A Doctor Dies, Comes Back A Healer: Rana Awdish's "In Shock"

Jul 15, 2025

I’ve been reading medical memoirs since 2001, and I’ve come to expect a certain narrative arc. Western medicine breaks its initiates down much like the military does during boot camp through sleep deprivation, a relentless mental load, and grueling physical demands, often without proper hydration and nutrition. The doctor who emerges from medical school and enters residency has been taught to regard herself as superhuman, superior to other mortals, and qualified, by virtue of that superiority, to weigh questions of life and death.

A scene in Patch Adams captures the idea, which seems not to have changed since that film was released in 1998 or since the 1960s, when the original Patch Adams endured his own medical training.

Dean Walcott addresses the incoming class with the following speech:

First do no harm. What is implicit in this simple precept of medicine? An awesome power. The power to do harm. Who gives you this power? The patient. A patient will come to you at his moment of greatest dread, hand you a knife and say, "Doctor, cut me open." Why? Because he trusts you. He trusts you the way a child trusts. He trusts you to do no harm. The sad fact is human beings are not worthy of trust. It is human nature to lie, take shortcuts, to lose your nerve, get tired, make mistakes. No rational patient would put his trust in a human being and we’re not gonna let him! It is our mission here to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you!

As a result, doctors come to believe that intellect, science, and technology conquer all. At some point early in their careers, they experience a catastrophic failure that sparks a crisis of faith in themselves and in their profession, and they learn the hard way that so-called soft skills, like communication, active listening, and storytelling, are actually the lifeblood of healing. Every generation of doctors produces a prophet or two with this message, often delivered through a medical memoir, and Rana Awdish belongs to this tradition. Her collapse just happens to be more dramatic than most.

In Shock tells the story of how Dr. Awdish nearly died of a ruptured tumor in her liver — did, in fact, die, in her accounting, before miraculously reinhabiting her body — and suffered a brutal recovery that taught her, at every step, how vital it is to honor the humanity that patients and physicians share.

The message that In Shock delivers is essential, but its power is diminished by a lack of sophistication in craft. If we are to take Awdish’s message to heart, that doctors ought to bring the same nuance and care to their use of language that they do to diagnosis and treatment, then holding the medical memoir to a higher aesthetic standard can only add texture and meaning to our understanding of life and death, illness and health.

Dead on the table

Awdish begins her tale with a harrowing account of how a routine day of chores and grocery shopping can be suddenly upended by a medical emergency. After feeling a little off all day, which she explained away by being six months pregnant, Awdish met a friend for dinner. Suddenly a wave of pain exploded across her abdomen.

Later, she would learn that a tumor in her liver had ruptured and that she was in grave danger of bleeding out. But she asked her friend to drive her home and wasted precious time lying on the floor with a pillow pressed against her stomach, rationalizing that if she could control the pain in that way, maybe she didn’t need to go to the hospital just yet.

After Dr. Awdish arrived at her own hospital, Henry Ford in Detroit, more precious time was lost with tests and a needlessly drawn-out ultrasound, where a male resident asked her (while she was still hemorrhaging internally) to show him where on the grainy image she could tell that her baby had already died. It was her first taste of how invisible human beings become once they don the patient’s gown, even if they’d been wearing the white coat just moments before. “We aren’t trained to see our patients,” she writes. “We are trained to see pathology…. The true relationship is forged between the doctor and the disease.”

By the time she made it to the operating room, it was already too late. Among what she thought were her final thoughts, she could hear the surgeons saying, repeatedly, that they were losing her, that she was circling the drain. She felt a coldness creep through her body as her limbs grew heavy and stiff, as though she were sinking deep into “a heavy water that was dense as mercury.”

Then she died.

All at once, I felt a sudden release and lightness. I could see the operating room clearly, although I struggled to orient myself. The view was deceptive, in the way pilots staring for too long at the horizon can sometimes suffer sensory illusions that cause them to mistake the sea for the sky…. I was falling up.

