Book Review: In Shock, by Rana Awdish
In early October, I finished Dr. Rana Awdish’s book, In Shock, in which she shares her experience going from a critical care physician to being brought back from death and resuscitated in the OR and coming back from that experience in the Intensive Care Unit, and going back to being an ICU physician again. In her book, she not only shares the physical experiences of this metamorphosis, but the impacts on the mind and soul that this has had on her as an ICU physician and as a human being. By writing this book, the reader, I believe, needs to appreciate not only the strength of Dr. Awdish in overcoming multiple adversities in her physical healing, but the strength of allowing herself to be vulnerable. Brene Brown defines vulnerability as “the emotion that we experience during times of uncertainty, risk, and emotional exposure..” As Brown says, “vulnerability is not winning or losing. It’s having the courage to show up when you can’t control the outcome (from Dare to Lead, by Brene Brown).
In her book, In Shock, Dr. Awdish has more than showed up through her writing when she cannot control the outcome, she has used her experiences not only to transform her own life and practice as a physician and educator, but also to provide a foundation to help transform the lives and practices of fellow health care workers as we strive to better understand suffering, our role in the lives of our patients, and in the lives of those around us during our journey on this Earth, in general. Through sharing her personal experience as a patient, she reminds us of the importance of seeing the humanity in each and every person we care for, and provides a blueprint for us to find our better selves.
She sets up her book on the early acknowledgement that in our training, we are trained to push aside suffering to help the patient. In a powerful early passage, she writes:
Medicine is a culture that does not indulge suffering, though it is everywhere. It is there in every patient, every family member, and within ourselves and our colleagues. The omnipresence of the suffering makes it the easiest thing to ignore. It is the most important thing to attend to and we are constantly dismissing it, pushing it aside, whether it’s our own suffering, or the patient’s suffering, or our family’s suffering. We push it aside to get to the patient.
I had distanced myself from my patients the way I had been instructed to do in training, in the same way the team was doing now. I had subscribed to the paradigm of medicine set forth by my mentors, one that advised me to cultivate space, to be sparing of myself. I was taught that connection begets loss, which in turn begets disillusionment and burnout. As if I were made of some quantifiable measure of stuff that once given away would leave me depleted. I don’t know if I fully believed in that model, but until my own experience as a patient, I didn’t allow myself to envision an alternative where I was unguarded, receptive and freely giving of myself. I didn’t understand that open channels would replenish my supply of self. That there was reciprocity in empathy.
Luckily, I had the chance to die.
Throughout her experience as a doctor-turned-patient, she learns the importance of empathy. She learns this not only through her own experiences in her own physical suffering through being critically ill, but also through the stories that medical colleagues bring to her when she is a patient in the ICU or later on when she is again hospitalized. She becomes a listener for people to talk about their own suffering and difficulty in caring for ill patients. Through this she comes to realize that we, as healthcare workers, are in this together. She writes, “We cannot avoid the darkness, just as we cannot evade suffering. Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.”
She prescribes cultivation of empathy as giving us the chance to have a truly healing impact in suffering. “If empathy is the ability to take the perspective of another and feel with them, then, at its best, the practice of medicine is a focused, scientific form of empathy. Truly caring for a patient necessitates traversing borders and inhabiting the view of another with the humility of a visitor who knows he or she can choose to look away. They each possess the power to heal.”
The chapter called “Broken Vessels,” where she shares story told to her by one of her empathetic patients, is a section I have gone back to again and again. Her writing is poignant, and it penetrates the barriers we put in place to speak to all of us who serve on the front lines in clinic or in the hospital or ICU.
I strongly recommend reading Dr. Awdish’s book, especially if you are a healthcare worker, and especially as we all work through our suffering during this COVID era. The weight we all feel is so heavy, and I believe our only real hope is that we love each other through this darkness. Perhaps in so doing we will find our meaning and purpose.