In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope

by Rana Awdish

Dr. Rana Awdish never imagined that an emergency trip to the hospital would result in hemorrhaging nearly all of her blood volume and losing her unborn first child. But after first visit, Dr. Awdish spent months fighting for her life, enduring consecutive major surgeries and experiencing multiple overlapping organ failures. At each step of the recovery process, Awdish was faced with something even more unexpected: repeated cavalier behavior from her fellow physicians—indifference following human loss, disregard for anguish and suffering, and an exacting emotional distance.

Hauntingly perceptive and beautifully written, In Shock allows the reader to transform alongside Awidsh and watch what she discovers in our carefully-cultivated, yet often misguided, standard of care. Awdish comes to understand the fatal flaws in her profession and in her own past actions as a physician while achieving, through unflinching presence, a crystalline vision of a new and better possibility for us all.

As Dr. Awdish finds herself up against the same self-protective partitions she was trained to construct as a medical student and physician, she artfully illuminates the dysfunction of disconnection. Shatteringly personal, and yet wholly universal, she offers a brave roadmap for anyone navigating illness while presenting physicians with a new paradigm and rationale for embracing the emotional bond between doctor and patient.

Genres: Medicine, Nonfiction, Medical, Memoir, Health, Biography, Science

265 pages, ebook

First published October 24, 2017

About the author

Dr. Rana Awdish is the author of In Shock, a landmark medical memoir and the follow-up, After Shock. A sought-after public speaker, she is recognized as a leading voice in the movement to rehumanize healthcare. Her writing has appeared in The New England Journal of Medicine, JAMA, Harvard Business Review, and The Washington Post. Her essay The Shape of the Shore was awarded a Sydney by The New York Times and nominated for a Pushcart Prize. Her work has been featured on NPR, BBC, and CNN.

In 2020, This American Life documented Detroit’s experience of the COVID-19 pandemic in an episode titled “The Reprieve,” using Dr. Awdish’s audio diary chronicling the frontline experiences of Henry Ford Hospital clinicians.

Dr. Awdish has received numerous national honors, including the Schwartz Center’s National Compassionate Caregiver of the Year Award, U.S. News & World Report’s Healthcare Hero distinction, and Press Ganey’s Physician of the Year Award. She has been inducted into the Alpha Omega Alpha Medical Honor Society, the Gold Humanism Honor Society, and named a Master of the American College of Physicians.

She serves as Clinical Professor of Medicine at Wayne State University School of Medicine and at Michigan State University College of Human Medicine. A board-certified physician in Internal Medicine, Pulmonary, and Critical Care Medicine, her clinical focus is Pulmonary Hypertension. Dr. Awdish completed her medical training at Mount Sinai Beth Israel in Manhattan, earned her M.D. from Wayne State University, and her undergraduate degree from the University of Michigan in Ann Arbor.

Reviews

[ReadAlongWithSue ★⋆. ࿐࿔catching up · Rating 4 out of 5]

This was an unexpected book that landed on my doorstep from the publisher.
I had no idea of this book, no idea it was arriving so an unsolicited copy for me to read.


I thought I’d pick this up over the weekend and flick through it. But I ended up reading this from cover to cover.

A doctor who ends up being a patient.

Let me copy and paste what developed in this doctors young body.

Quote

HELLP syndrome is a complication of pregnancy characterized by hemolysis, elevated liver enzymes, and a low platelet count. It usually begins during the last three months of pregnancy or shortly after childbirth.

Unquote

There is without an ounce of a doubt that this woman went through hell and back, even after she recovered.
Loosing her baby daughter was something she needed to come to terms with, but she herself was so unwell.

During that time she recognised that it’s not just medically treating a patient. Filling in forms.
It’s support. It’s communication.

Everything in life comes down to communication.

Although this isn’t the UK health practice, it’s the same. They don’t seem to have the time to stand around and chat, to make conversation, to explain things, to emotionally be aware ...as this person found out....to treat the WHOLE person not just the symptoms.

A very well put together memoir. Which normally I don’t read. But it did leave an impact. One word.

Communication
Secound word to add, compassion.

[Lane Patten · Rating 5 out of 5]

As a physician, this is the perfect reminder that what seems routine to us, is someone's very worst day. And we have the power to connect and offer more than just modern medicine. Another reminder of how important words are, and Dr. Awdish's words are amazing-powerful and haunting at the same time. This should be required reading in medical school!

