I read Rana Awdish’s book In Shock quickly and greedily over the span of three days. In books I tend to mark up pages with passages I want to revisit. Poor In Shock is completely dog-eared – pages turned inward every second or third page. This is the sign of a good story. In the grand tradition of physician writers Oliver Sacks and Paul Kalanithi, Rana Awdish has a rare talent for both science and writing.
It would be easy to describe this book as a medical memoir, but it is much more than that – it is a book of loss and grief over the death of a child. It champions quality improvement and compassionate care. In Shock is a love story too.
Dr. Awdish vividly recounts her time spent as a patient in the ICU with a sudden critical illness and contrasts it with her experience in the same ICU as a critical care physician. This unfortunate coincidence allows for insights from both sides of the bed as both a patient and doctor.
I’m all about the feelings all the time, so I appreciated Dr. Awdish’s skill at recounting how it feels to be a patient. She doesn’t white-wash the horrors inflicted in the hospital. She also offers practical advice to health professionals about using thoughtful communication techniques to avoid emotional harm. She emphasizes how as a patient, she was much more than ‘abdominal pain and fetal demise.’ She reminds clinicians how much patients can hear from their beds, even in critical care. I wince at her recollection of overhearing a doctor say in the ICU that ‘she’s trying to die on us.‘
The author serves up great insight into the makings of a physician and training programs that train compassion out of the most earnest of students. I believe the hope for change lies in medical education (and all health professional education), but alas, the workings of that education mirrors the dysfunction of the health system. The two are intertwined. I can only hope that sharing patient stories from both health professionals and lay-patients will help.
This book reminded me why I was a failed student nurse – I could not figure out how to detach myself from patients. Training to mold students into a ‘cooly distant authority’ happens in all health faculties, including nursing. Dr. Awdish describes her experience as a medical student in the pediatric ICU:
“I found it utterly impossible to be detached or reserved in that unit.”
Later, she was chastised by a supervising physician for expressing sadness for the death of a child, harshly learning, “…if we felt our feelings, we would kill the people we were supposed to help protect.”
My shock from In Shock was at the effort physicians make suppress to emotion, often at their own personal cost. My best experiences with physicians have been those when doctors dared show they were human – not in a check-box way – but in an authentic, vulnerable way. There are those rebels out there, but they are hard to find. The training and health systems seem determined to squash them down. I admire these kind champions even more now for swimming against the tide.
All is not lost and Rana does give us hope. She reminds us that there is “reciprocity in empathy.” She shares positive experiences, too, including one with a Nurse Practitioner who demonstrates compassion for the death of her baby girl. She explains how health professionals can “humbly witness suffering and offer support.”
Embedded in her harrowing story of experiencing a life-threatening event there is also an important love story about Rana’s relationship with her husband Randy.
“My bruised and discolored body was proof to him of what I had endured to stay with him,” she recounts. I thought of my own husband and how both the author and I are graced with partners who granted us unconditional love during our health crises. This deep, unwavering support can be healing too.
Dr. Rana Awdish’s In Shock covers a great amount of ground: shock at suddenly becoming gravely ill, losing her beloved baby girl and grieving for her previously healthy body. There’s shock at how it feels to be a patient, shock at the resistance to her attempts to change the rigid medical culture to be more patient centred.
It is a dramatic and engaging read. I was spell bound until the very last page. I might be predisposed to like this book as the mother of a son with a disability and now as a cancer patient. But this is a book for anybody who is a health professional or who has ever been – or might be – a patient (and that’s all of us).
I am heartened to have connected with Rana on Twitter and to discover she has a platform to preach for improved health communication as a speaker, writer and the Medical Director of Care Experience. While it frustrates me that us simple layperson patients struggle to be heard, it does give me hope that doctors-as-patients are able to use their own stories to influence positive change. Thank you Rana for gifting us your story. I know it will make a difference in the world.