Awdish could see everyone — the anesthesiologist, the surgical team, herself dead on the table.

I felt nothing. The pain miraculously gone. The panic surrounding the pain was gone. An anodyne peace. I felt weightless and buoyant and very small. I watched the events unfold before me, unattached to any outcome, with an easy stillness.

It’s a gripping description, but it leaves many questions that Awdish never circles back to explore. In the next chapter, she wakes up hooked to a ventilator, terrified and confused, and from that point on, the book follows her long journey back to health in what often feels like an episodic play-by-play.

Even as I read about Awdish’s struggle with basic tasks, like getting dressed and learning how to walk again, I’m wondering about that out-of-body scene. How could she have such vivid memories of her own operation while under anesthesia unless she really, truly, had died and experienced a brief taste of an afterlife? But then why would the soul be so spatially limited to the operating room — why didn’t she see herself at the heavenly gates or accompanied by angels, as others who have ostensibly died and come back have reported? Presumably the spirit or soul would not be limited to gravity, the speed of light, or any other natural law, yet that is precisely how Awdish’s death is rendered.

I would expect a scientist to be fascinated by this puzzle, since it raises many questions about consciousness. A secular physician would assume that consciousness dies with the body, that dreams and memories are advanced cognitive experiences, only possible in a brain with sufficient blood to produce thoughts and images. Could a sedated brain with a dangerously low blood supply experience a rapid firing of neurons capable of producing images that could be recalled this vividly later, once the physical essentials had been stabilized?

We read memoirs to learn about our own lives. I’d like to have learned a little more about my own body and consciousness than Awdish’s tale reveals.

Voices of innocence and experience

Friends have frequently taken me to task for criticizing Paul Kalanithi’s When Breath Becomes Air. My feeling is that the book was published more because Kalanthi was dying as he wrote it (a touching premise guaranteed to sell copies) than because of its excellence in craft or insight. Indeed, I find Kalanithi’s sentences dull and his insights flat. This is apparently a very rude thing to say about someone who can’t defend themselves, and I expect that some will feel similarly about my critique of Awdish.

Indeed, her story is horrific and I cannot imagine enduring everything she did. For instance, none of her doctors thought to repair the stitches used to sew her abdomen together that night when she died on the table and miraculously came back to life. The surgical team thought they were preparing her for autopsy, so they did a “whip stitch,” which isn’t at all intended for healing. As a result, some months into her recovery, Awdish suffered multiple hernias; her intestines began bulging through her abdominal wall “in fist-sized punches like some grotesque alien baby.”

The slipshod surgery also compromised her uterus, creating a high risk of rupture when she attempted a second pregnancy. And, as if she hadn’t suffered enough, Awdish learned — six months into her second pregnancy — that there were, in fact, two tumors in her liver when the first one burst, and the second one could hemorrhage at any time with the same deadly results.

But these powerful moments could resonate even more deeply if they were not rendered so episodically.

Large portions of In Shock read as this happened, then this happened, then this happened. Most of these segments are narrated with a single voice, what we might call the voice of innocence, or the self caught up in each moment in time, blind to the larger meaning, prey to impetuous feelings, incapable of rising above piques of fear or resentment or anger. This is how the opening scene is told, too: as if it is happening in real time rather than as a memory that is both recalled (in dramatic fashion) and reflected upon from the calmer distance of months or years.

I once heard a French scholar describe how translations of Willa Cather’s historical novels — which contain long passages of untranslated French — into a single language destroys the “energy of difference.” It’s the juxtaposition of English and French that adds richness. The same is true of these two narrative modes.

Literary memoirists learn to weave the voices of innocence and experience together, punctuating bursts of imagery with larger insights. This is the method that distinguishes Atul Gawande’s classic debut, Complications, from more one-dimensional books. Gawande draws us through gripping scenes and character-driven plots while taking strategic pauses to educate us about medical history or his own psychology. The effect is to build both suspense and resonance, because we want to get back to the action, but we also want the story to be more than a thriller where it’s just one adrenaline-spiked crisis after another.1

Take, for instance, a scene where Awdish’s husband drives her to the new family home he bought in hopes that she could rehabilitate there while they leave their suffering, sadness, and old life behind. It would be cloying if all she felt was love and gratitude, but Awdish leans to the other extreme, emphasizing suspicion and resentment to a confusing degree.