[Rebecca Fernea · Rating 2 out of 5]

Well I really wish reviewers would stop saying “a must read for those in the medical field.” I have been an ICU nurse for almost 15 years. The majority of nurses already have the compassion that lots of doctors lack. Often we pick up the pieces after the doctor delivers devastating news. We interpret medical jargon into layman’s terms after the doctor leaves the room. The list goes on and on.

I found the book rather lacking. It felt repetitive in that she tells readers the same message over and over. While her story is a tragic one, it could have been presented differently. Too much jumping around. Tell me your story and then go back and give the details.

Not one who leaves a book unfinished, but started to on several occasions.

Wouldn’t recommend this book.

[Rebecca · Rating 4 out of 5]

The doctor became the patient when Awdish, seven months pregnant, was rushed into emergency surgery with excruciating pain due to severe hemorrhaging into the space around her liver. Initially diagnosed as HELLP, an often fatal liver syndrome that affects 1% of pregnant woman, her condition was later explained by a ruptured liver tumor. Her unborn daughter didn’t survive, and she nearly died herself. It was as if she was hovering in the upper corner of the operating room, watching her body being worked on, hearing colleagues yell things she’d uttered without a thought so many times: things like “she’s been trying to die on us,” “she’s circling the drain here,” “we’re losing her.”

Over the years of her recovery, which involved multiple further procedures as she tried to get well enough to bear another child, Awdish’s whole perspective on medical care changed. Having experienced brusque, cursory treatment, even from colleagues at her Detroit-area hospital, she was convinced that doctors needed to do better, to truly listen to their patients’ stories and fears – not so they could fill out the necessary forms and move on, but so that their decisions could be “built on empathy and a patient-centered narrative.” Trust and honesty are more important than efficiency, she argues. This memoir is a gripping story of her own medical journey and a fervent plea for compassion from medical professionals.

[Alex Wilson · Rating 2 out of 5]

As a 4th year medical student, I found most of the observations and advice in this book to be helpful, but they were restated to death and the message began to wear thin and verged on being excessively preachy. I found myself scanning the page when she got on her pedestal and repeated her advice ad nauseam.

I also found a fair bit of the advice to be impractical at times. Given the time pressure of our career choice, it’s hard to tell someone to just spend more time with patients when there is pressure from every side to be efficient. I would’ve appreciated more insight around how to change the system and not just ourselves.

Furthermore, I found that I disliked the author, especially as she criticized everyone around her and only occasionally looked back on how she behaved. Specifically, she told a doctor his tie was childish and seemed to take pride when he came back the next day with a different tie. She also berated a young obstetrician for trying to quickly meet her before surgery before looking at her scans, antagonizing him so quickly, and eventually requesting that he not be involved in her surgery by going to the attending. I can just imagine the attending telling the resident he can’t be in on the surgery and apologizing on behalf of this uptight and antagonistic patient of his who seems to have forgotten what it’s like to be a doctor.

Dr. Awdish is good at writing individual sentences that capture a feeling, but I would say it’s a stretch to call her a good writer. The book mentions early on that she is able to give birth to a child after her initial illness, ruining any sort of tension that could’ve existed when she later describes what it was like to have this child. She also gave away the bit about the tumors in her liver far too quickly. She also bounces around in time, which is a perfectly fine way to write when done correctly, but she manages to make it disorienting with no obvious reason for doing so. It was also unclear why she had a placental abruption if all of this was caused by vascular tumors in her liver. Parts of this book just left me confused.

I gave it two stars, the second star only because I think the overall message is important even if redundant, and because she has a knack for describing feelings with effective metaphors.

[Nadia · Rating 5 out of 5]

"It's a difficult thing to know that much of the suffering we witness will in some way touch us as will. All of the illness and dependency and death. But it seemed to me in retrospect that the anchors intended to moor us had actually pulled us under."

Am I partial to books written by physicians? Maybe.

But Dr Rana Awdish writes with the clarity that comes from being on the far edge of the cliff, the point from which few return. This book is full of wisdom and resilience and humanity.

I hope medical training evolves to include teaching how not to be pulled under, how to see beyond the beeping and whirring of machines, how to be the doctor we all will one day need when we're (inevitably) on the other side of the curtain.

