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In Shock

In Shock by Rana Awdish
265 pages, St. Martin’s Press, 2017

I read Dr. Rana Awdish’s book, In Shock, from cover to cover on a six-hour flight from Philadelphia to San Francisco. I started it expecting to read for just an hour or two and then nap, but I just couldn’t put it down. It’s a suspenseful personal story of surviving a near-death experience, but that wasn’t the only thing that made it riveting. What transfixed me were the lessons that Awdish drew from the experience, which she interspersed throughout the book, and the raw emotions she shared. Having just finished clerkship year, and seen some of the lapses in humanity towards patients that she describes, reading this book was cathartic because she finally put in words so much of what I already felt needed to be changed in medicine.

From the very outset of this book, you know that Awdish will eventually end up in her own ICU, but you also know that she will survive to tell the tale, write a book about it, speak about it around the world, and get back to work as a physician.  Even so, each part of the story feels suspenseful. A particularly poignant moment occurs when she goes to the ER, pregnant and in pain, knowing that something is deeply wrong. A resident is ultrasounding her belly, and Awdish realizes with agony that there is no fetal heartbeat, and says so out loud. The resident, green with inexperience, asks, “Can you show me where you see that?” Awdish writes: “I realized the resident’s perspective in that moment was aligned squarely on himself….The insensitivity of what he was asking struck me hard. I felt invisible to him. His detachment reveals an unsettling, largely unspoken reality. We aren’t trained to see our patients. We are trained to see pathology.” I read that and knew that I had seen and participated in many moments like that in the hospital, which still bothered me months later.

There are patient memoirs and physician memoirs, but sometimes we forget that physicians are patients, too. And a memoir from the perspective of an ICU physician becoming an ICU patient is filled with a certain level of in-depth detail and knowledge of the system and its frustrations. For example, when Awdish is taken from the ICU to get a CT scan, she reflects: “It was just a CT scan. I thought of how many scans I had ordered on my patients. How many everything I had ordered. It was shocking how little thought I had given to what it meant to leave the safety of the ICU, to be bumped and jostled and made to lie flat with lungs filled with fluid from heart failure or pus from pneumonia. How pathetically arrogant that I thought only of how clinically useful the images would be, or how necessary the test.”

Awdish’s memoir is full of these moments of self-realization, and she has a gift for language in the way she expresses them. I think that every person in medicine would benefit from reading this book, no matter his or her level of training. As a medical student, it affirmed my desire to value empathy over efficiency, and never lose sight of the importance of communication with my patients.