Fascinating, Joshua. Sounds like this could’ve been a much better memoir had she worked with a great editor, say, you for instance. 😊 I’ve just finished listening to The Telepathy Tapes podcast and all the extra episodes exploring human consciousness. It does get into near-death experiences, which is such rich terrain begging to be explored.
Your point about her critique of the lack of humanity in medicine being a new revelation to her is so telling and ironic. The training turns whole humans into narcissists with outsized confidence.
In fairness, I have no way of knowing how much of her original manuscript was dumbed down by a commercial editor. Dr. Awdish is a reader of Haruki Murakami and named her son after Walt Whitman, so it's not as if her taste is lacking! It's possible that she told a more nuanced story and then was urged to simplify it for a broader readership. But it's another example of how aesthetic standards seem to have declined in recent years. Danielle Ofri, Perri Klass, Richard Selzer, and Atul Gawande are all stronger stylists. Damon Tweedy, too, writes more layered essays.
I haven't read this book, but what really jumped out at me was when you described her writing as, "this happened and then this happened and then this happened." It jumped because that is exactly what happened the first 10 or so times I tried to write about my experiences during COVID. For some reason, I couldn't write it differently. Eventually, with the help of someone else to edit it, I was able to write something that was both more artistic and more therapeutic. I wonder if I looming deadline kept her from getting past the sort of numbed, trauma recollection to a more integrated perspective.
Ah, interesting. As I note above, it's possible that this is an artifact of commercial editing, with an eye toward maximizing sales, not sophistication. The accordion of time is another technique that would add considerable depth to a story like this. Atul Gawande uses that tool masterfully. Not every scene is worth drawing out for several paragraphs. Sometimes we need to press the fast forward button to cover some ground, then linger on the more portentous moments.
Jessica Abel, the graphic novelist, once told my class that prose writers violate a basic principle for cartoonists, namely, that every scene is set in the middle distance. A visual artist instead thinks about zooming up close to the hands writing in a notebook, out to a living room with a character on a sofa, and sometimes to the bird's eye view of a whole town or mountain valley.
We don't want public speakers to drone on with a monotonous tone. Variety is the spice of any story, and this book could use more of it.
Thank you so much for this thoughtful critique! I teach essay-writing classes to medical students and your piece gets at some of the dissatisfaction I've been feeling with the genre of "physician narratives." I will be thinking about this for a long time...
Ah, so glad it landed! I'd love to talk more about your teaching. I taught medical humanities courses for many years and miss it greatly. Have you assigned any Richard Selzer, Danielle Ofri, or Atul Gawande in your classes? The subject is close to my heart, because I wrote my dissertation on doctor characters in American literature. Oliver Wendell Holmes was/is a fine essayist, too, and played a considerable role in convincing the public (through his writing for The Atlantic) that experimental medicine was superior to the old speculative way.
I like your boldness in this review Josh. I don't have the courage to be as critical as you, perhaps that's what separates a reader/writer from an editor. For example, I read Cheryl Strayed's Wild and I was bored multiple times and struggled to finish the book. In the end, my only takeaway was I want to hike the Lake Superior shoreline and I'm glad she got to go on a long hike. But, I declined to criticize it in my Instagram post about it because as a writer, I know how much hard work goes into writing a book, it's a lot! So I don't want to put down someone's work. But I was relieved when you were a little critical of Paul Kalanithi's book - true the premise itself of neurosurgeon who's dying while operating on others sold the book - but the book largely in the middle struggled to keep my attention. I will never forget the last paragraph of that book and how heartbreaking it is.
In regards to In Shock, this book felt important to me because no one, at least not a physician, has called out the backwards culture of medicine before in a memoir-style relatable fashion. We all get sick, but not necessarily a critical care physician who can call out some of the flaws in medicine. I don't think that's been done before (if it has please let me know). It has changed my communication style in the hospital. I have used language that I wouldn't have thought of twice before in communicating with my colleagues and this book made me eradicate some of that language. If a book can change my behavior, I think it's a good book.