[chichi]

This was another required book for school, and I'm so grateful this was assigned. There is a lot broken in the American healthcare system on a structural level and it would take way too long to outline that here. But as someone who intends on working in healthcare, experiencing a story that confronts the emotional gaps of our current system really resonated with me. I've seen and heard of many physicians who come into medicine with wide eyed dreams of saving lives and are then ground down by the way training and for-profit healthcare and countless other factors don't hold space for emotional vulnerability. And even while being empathetic towards that circumstance, I especially appreciated that this book did not absolve physicians, trainees, and other healthcare providers of the harm they've committed to patients. It was just overall very nuanced and written with a lot of compassion. Lastly, I really want to acknowledge the author's vulnerability in telling her story and including as much detail as she did. There was a lot of pain and near-death experiences in here, so I am grateful that she is still here to share this part of her life.

I think this book was a great addition to the beginning of my journey into healthcare, and I'll be thinking about it for a long time.

[Frosty61 · Rating 4 out of 5]

This author's journey begins when she becomes a critically ill patient and gains a new perspective on how doctors are trained to do their jobs and the flaws in that education. The story is very readable despite the many medical terms and procedures described. The author's experiences are harrowing, but she describes them clearly, sometimes with humor and usually with words that a non-medical person can understand.
How I wish more doctors would figure out what she figured out after she almost died - we all need compassion, empathy, and understanding; patients are people not just case numbers and diseases; doctors need to listen to their patients without judgement and put their egos aside in order to provide the best care possible. Kindness, communication and support can go a long way in helping patients on the road to healing and recovery and I applaud this author for her efforts to showcase these ideas.

[Jackie · Rating 5 out of 5]

This book has truly changed my practice as a nurse. I take the time to sit down introduce myself and actively listen without interrupting. In a busy emergency room, this easy task can be challenging. However, I leave work with energy instead of physically and emotionally exhausted. When I leave for the day I feel I have really made a difference because I took the time to listen and address their biggest fears. Thank you for your insight and sharing your experiences! It has made me a more compassionate nurse!

[Jeanne · Rating 4 out of 5]

Medicine cannot heal in a vacuum; it requires connection (p. 3).

There is something powerful about seeing a situation from a very different perspective than has been habitual – as Rana Awdish does in In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope. Having been ill is not enough to ensure empathy – as it could easily lead to being triggered by illness or feeling superior or any of a number of things – but it can be helpful. (Lemonade from lemons and all that.)

My guess is that Awdish was a sensitive and empathic physician even before her almost fatal illness. Nonetheless, her experience of being severely ill for eight years further sensitized her, as she heard physicians and nurses say things to her that were far from compassionate:

She’s circling the drain.
She’s been trying to die on us.
That was a really bad night for me.
Your kidneys aren’t cooperating.
It wasn’t my call.
You should hold the baby. I don’t mean to get graphic, but after a few days in the morgue their skin starts to break down.
At least you didn’t die.
How much pain medication do you take at home?
Are you sure your pain is an 8? I just gave you morphine an hour ago.
Maybe you’re just anxious. (p. 242)

I'm sure that you have your own stories. A neurologist told our family was told that my brother would likely be a vegetable after he was hit by a truck (he has since earned two masters degree). My parents told us that was just what you had to do to survive as a neurologist (it shouldn't have been their job to take care of and excuse this neurologist).

In Shock is a compassionate, insightful, and thoughtful read. I particularly liked the ways that Awdish turned the table on her initial analysis of some early reactions. While she firmly believes that one should comfort an ill patient and dump bad feelings elsewhere, she came to understand the ways that the medical establishment shuts down physicians' ability to feel – to feel hunger and fatigue or frustration and grief. The doctor's feelings that "that was a really bad night for me" weren't the problem – they are at the heart of being human and at the heart of being a human physician – but where and how he expressed them. (Please. Don't make your patients comfort you.)

In Shock ends with communication tips for both medical staff and patients. Much of this section is pretty straightforward – but these are things that all should remember. Physicians should "take their temperature" before they visit a patient: what emotions are they bringing into the room? Are they hangry, tired, or distracted? Similarly, a patient should prep for a doctor's visit by bringing support, making a list of questions, and keeping a journal tracking symptoms, their natures, and when they are better or worse. These are just the beginning of her list. This chapter – or some version of this chapter – should be shared with all new patients – and new physicians.

The Spirit Catches You and You Fall Down, The Immortal Life of Henrietta Lacks, and In Shock should be required reading of all people in the medical field. From diverse perspectives, these three books remind us of the humanity needed to be an effective healer.

[Elizabeth Kitley · Rating 3 out of 5]

This was obviously written by a very intelligent individual. I especially liked the anecdotes and personal experiences that Dr. Awdish included. Her story is amazing.

