"Always the beautiful answer who asks a more beautiful question," said the poet EE Cummings. Rana Awdish asks beautiful and brave questions in In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope. Awdish is an intensive care doctor who suffered a catastrophic medical event seven months into her first pregnancy, resulting in the death of her unborn child and a prolonged fight for life in her own hospital.
In Shock is Awdish's account of the trauma of losing her unborn child, her close call with death and, most importantly, her transition from the role of doctor to the role of patient. It provides the reader with a unique perspective into the sometimes dehumanising culture of acute hospital care. This culture, according to Awdish, is one in which the person is often replaced by the diagnosis and simply seen as a puzzle to be solved.
Awdish goes one step further and describes the often unspoken rule that underpins acute hospital care: Keep your distance. She bravely challenges the dominant paradigm of medicine that directs the doctor to maintain distance from the patient, because the alternative “begets loss, which in turn begets disillusionment and ultimately burnout”.
It is within this paradigm that, according to Awdish, the fundamental flaw of the medical profession lies. It is this flaw she sees as doing great harm to the patient and the practitioner, causing disillusionment and burnout in doctors.
Challenging the paradigm
In her book, Awdish presents a challenge to this dominant paradigm. She asks brave questions in the context of a medical culture that has imposed implicit rules about the types of questions that can be asked. She describes this culture as one in which “we were trained to ask questions that steered people to a destination. We were not wise enough to know that questions generate answers that are formulated in their likeness.”
In Shock presents an ambitious and compelling alternative to this paradigm. Awdish describes a different way of being with patients, where the unguarded and receptive self could actually be replenished by the act of being fully present with another person.
Any temptation to dismiss Awdish’s alternative is undermined by the personal story told in the book. She writes with a deeply vulnerable human voice about her illness, her agonising recovery and the loss of her baby. She does not shy away from describing the emotional complexity of her miscarriage: “I felt sorry for myself that I’d been through all of this and there was no baby even to show for it … I feel angry that the pregnancy nearly killed me.”
There are times, however, when Awdish’s account of the miscarriage and the gruelling months of recovery get somewhat lost in the mire of dense medical detail. On occasion this runs the risk of diminishing the universal appeal of the narrative – that said, the delicate balance achieved between the personal and the universal is admirable.
In Shock is a notable, ambitious and welcome contribution to an emerging dialogue concerning the quality and orientation of acute hospital care.
Dr Paul D’Alton is principal clinical psychologist at St Vincent’s University Hospital, Dublin
