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

Book Title: In Shock: My Journey From Death to Recovery and the Redemptive Power of Hope

Book Author: Rana Adwish

Publication Information: New York, St Martin’s Press, 2017, 272 pp., $25.99, hardcover

In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope by Rana Adwish, MD, FCCP, details the traumatic experience of a pregnant critical care physician who loses her unborn first child and nearly dies of hemorrhagic shock. Instantly she is thrown from her role of physician into the patient role. The true shock comes when she is further traumatized by her fellow physicians’ inability to be present with loss and suffering, and to respond compassionately.

In Shock juxtaposes a series of organ failures, major surgeries, and code events with careless comments, dismissive behaviors, and occasional outright bullying from medical teams. In one memorable example, an obstetric resident asks Dr Adwish, who has just identified the absence of a fetal heartbeat in her own ultrasound, “Can you show me where you see that?” (p 26). Eventually, she resumes her work as a critical care attending. While rounding on a patient with a presentation eerily similar to her own, she notices: “What was missing [was] any acknowledgment of the absolute shattering horror of this particular sequence of events. They didn’t see her as a person. She was a case to them” (p 119). Dr Adwish examines the educational culture causing this phenomenon: the grueling hours, the pressure to dispassionately diagnose a variety of pathology in pursuit of competency, and the lack of emphasis on humanism. She knows this well, having been through it herself. One key passage depicts Dr Adwish mourning the death of a pediatric patient, then being chastised—after all, the work must go on.

While the subject matter could easily lend itself to being dreary, Dr Adwish maintains a persistent tone of hope. Just as we learn pathology, we can learn empathy. We can heal ourselves and our patients. Anecdotes of Dr Adwish encouraging empathy and patient-centeredness on a small scale with her own ICU team parallel her gradual physical and emotional recovery. She also begins to note larger-scale changes at her institution—learners are now being specifically taught skills in communication and empathy. She has another bout of shock several years later. This time she is treated with empathy, respect, and compassion by the learners charged with her care.

In Shock touches on many themes present in literature: wellness, burnout, physician-patient communication, and dehumanization. Generally, Dr Adwish does not refer the reader back to the known literature. It’s a wise choice to keep the focus on the true strength of the book: her narrative as the patient. She shows us through her harrowing experience that we need to be intentional about our words and interactions. We need to connect to patients in their time of suffering. We should teach our learners to do better. She offers practical tips for effective communication at the end of the book. This section is readable in under 10 minutes, and is easily shared with patients and learners even without reading the book, though putting them at the end of this powerful narrative makes their necessity and value more evident.

For educators hoping to delve deeper, a reader guide is available at https://www.ranaawdishmd.com/book. The guide is composed of six sections of three to ten questions for reflection. It would lend itself best to an ongoing series of discussions with learners. The questions themselves are generally thought-provoking and insightful. Supplementary references and reading materials to help further illustrate themes of burnout, wellness, communication, and dehumanization in medical training would have been ideal for educators. These could help the book and guide to reach their full potential to serve as a basis for a formal curriculum about physician-patient communication, empathy, and humanism. The art in medicine section was interesting, but felt a bit disconnected from the theme of the narrative and the very necessary and practical call to action it embodies. The narrative medicine section feels underdeveloped. This segment does not currently offer any reflective questions; I would have loved for Dr Adwish to encourage her readership to reflect on times when they’ve invested in patients’ stories as much as their illness, to explore why that was, and how it affected their relationship and care delivery.

Ultimately, any qualms I have with the reader guide are minor, especially considering the power and impact of the book itself. In Shock is exceptionally well written. It is honest and unflattering but also offers understanding, grace, and hope. I’d highly recommend it to any clinician, educator, or learner seeking to become a more empathetic, passionate, humanistic physician.