However, a large percentage of this book is basically communication advice to physicians. Some of this felt useful and applicable to me, but a lot of it I found boring. It just wasn’t always for me and that’s okay.

[Laura · Rating 5 out of 5]

This was a beautifully poetic memoir chronicling a doctors journey to the brink of death. I initially believed this to be some kind of quasi religious epiphany but in actual fact the authors spirituality is not the focal point of her book.

I found this memoir so difficult to put down and caught myself thinking of it even when I wasn’t reading. The author highlights the difficult transition from doctor to patient and how she comes to realise that even the smallest interactions leave a lasting impression on those under her care. Seeing first hand what her patients go through is her greatest lesson and something which she acknowledges could never be taught in medical school.

The overall message of this book is communication and how it impacts on the patient experience. I loved how the author unashamedly details her own weaknesses as a medic and how her experiences influenced her practice since. Her own tragic story is enough to make anyone grateful for their health and examine their own mortality.

A pretty much flawless read for those interested in modern medicine and the American health service.

[Lauren · Rating 5 out of 5]

To all of my BIDMC friends on here - this is a must read. Dr. Awdish is an intensivist who ends up facing multiple ICU admissions and complications herself. She speaks from both angles, being a physician and patient. After reading this, I’m feeling so much more mindful about the way I interact with patients, especially with our intubated, critically ill population. Clearly if I’m writing a review, I feel some type of way about this one!!

[Traci · Rating 2 out of 5]

UPDATE: I wrote my review when I was just over halfway done with the book because I figured it was safe enough to write the review. Boy was I wrong. The book completely changes tone in the last third and my overall impression is now far more positive than when I read the first half.
***
By library coincidence, I began reading In Shock at the same time that I was listening to When Breath Becomes Air, and I found the perspective differences between the two writers jarring. While Awdish has many important lessons here, I struggled to absorb them because I found her very dislikable.

She comes across as a Very Serious Person. Awdish is the type of person I would meet, realize after a few moments has ZERO sense of humor and holds everything tightly, and whom I would actively avoid forever. (She would meet me and decide I was an offensive idiot and do the same.) The writing resonates with a stereotypical physician's arrogance even as she rails against physician arrogance. Almost as if instead of being humbled by her experience, her arrogance just unlocked a new level.

Her writing about her loss of a baby at 7 months is uncomfortably cold--as she writes about the emergency that precipitated all the following events it feels as though there is some subconscious blame still present. It reads like she blames the pregnancy for her misdiagnosis and the severity of her illness and has written off the baby as a person. While she writes as if maybe the loss of what that baby would have meant to her life is something that brings her sadness, you never get the feeling that she grieves for the actual baby herself.

I remember from early in my first pregnancy telling Nic that "if there's ever an accident and you have to choose between me and the baby--CHOOSE THE BABY." In my second pregnancy I revisited this advance directive, telling him "if there's ever an accident and you have to choose between me and the baby and we both have an equal chance of survival, choose me!" (with my most urgent instinct being to protect the baby that was already alive). This prompted him to say "eeew--now it would be a much harder call" (because a mother saying "SAVE ME!" is gross and inherently you question the saving of such a selfish individual). While Awdish skims the periphery of analyzing that social/biological/evolutionary ground, she only glances at it, and does it with the construct of someone either incredibly cold and unlikeable or as someone who still has some serious defenses and blind spots.

She is so critical of those who provide medical care or attempt to provide social comfort during her illness that the reader gets the feeling that there isn't anything anyone could have said or done that would have made her happy. (Although sitting in silence next to her in acknowledgement of your ineptitude seems to be acceptable.) She revisits the anesthesiologist saying "she's circling the drain. we're losing her" several times as a great crime in her care while she was dying, but she never says what should have been done. Certainly the clinicians could not have left the OR to discuss the situation outside the room. Is it the wording of "she's circling the drain" that she objects to? That seems reasonable, but she includes "we're losing her" in her objections each time. It feels as though Awdish most objects to the idea that people were talking about how close she was to dying as she was close to dying. Not really sure what the solution is there, and I certainly want an anesthesiologist to use whatever words get the message across to the rest of the team if I'm circling the drain in an OR! "She's circling the drain." "Yeah--I'm dying here, people--I'm seeing the light! Do what you gotta do!"

