In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope Paperback – October 16, 2018

Firstly, this is a book I would recommend all to read along with many of Dr. Atul Gawande’s books and Dr. Pamela Wible’s work and when breath becomes air. This book hits home for so many reasons.1. Dr. Awdish was my esteemed attending in 2013 Fall for a week on the pulmonary floor of the same hospital this happened at. The micu and sicu are also floors I’ve rotated on with other rotations. She mentioned this satirical almost comical need to protect students and residents to the point she’d bake cookies for them. I remember seeing that happen and thinking she is just showing her more feminine side and just a nicer physician. I assumed it was her foreign background that made her nicer but hadn’t known the darkness of her own experience at the time. You see we forget as individuals when we are barely surviving the medical world that even those who look more confident to us are internally suffering as well and hiding their own demons. This story proved it to me and gave me the courage to speak some of my own horrors both as a patient elsewhere and a student at ford to Dr.Awdish!About a year later someone pointed out a lecture called sepsis day lecture. She alludes to it in the end of the book when she talks about how she made slides with black background and in white the insensitive things said out loud during her hospitalization. That’s when i began to hear her story. However, even then my shock to what was said was there but not the level of emotion reading this bookFastforward to January I learned she was coming out with this book after an nejm article about her came out and now today done reading it..As I sat through this book I wanted to cry hearing her near loss of life and suffering. In the medical profession our own burnt out state, years of abuse by our higher ups who try to beat empathy out of us, and assembly line medicine and corporatization of Medicine (profit over people) motto, along with an admissions process that often selects scores rather than who is truly suitable (we attract many deeply insecure who think a title will mean automatic respect and who go onto abuse that power).... all these things create a malignant culture. A culture that leads some doctors to suicide and most others including the most idealistic to lose their empathy! We teach our students and residents that fear is the only way to teach them and employ strict hierarchies and use a hazing like quality remiss of fraternities and sororities (we had to go through the suffering so so should you attitude). We teach our patients that we are on a throne higher than them and forget our own mortality that one day it can all be taken from us and we lose everything due to the neglect of own help. But we forget to teach our students and residents that when they are the helpless one in a hospital those same doctors will treat them as they treat everyone else not with special treatment. That they too are just as mortal.2. Dr Awdish’s book reminds us we are as mortal as our patients are and not any more godly than them. We can lose it all in a brink of a moment and be as helpless and powerless as them. And in those moments we will neither want just statistical facts and knowledge thrown at us but rather the human empathy will matter more. And that teaching stoicism over empathy is part of where we have failed as physicians in modern society. To be able to share real emotion with our patients and think about how we communicate will make us stronger physicians. She will challenge you to throw away your paternalistic views of the medical profession and to make you wonder why we don’t show more empathy and equity with our patients.Having also been part of the system as a medical graduate, I’ve seen we can stop these abuses by doing 4 key things:1. Treating each other in the profession more professionally rather than letting those who abuse power reign. There must be system of checks and balances and reprimanding unprofessionalism til we create a culture that most would want to respect2. We must stop becoming so detached we forget how to feel. I’ve been there and shut down in the past Bc I didn’t want to feel vulnerable and all it does is build up that when you do release all that’s eaten at your soul it’s so much worse. We don’t need to become so emotionally attached we can’t see reason but we must not become too detached either that we can’t show empathy like a bunch of sociopaths. Too many in medicine do become this way that they can’t see straight.3. We must look at how we are admitting people into medical school and residency and stop with the scores are the biggest defining point attitude and find a way to assess who is truly right for this profession to weed out the ones just wanting to profit in medicine at the expense of the patient.4. We must find a way to not overwork doctors to the point that we tell them their own mortality and health doesn’t matter. How are we in the profession of healing and surrounded by doctors but red tape and regulations prevent even our own colleagues from on the spot treatment when we are sick and at work? How do we tell people we need 8 hours a day of sleep but tell physicians they must remain sleep deprived even women who are pregnant and must come in no matter how not so great they are feeling? And when they don’t show we tell them they are abandoning patients or we ostracize them other ways.Bottom line we must be kind to ourselves our colleagues and our patients to create a culture of caring and we must rid profiteering from the medical professionDr Awdish’s book is one of many books by physicians that begin to make this call for a cultural change at even one of those levels I discussed above—the level of patient care and showing greater empathy towards patients. To feel is to put ourselves in their shoes and ask ourselves how we’d like it if someone didnto is half of what we do to them.3. Dr.Awdish’s book was also deeply personal to me because while I have never been in critical condition I have had many a horror filled memory of doctors. The time a gynecologist didn’t believe my sexual activity status until he examined me, the time my family “friend” internist dismissed me saying I wasn’t a doctor and couldn’t have known what I was talking about. Mind you I had an ms in medical sciences and bachelors of science in microbiology and knew how to look at medical literature quite well by that point. The family physician who didn’t get a thorough history to realize I had taken a medicine I was allergic to Bc he nor my parents informed me of my drug allergies. These are the types of communication failures dr Awdish refers to when she says listen to the patient Bc often the patient will tell you what I need to know if you are truly listening. Don’t just listen for the preformed biased questions you are formulating in your head.And as I brought up the passage from page 174 where she refers to her satirical need to protect the medical students and residents she mentions, I found myself reacting the same way to a degree after what I went through at the same hospital in medical training as a 3rd year. I found myself wanting to prevent the malignant things that could happen to the students to those younger than me.But for what may have been satirical to some degree with the trainees was not when it came to the patients. There, she departed to a far more genuinely empathetic physician as an attending. I still recall seeing the truly genuinely empathetic way in which she broke bad news to a newly diagnosed cancer patient.If you are in medical training take this book with seriousness and it’s deeply resonating message. Imagine yourself in your patient's shoes and realize the loss of dignity these patients feel and that they are here in their time of need and the least we can do is make them comfortable.