I do agree with some of your critiques/missed opportunities while acknowledging that if a book didn't satisfy my desire, maybe that's not what it was set out to do. Your notes on innocence and experience struck me, I have to reflect on this a little bit!
Thanks for reading and for sharing your perspective (and for the initial recommendation!).
As you know, I am also a reader and writer, and I don't want anyone taking it easy on me, either. So I suppose I would rather let it rip than play nice, understanding that I deserve the same scrutiny. I suck at the Dale Carnegie methods that the attention economy requires anyway.
You actually reinforce my closing point. There's nothing at all new about Awdish's critique (though her harrowing experience is far more extreme than most). Rita Charon made it over twenty years ago -- that critique was the basis of her narrative medicine program at Columbia. Penn State Hershey was doing something similar before that by requiring their MD students to study the humanities.
In fact, Danielle Ofri's essay "Merced," included in the 2005 Best American Essays, is an even more gripping takedown of medical arrogance. Ofri's memoir "Singular Intimacies" is almost exclusively devoted to improving medical communication, and her second book, "Incidental Findings," emphasizes her experience as a maternity patient, when the roles are reversed. As Ofri notes, when her OB remarks on an "incidental finding" in one of her test results, nothing is incidental to the patient. Like Awdish, Ofri is able to pull rank at times and be "seen" as a patient because she gets care at the hospital where she works. But she also struggles with the power differential once she dons the patient's gown.
Richard Selzer's "Mortal Lessons: Notes on the Art of Surgery" is another classic (published in 1976). Perri Klass's "A Not Entirely Benign Procedure: Four Years as a Medical Student" (1994) takes a feminist look at the macho culture of medical training.
It's really too bad that MDs are not required to take a survey just in medical memoirs, because that is a rich literary tradition of its own!
Josh, I read your essay from several viewpoints simultaneously: that of a potential reader of the book who is not an MD, being fascinated by all the author went through and still lived (overlaid by my own experiences of most serious illness), that of being a daughter of a medical doctor who shared almost everything over the dining room table each day, and that of a person who has also been fascinated by near death experiences and read/ heard interviews with/ and danced seriously close to the edge of death myself.
I am writing this to you from my therapist view pint, so please read with a gentle, curious tone.
What you convey to me in your essay is that the author lacks the certain perspective of spirituality that people have come to expect from NDEs. The medical boot camp style training drains that out of most all MDs awareness.
I am not really surprised at all by the lack of circling back.
My 33 years as a psychotherapist has taught me that many people do not have the connection to spirit to reflect on the level that would have been a more nourishing read for you. And in this case, this is a doctor, not a spiritual leader. In the context of her being a doctor, I’m only too familiar with this style of communication from both my Dad and the five pages worth of MDs I have been seen by over the last five years.
Most MDs are taught to report facts to other MDs with all emotion removed. My comparison of a boot camp is sincere, the people who have a personal connection to MDs who may be fortunate enough to hear the emotional and spiritual insights gained. Yet most MDs have their spirit drummed right out of them.
From what you have shared, the humanity the author shares by sharing unfiltered facts is the most honest depiction of what modern medicine is.
I lived through going on “house calls” with my dad in rural Upstate NY. I watched my Dad remain solid, stoic, factual, direct, and yet kind in every interaction he had with patients. Most doctors are forced to keep moving through all their experiences because there is ALWAYS another patient who needs them next.
I’m be interested to go and read this book myself now. And my suspicion is that the author conveyed exactly what they intended, that being a true medical doctors’s view of their profession by portraying themselves without reflection and their training (including the lego situation). And thereby causing the exact response in their readers that you experienced… surprise at the way MDs walk through the world, not being allowed to spiritually reflect, for if they did, they would surely collapse under the weight of it all.
Always appreciate your take, Tey. Thanks for sharing about your father -- he sounds fascinating. All of this is fair enough, but I'd gently suggest that this isn't just a matter of my taste. Some moments, like an NDE, raise questions for readers that a careful writer will anticipate. To my mind, this is part of keeping a reader (a stranger, who can't be expected to understand insider medical culture) in the waking dream of reading.