That said, I think it's incredibly important for me to read books like this and become aware of perspectives like Awdish's. It helps to be actively conscious of the ways I am biased against different personality types. Bringing full compassion to pain and loss is always harder when the person experiencing that pain and loss isn't doing it the way you want them to, and trying to read this book with active compassion for Awdish is a good exercise.

[Bookslut · Rating 4 out of 5]

Some parts of this were very strong and compelling. The parts that I found most impactful were the instances when she was spoken to condescendingly by medical personnel, or when they would not listen to her. I find this routinely in my medical care and that of my children, and wish every doctor would read this book. Maybe, coming from another doctor, it would improve the system. Her story was very moving, though at times I thought it struggled with the chronology and simple conveyance issues--I'd read and reread, unsure of exactly what happened. The sections that waxed philosophical, which I suspect were the meat and purpose of her book, were unengaging and added a lot of drag to the pacing.

From a dead baby standpoint, which (of course) is why I read this, it was hard to feel a connection for much of the book. I was at first struck by her ice coldness--I think if you only read the first half of this book, you'd think the death of her baby barely bothered her. You later learn that she had a pretty big wall up, and there is a touching line midway through that I have to roughly paraphrase, since I have already returned it: 'That I had a lifetime to feel these things. That they could forgive me for not being able to feel everything all at once'. I worry, that if people don't read it all the way through, that it would give a pretty big misrepresentation of what infant loss is like, and with some authority, since she is a doctor. Throughout the book, the mentions of her lost daughter are very few, very reserved, very restrained, and coupled with her personality and sense of humor, are so subtle that I doubt someone who has not lost a baby would understand the profound nature of what she is telling us. It is very understated, I guess is what I am trying to say, not because she feels so little, but because she feels so much. My favorite, and the most relatable, section of the book, is when she is preparing for the birth of her second child, her rainbow baby. Because you are so unprepared to trust in the safe delivery of any baby after you lose one, a lot of dead baby parents just...don't prepare, when it comes to the next one. We found ourselves, just like she did, in the parking lot of BabiesRUs, eating Taco Bell and trying to make a list of essential baby care items with a week-old baby. That section of the book brilliantly evoked for me the terror, relief, and exhaustion of the weeks surrounding Cal's delivery.

[Vivek Mahapatra · Rating 5 out of 5]

My friends from medical school will remember me scoffing at the idea of informed consent. How are we supposed to distill the information gained over decades of memorizing, understanding, reflecting and accurately represent it to someone having the worst day of their life and expect them to come to the conclusions and make a decision. There's a line in the book which struck me, and out of context, I don't think it'll be as powerful, but I'll share it with you just the same(I'm paraphrasing the book)- When patients ask you questions, we're trained to see them as questions for data.

In those terms, yeah, scoffing makes sense. But thinking back on my patient interactions trying to understand what they were actually asking me, I can see how I could have said so much more. As a person squarely in the middle of my medical training, I thought that once I was done with it, I'd be able to reassure them with my confident knowledge of vast amounts of medical information gathered by the community of medical professionals over our long collective memory.

But I can do so much more right now. I always could. Because a large unsaid part of the practice of medicine is the practice of being a person whose purpose is to simply help.

There are too many moments and realizations in this book for me to point to, so I urge you to read it. Her story took me through all three perspectives, of a patient, a doctor, and patient party. The insights she gleaned and is sharing are invaluable because she went through a trial by fire as all three. It reflects my feelings when I have been in each of those positions. I hope reading this book will offer you some insights as it has done for me.

[Kathleen Gray · Rating 5 out of 5]

This is a book I wish physicians in training were given to read and to discuss. Awdish's tragedy- the loss of her child- is a teaching point for other physicians even as she is trying to process what has happened. Her illness and recovery are amazing; be aware that she does not spare us details of what are sometimes difficult medical and personal issues. If you've ever thought that doctors have it better when they are hospitalized or treated, this book will make you think again. The language is not poetic- it's straightforward and at times seems almost emotionless but at the same time, you always feel Awdish's beating heart. Her struggles and her relationship with her husband are documented in a way I've not read before in this type of memoir. Thanks to Netgalley for the ARC. Try this one if you are interested in well written memoirs, the state of health care, and as the title states- hope.

[ElleDee · Rating 1 out of 5]

This book deserves -2 stars for pathological self-centeredness and +3 stars for descriptive writing.

The author writes as if she is the only person to have ever been sick. She’s a wealthy white physician who is, apparently, horrified that her doctors didn’t bind the entirety of their emotional selves to her fate.