My daughter, a newly minted internal med MD, has always had an uncanny ability to discern what’s troubling people. She’s a great listener. She is the one who read this book first, and used what the author describes in her own practice. She allows her Self to be present, and is so careful to actively listen.She developed her empathy early; and went through a “phase” in high school where she was the emotional advisor to her friends. This was her baseline. As she read this book, I can feel her growing ever more confident in bringing her Self to the patient.Thank you for sharing this story of emotional and physical pain as well as the patient perspective. As a survivor of breast cancer, I have experienced the care of a number of people. One of the worst things demanded of me: “why are you crying?” And the best was “I’m sorry you’re here.”Doctors, please continue empathy. Patients, please tell your docs your fears.Thank you for this book.

I like the book for the most part. Very emotionalaccount of a doctor who went through our healthcare system and while on a hard path “ loosing pulse, loosing a child, multiple surgeries” she did not loose a desire to make a change or hope. We have to give our patients hope, not dismiss their pain, not act like Gods or our profession, not be arrogant, never stop learning from our mistakes, never stop listening… the only thing I did not like is it felt a bit more negative at times and very on a high note. Overall good book. Thank you for sharing.

This book was written by an ICU doctor who was pregnant with her first child when she got sick and all hell broke loose in her body. I have had a similar experience, though not while pregnant, with a flesh-eating bacteria and a bleeding ulcer that nearly killed me, so this book was especially poignant to me. I was never as horribly ill as the author was, but I could definitely sympathize.This patient goes into labor prematurely, delivers, and continues to have horrible bleeding and severe pain in her abdomen. She's admitted to the ICU instead of the maternity floor she expected, and while she was severely and critically ill, she overheard doctors using slang terms which were so disrespectful and inappropriate that she wanted to correct, but she couldn't speak. They thought she was unconscious, but she wasn't, not totally. Having worked as an ICU physician for several years, when she got better, she reflected on the times she had said things around a patient she thought was unconscious and wondered if they, like her, actually heard the medical slang.What happens after her ICU stay, during which time her husband and her mother were always with her to hold her hand, one at a time, is truly remarkable. The problems she had with abdominal pain after her delivery lead to more problems which require major surgery.Somehow this strong, determined woman actually goes back to work as an ICU doctor between her first serious illness and dealing with the additional problems. She gets tired, but she manages to do her job well. She no longer uses derogatory medical slang terms around her patients and lets her team of residents, interns, and students know that they won't use those either. She becomes a better physician after her illness.Her husband's love and devotion never falter. The author comes back from all her medical problems a kinder and more compassionate person. This happened to me, too, when I was dealing with two life-threatening illnesses.I had no one with me when I was sick. I was all alone, and I made it back, too, although my story is not as powerful as the author's. I found myself identifying strongly with her and still pray for her. A near-death experience or three, as I had, definitely changes your focus in life and your attitude. I had a wonderful doctor who was assigned to me on my third hospitalization. He saved my life all three times and was my primary care physician afterward for fifteen years.After the near-death experiences the author and I both had, our attitudes changed, and things that might have seemed a big deal before getting so sick just didn't matter any more. I know it made me a better person, and I can see that her illnesses made this remarkable author a better person, too. She knew exactly what her 4+ sick patients were going through, and she knew what they needed in addition to expert medical care.I admire this woman so much and hope the rest of her life with her family will be a smooth and steady path. I know her patients will wonder how and if they would have made it through their own illnesses without her compassionate, expert, and understanding care. I would love to be able to talk with her and find out how she's doing today.