an organ to be fixed or a disease to be treated. We have such an honorable opportunity to truly help patients and make a difference in their lives at the most vulnerable moments in their lives, but I worry that our training and the culture of medicine will make us miss the point, and turn us away from the people and doctors we wished to be.
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August 7, 2011This one was hard for me to read. It's by a friend and fellow Family Physician who died in 1999 at 44 years old. Steve talks about his illness, his faith and his family. He talks about being a patient and having to give up control. He talks about the support of his church group and his family and the good, the bad, and the ugly of medical care at the end of the 20th century. It all hits way to close to home and I found myself in tears through a lot of the book. It is based on his diary entries and was edited by his wife and a journalist-friend Jim Belshaw
April 16, 2008
Pretty typical fare for the "physican discovers his humanity". Although heartwrenching for his family and friends, I've heard this story before and wonder why each physician has to re-invent this wheel.
August 30, 2009
I have my first year BSN students read this book for our book discussion. There are so many relevant and profound themes for those of us who provide care for others. Medical treatment or nursing care without humanity is deeply flawed. Caring for the soul is a basic need.
June 29, 2013
Recommended to me by a friend who knew Dr. Hsi; a must read for anyone who is struggling great book and very poignant.
July 5, 2014
Moving memoir. In college I had the privilege to meet the author's widow and her story has always stuck with me.
June 27, 2008
Currently half way through this thought provoking book.
Displaying 1 - 19 of 19 reviews