And, all of this I could maybe get over IF she didn’t go on to glorify her abuse of residents and fellows. Abuse that is fueled by self-righteousness and the near pathological certainty of the authors “I know what’s best!” mindset.

Physicians owe patients professionalism, compassion, competence, and patience- but we already knew this. This book adds nothing to the conversation.

Read this if you’re interested in a well informed and very descriptive account of personal illness.

Don’t read this if you’re easily annoyed by endless complaints and circular logic.

[Laura Stone · Rating 2 out of 5]

Mixed feelings about this book. The author truly has been through a nightmare with her health and her efforts to better the experience for patients through better communication are important. Minor points.. The narrative ran on at times to the point of boredom so I had to skim parts. The part that really bothered me was the sections about the baby she lost. I was horrified when she her imagined the baby would just go to pathology to be sliced up and examined as a specimen instead of having to be buried and that she would never visit the grave. Odd lack of emotion expressed toward her baby girl more towards her patients. Can't judge her situation maybe it was just the way it was written.

[Marika · Rating 5 out of 5]

One of the last things that Dr. Rana Awdish remembers hearing was “we’re losing her.” She was on the surgical table at the hospital where she worked, and had gone into multisystem organ failure. That she survived was a miracle, and her recovery was long, with many setbacks. She recounts her medical treatment from the standpoint of knowing how medicine should work and why it sometimes doesn’t. She writes about the lack of empathy from clinicians, miscommunication among hospital staff and absolute failures. She is not bitter about her experience, instead she vowed to make a difference in how patients were treated. This is must-read for medical professionals and non-medical readers alike.
I read an advance review and was not compensated

[Latonya Davis · Rating 5 out of 5]

"Medicine cannot heal in a vacuum; it requires connection." ~Rana Awdish, MD

This book would not allow me to put it down! It is a memoire that will serve as a template for medical empathy and revising approaches and conversations had at patient bedsides. It reads as a "Do Better" manual for healthcare workers. It is a testament to true love and a hope for altruistic medical practice. Her descriptions were so visceral they left me altered. I feel as though I have done right by my patients as their primary nurse, but my practice will never be the same after reading this. Brava Dr. Awdish for not only surviving such a horrific ordeal, but coming out the other side changed for the better. I hope this book touches enough of us to change the face of medicine.

[Soo · Rating 3 out of 5]

Mixed feelings about this book. Whilst I had sympathy for what the author went through, I didn’t warm to her at all and felt she was rather arrogant. I was particularly bothered by her coldness towards her baby girl’s death. Considering she wrote a book about empathy, the incongruity was startling to me. Although some of her writing/language is beautiful, a lot of it is tedious and rather pretentious. I’m glad I’ve come to the end - it was a exhausting book to read - and I skimmed most of it.

[Heather Collins · Rating 3 out of 5]

The book was well-written with good points but the author’s attitude seemed arrogant and condescending. I had a hard time liking her and that tainted the book for me. However the overall message was insightful and worth reading, especially if you are in the medical field.

[Judy Gacek · Rating 5 out of 5]

A must read for anyone working in the health field. She has an understanding of medicine that rivals that of Abraham Verghese.

[Erin McClellan · Rating 5 out of 5]

This book is incredibly important. All healthcare workers should read this to be reminded that humanity and connection are vital to our fields.

[Susan · Rating 5 out of 5]

A gut-wrenching, important read for those who work in health care, especially those that prescribe/order/diagnose.

[Nicole Fye · Rating 5 out of 5]

This books was inspiring and a good reminder of what it is like from a patient’s perspective listening to the care team. Dr. Awdish reminds us not to take our health for granted even if we are physicians. I will definitely remember her story and lessons of having empathy, tapping into our emotions, and communicating condolences in an appropriate way to patients.

[Janelle · Rating 5 out of 5]

Well written amazing story of an ICU physician’s experience with significant illness in the hospital where she practiced.

[Julie · Rating 4 out of 5]

After reading a lot of so-so books lately, I was pleased to pick up this at the library. I love memoirs and I love books about medicine/health so this was right up my alley. Awdish covers a lot of ground. She writes about her medical training. She details her serious health issues and subsequent recovery. Finally she discusses what she learned while sick and how that knowledge helped her to become a better doctor. She takes the knowledge she gained and her personal changes from it and uses those to implement broader changes in both medical school and within the atmosphere of the hospital. She packed a lot into about 400 pages.

in the same way physicians had denied the primacy of the patient voice, medicine had also silenced physicians. We'd been trained to believe that the burdens we carried, the suffering we witnessed was meant to be borne in silence. We were taught to establish clinical distance, to don white coats that declared we were on the side of health. It was an intentional delineation of ourselves as separate

I've read several memoirs by doctors and my father was a professor at a medical school as well as a surgeon himself, so I already knew how rigorous the training is. Adwish had a fresh take on it, focusing more on the emotional cost of that intense schooling than on the intellectual and physical demands. She calls out the tradition that tells doctors not to get attached to or emotional about patients.