“Did you have me sign something, when I was drugged?” I asked, sounding more accusatory than I had intended.
“You had just lost the baby, and I couldn’t stand the idea that you might lose this house, too, so yes. Even though you weren’t in the best shape, I had you sign papers so that we could buy it. We can rip them up now; you don’t have to worry.”
I allowed that maybe he wasn’t a complete sociopath who was trying to take advantage of me. Maybe.
…
“So which house did we end up buying?” I asked…
“We got the one that you really loved.” He beamed with pride.
“Oh, wow. Great.” I forced enthusiasm. I had absolutely no idea which house he was talking about.
We pulled up to the front, and I stared at it. I was afraid to ask questions, knowing I might disclose my total lack of attachment to this particular house.

This would be the ideal moment for a thought experiment about what it might have been like for her spouse to be keeping a bedside vigil while unwaveringly believing in their future together. The voice of experience doesn’t need to bright side messy memories or deliver a cheery homily, but it can add texture by considering multiple interpretations of the same moment, or acknowledging truths that a self immersed in illness cannot see. Failing to do so interrupts the narrative dream.

It’s not that I expect Awdish to gush over her husband in this moment, so much as to layer what she sees now over her unenthusiastic response then. It doesn’t feel like the whole story or even a good faith approximation of the whole story without that depth.

I feel similarly in later chapters as Awdish rides another roller coaster of hope and fear, undergoing surgery yet again while pregnant, and watching her son struggle with his premature birth and delayed development. It’s an impossible and miraculous outcome, and no reader can remain unmoved at Awdish’s recitation of Walt Whitman, her baby’s namesake, as she rocks her son in their new home, “I swear to you, there are divine things more beautiful than words can tell.”

Yet Awdish had been hospitalized so many times, sometimes as often as once per month, and had undergone so many tests and surgeries, including the Caesarean required for Walt’s premature delivery, that it seems tone-deaf to ignore the high mortality rate for other American mothers or the barriers that poverty and access to insurance would have posed for anyone else in her situation. If this seems petty or harsh, consider that the foremost responsibility for a narrator, in fiction or in memoir, is to be a friend to the reader. That means anticipating potential confusion — not pandering to a reader’s prejudices or people-pleasing to the point of dishonesty, but making an effort to see beyond the self’s blinkered view.

The sad fact is that most American women who suffered a burst tumor in their liver would die long before they reached the operating table. They would not be admitted to the same hospital where they worked and where their colleagues would bring a heightened urgency to their care. If they were lucky enough to survive, very few could afford the care necessary to recover, much less attempt a second high-risk pregnancy. Assuredly Dr. Awdish had some of these thoughts, but they are mysteriously absent from the narrative.

The voice of experience doesn’t need to sermonize or strike overly performative poses to weave in acknowledgements of privilege. The simple effort to see beyond personal experience often has a profound impact, even if used with a light hand.

In Shock often lacks these larger insights, but Awdish makes up for those gaps with her mission to transform medical communication, particularly the ways her own residents listen and hear and speak to (and about) their patients. Indeed, her most powerful message is that doctors need to learn how to listen and hear themselves.

Medical communication

Halfway through In Shock, long before she is fully recovered, Dr. Awdish brings her message of better communication back to work. Her first case is a woman suffering from HELLP syndrome, a serious and often fatal diagnosis that Awdish herself had been mistakenly given during her ordeal. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. All her medical team can see or hear is the lab numbers, imaging results, and prognosis, but Awdish takes pains to hear the deeper story.

This was a woman who had one single day with her baby and now was perilously close to death, her body cascading before us in an ever-deepening downward spiritual, with her mother holding vigil at her bedside, her husband and father in the waiting room. What was missing, I realized, in his reporting of her case, seemed to be 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.