A twelve-hour case meant twelve straight hours in which you did not move from the operating room table. You learned not to drink or eat, you learned not to feel hunger or indulge thirst. Corporeal needs were marginalized, ignored and dismissed.

Any and all signs of emotion were immediately met with an assessment of "perhaps this is too much for you. You may not be cut out for this kind of work." We learned that crying happened in closets or on the drive home, but always alone.

Some of our classmates found their feelings unbearably difficult and instead attempted to drown them in alcohol and addiction. Some left medicine for alternate careers. Some committed suicide.

The demeanor modeled was a coolly distant authority, with little value placed on empathy. "Caring" was the purview of nurses and social workers. The mantra was, if you want to treat disease, become a doctor. If you want to care for patients, become a nurse.

I was taught in medical school that connection begets loss, which in turn begets disillusionment and burnout...I didn't understand that open channels would replenish my supply of self. That there was reciprocity in empathy.

"You are behaving in a way I would characterize as immature and reckless. If you allowed yourself to get close enough to this child that you need to mourn his death, which, by the way, if you knew anything about medicine, you would know was a complete inevitability ... if you feel close enough to mourn him then you are irresponsible. Period. How do you expect to care for the other children in your charge?" A doctor yelling at Awdish when she is doing rounds in a pediatric ICU ward and Awdish starts crying when a little girl dies.

The section of the book about her near death experience - bleeding out, a stroke, a coma - and the loss of her daughter, a stillbirth at 7 months - was intense. It is truly amazing that she lived. In fact, she died in the operating room and had a classic near death experience of floating above her body before the doctors brought her back. Going from an ICU doctor to a patient in the ICU was a sudden switch that threw her life trajectory into question.

I struggled to make sense of a trajectory toward nothing. Training that demanded I lock myself away, abdicate all fun and miss family events all in the name of the pursuit of medical knowledge, only to have the path stop dead.

no one thought you'd survive the operating room that night. I was there when they were closing you and they really just thought they were closing you for an autopsy. They did a whip stitch," he explained, referring to a type of suture that is quick but not intended for healing. Its a stitch they use on corpses or soon to be corpses

my true medical education had begun the moment I had gotten sick,

In that bed, in pain, I felt terribly, frighteningly vulnerable, dependent on the care of strangers for my most basic needs as well as the most complex care. I felt powerless in a way that is impossible to imagine, from a privileged position of wholeness and well-being...I pathetically tried to ingratiate myself to the team. I believed that I needed to make them like me in order to care for me. I believed I had to earn pain control through good behavior. I felt I had to prove to them that I was deserving.

Her experiences as a patient were eye opening to her. It made her rethink the way she had been acting towards her patients. Especially upsetting was the scene with the nurse insisting she knew Awdish's emotions better than Awdish herself did.

Did I want to see the baby?
"No," I replied flatly.
"Well, I think that's really sad," she stated, visibly disappointed.
I was surprised by her reaction. It hadn't occurred to me that there was a right answer. It struck me as unnecessarily cruel to ask me to hold a baby that had been dead in my mind for days already.
"Well, you won't get another chance."
Interesting tactic, I thought, resorting to threats in an attempt to provide her version of compassionate closure on a failed pregnancy.
As if to further drive home her point, she added, "A baby deserves to be held by her mother at least once."
This baby was not alive. This baby stood to gain nothing from this imagined interaction with its mother. I felt as if she were asking me to submit to some act of self-abuse that she bizarrely construed as constructive. As if she were asking me to bare a wound she had neither the intention nor power to heal. In her desire to help, she needed me to conform, to accept her predetermined plan. But there was no room in her plan for my needs or values.

Once she is out of immediate danger, then comes the very long road to recovery. Recovery is not in the purview of doctors. That falls to the nurses, the physical therapists, the occupational therapists. It can be a huge component of a sick person's experience and Adwish realizes she'd never deeply considered what happens after the doctor swoops in like a superhero to save the day.