Awdish asks a question that no one has considered medically relevant: “What did she name the baby?” This is more than bedside manner — personal connection can affect the whole tenor of care, the body’s response to illness, even the information available for diagnosis. If her residents have only been taught to hunt disease and exalt themselves as warriors against death, Dr. Awdish resolves to model better communication for them.

When her team cares for another maternity patient, this time a woman who is comatose and has not yet delivered her child, Awdish shows zero tolerance for the resident who asks, thoughtlessly, “Do we know who is going to get the baby when she dies?” She orders him out of the room and asks another team member to complete the test he’d been conducting.

In moments like these, Awdish layers the voice of experience over the scene masterfully.

While the team was increasingly thoughtful with regard to what they said directly to patients, they lapsed in those times when the involvement of the patient in the conversation was less clear. The conversations that occurred around rather than with patients; patients who couldn’t participate or who had clouded mental acuity due to medication or illness. It was the arrogance in these conversations that galled me, an arrogance amplified by the abject vulnerability of the patient…. In my mind, the carelessness of the resident’s conversation revealed what little regard he had for the potential impact of words on the broader context of patient emotion, healing and recovery.

Interhuman carelessness imperils not only patients, but doctors themselves. Dr. Awdish recalls at least two suicides from among her cohort: colleagues she believed had been shamed into burying their stories of failure or weakness and who had ultimately died of that silence. After years of telling her own story so openly, both in print and in public, Awdish has encouraged others to confide their own experiences in her. She often receives emails, letters, and handwritten notes — all from colleagues desperate to know that they are not alone.

This is an inspiring legacy and assuredly better than the stoicism doctors have been taught for generations.

However, I am stunned by other silences in Dr. Awdish’s book. The very thing that she says is needed in medicine — humility in the face of mortality, emotional intelligence and understanding, space for sharing and absorbing each other’s stories — is what the humanities teaches. It’s why Billy Collins joked that when you major in English, you major in death. In fact, many medical schools have intentionally woven medical training and the humanities together under the name “narrative medicine” since the late 1990s. At least a decade before that, the M.D. program in Hershey, Pennsylvania, was the first in the nation to embed humanities requirements into its four-year curriculum.

Yet humanities courses are precisely what universities and medical schools are purging ruthlessly from their catalogs.

Awdish belongs to a tradition of medical writing with a long history, but In Shock perplexingly frames her revelations as new. As a result, reading her book often feels surreal, like listening to a fourth-generation immigrant discovering their ancestral tongue without any apparent knowledge of the cultural history that came before.

Despite my sympathy for everything Dr. Awdish has endured and the inspiration she has brought to others through her teaching, writing, and public speaking, I have little faith that her message will transform medicine, in part because none of the medical prophets that preceded her have succeeded in doing so, but also because her own vision is too narrow.

Near the end of In Shock, Awdish shares an anecdote about how interviews for residency have changed at some hospitals. Instead of candidates explaining, in traditional interviews, why they want to be a doctor and how their research has prepared them for this calling, she describes a scenario in which two candidates must sit back to back as one instructs the other how to assemble LEGO pieces into a particular shape.

This is supposed to be an encouraging example of evaluating doctors on their communication and listening skills rather than their resumes. But I find it appalling.

Patients aren’t piles of LEGO pieces to be put back together in a predetermined shape. Disease itself is embedded in complicated social, cultural, and religious contexts that can’t be isolated from diagnosis, treatment, or healing. Doctors who can tell each other how to complete puzzles and listen closely enough to collaborate on practical tasks like that are still woefully unprepared to face their patients’ suffering and grieving, much less their own mortality and human frailty.

But perhaps no amount of reading and writing can make a doctor into a healer. This might be the enduring truth of In Shock, that every generation of Western physicians must learn these lessons by being broken anew, the way a shaman can only truly nurture the sick after having been brought to the threshold of death himself.

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