I tried to integrate what had just happened into who I believed myself to be. I was apparently now a person who took over an hour to put on socks using a sock-hook. And I was a person who found it incredibly difficult.

Though I had no psychological dependence on the medications, my body had become habituated to them. I had become physiologically dependent. I realized this with a start two days into the "flu." I held the amber bottle as if it were precious, knowing that I could put a stop to the cold sweats, the pain, the nausea, the shaking chills. By satiating the need, I would only restart the clock. If my answer in this moment was more medication, another bout of acute withdrawal would always be in my future. The bottle took on a magnetism far greater than its actual physical size should have allowed. It was the center, and I was in orbit around it. I flushed the pills away. And then they were quiet. Proximity proved necessary for them to have any influence over me. Would that everyone could be that lucky.

I was completely terrified and, not knowing how to quiet my fear, took the only option I thought available to me: to attempt to bludgeon the feeling into submission with data. I was making the same mistake with myself that physicians make with their patients. I was not naming or tending to my own emotion.

Once she goes back to work she starts implementing her new understanding into her treatment of patients.

I felt them eye me quizzically as I leaned down to speak into an unconscious patient's ear, "You're doing much better. You have a pneumonia, but the antibiotics are working, and you are getting better." "I believe he can hear us," I'd explain. "And if it was you, wouldn't you want someone to explain what was happening?"
They would shrug, unable to imagine such a thing.

It took me ten years to figure out I should stand and face the same direction as my patients.

in all these years of being a doctor, why had I never just sat down and held someone's hand? It could have made all the difference for someone, but I just didn't know.

I recalled a time when I had responded to a tearful patient's question,"But how could this have happened?" with explanations of the complex interplay between genetics and environment, behaviors and predispositions that had led to the terminal diagnosis. I had been trained to believe that all questions were a request for data. Because of this orientation, | recognized neither the fear nor the existential nature of the question. It would be years before I understood the subtext behind the questions.

Awdish recognizes the need for doctors to reframe how they are dealing with emotions, both their patients and their own. She implements changes at her teaching hospital(hospitals connected to a medical school) that are hopefully letting the younger generation of doctors grow both as a doctor and a human being.

I was taught in medical school that connection begets loss, which in turn begets disillusionment and burnout...I didn't understand that open channels would replenish my supply of self. That there was reciprocity in empathy.

We all desire to be seen, to be known, to share our experiences and feel heard. To have our life events given context and meaning, redirected back to us in a way that we can understand and integrate into our understanding of who we believe ourselves to be.This need is more acute in times of sickness. We believe ourselves to be the narrators of our own lives. When we are sick, we are humbled by our dependency on others, the loss of control, the uncertainty of the ending.

The simplicity of telling someone you are sorry for their loss, or that it isn't OK, can feel weak and puny in the face of suffering.We avoid it, feeling impotent, knowing that our sentiment won't fix anything. And we want to fix things. We cannot change that which is true and sad. But we can acknowledge it. We can humbly witness suffering and offer support.

We cannot define success as beating death because death cannot be beaten. Our ability to be present with each other through our suffering is what we are meant to do. It is what feeds us when the darkness inevitably looms.

It is entirely possible to feel someone's pain, acknowledge their suffering, hold it in our hands and support them with our presence without depleting ourselves, without clouding our judgment. But only if we are honest about our own feelings.

Awdish mentions something called The Ring Theory which I found very helpful. It's about how to support people who are suffering. Something to remember for the future.


They were violating the basic rule of the Ring Theory, which I first encountered in a Los Angeles Times article by Susan Silk and Barry Goldman. The concept is an etiquette lesson in complaining during times of crisis. Imagine concentric rings. The center ring represents the sick person, in this case me. The next circle is composed of the closest family, people who are also affected by the illness or loss, in this case Randy and my mom. The next circle, less close family, friends and so on, until eventually random acquaintances conceptually inhabit the outer rings. The person at the center, by virtue of being the most vulnerable, gets to say anything she wants at any time to anyone. That is the sole benefit of being encased in that awful central ring. That person should not be the recipient of complaints from people in the outer periphery. They can say how they feel, how the trauma is affecting them too, but only to people in larger rings. The rule, as described in the article, is simple: "comfort IN and dump OUT."

[Mrs. Danvers · Rating 4 out of 5]

This book is like what a TED talk would be if the talk were true, honest, helpful, clear, but not over-managed. In other words, a straightforward lesson illustrated by specific events in the life of the storyteller. Well done!