There's no way to know about the author's intentionality, but I expect we could have a respectful debate about Dr. Awdish's intention to leave the gaps that I've described. I say this for many reasons, chiefly because she seems unaware (as I said in my comments to Istiaq above) that many of her critiques of medical communication have been made by earlier writers, as far back as the 1960s, perhaps further back than that. Hawthorne makes a similar critique of the clinician in "The Scarlet Letter."
Now, it is possible that I'm asking too much of a trade book. And I would not hold it against you if you find me judgy about these things (I am a discerning reader with high standards -- I own that). But Awdish includes another anecdote near the end of her book that is meant to be part of her grand finale, in which a patient shares a myth about God separating light from darkness, then separating that divine light into ten sacred vessels too weak to hold it. So the shards of light were scattered over the earth, and those shards are us, and we're all trying to piece ourselves back together into that dazzling and unified form.
It's a lovely story if you've never heard it before, but it is also one of the classic passages in Zora Neale Hurston's 1937 novel "Their Eyes Were Watching God." It's a pagan story that has been translated into a Judeo-Christian version in Awdish's telling. I expect most readers won't know that, and I expect that Awdish doesn't, either, which rather punctures the intended epiphany in that passage for me.
My Dad was very fascinating. I wrote about him on Father’s Day in 2024.
Thanks for responding back to my thoughts. I do agree that most people who read about NDEs are hoping to gather information of profound spiritual insight, reflections on the meaning of life, and deep changes in the humans who live thru it.
I mostly imagine that this author is not capable of that level of self reflection, and thus the book might read more like a physicians report of situations instead of an insightful self reflection.
The story at the end is one I am familiar with.. and fascinatingly enough has even been retold (with theatrical interpretation) in a movie Jim Henson created back in 1982 called Dark Crystal. It’s been one of my all time favorites for decades.
Really enjoyed this post, Josh. Especially the part about the soul and death. Have you read, "Graceful Exits: How Great Beings Die: Death Stories Of Tibetan, Hindu And Zen Masters" ? I found that had a lot of depth to it that some of these other NDE books haven't quite captured. Practicing states of consciousness while alive seems to change the experience.
I don't know that book, but thanks for the lead! Death is perpetually mysterious, and I find it odd that Awdish acknowledges some mystery in her own ostensible death and recovery, but doesn't probe the spiritual implications of it very much. In fact, I can't tell much about her spirituality at all from the book (there's some vague mention of the divine and of miracles, but no explicit faith, it does not seem, in divine protection throughout her ordeal). I'm not even sure she believes in a soul? Not that a memoir needs to resolve all of its ambiguities, but sometimes meditating on the mystery a little more adds richness.
Great points. There's her "waking up" level. And then there's the "growing up" developmental stage. How much time did she spend taking wider and wider perspectives before she was on the surgery table? I have a hypothesis that being able to access wider than the room at that moment would have required more practice leading up to that moment. And I could be very wrong. Always curious about these types of topics. Which was a sidebar from your main point about writing. :)
Fascinating, Joshua. Sounds like this could’ve been a much better memoir had she worked with a great editor, say, you for instance. 😊 I’ve just finished listening to The Telepathy Tapes podcast and all the extra episodes exploring human consciousness. It does get into near-death experiences, which is such rich terrain begging to be explored.
Your point about her critique of the lack of humanity in medicine being a new revelation to her is so telling and ironic. The training turns whole humans into narcissists with outsized confidence.
In fairness, I have no way of knowing how much of her original manuscript was dumbed down by a commercial editor. Dr. Awdish is a reader of Haruki Murakami and named her son after Walt Whitman, so it's not as if her taste is lacking! It's possible that she told a more nuanced story and then was urged to simplify it for a broader readership. But it's another example of how aesthetic standards seem to have declined in recent years. Danielle Ofri, Perri Klass, Richard Selzer, and Atul Gawande are all stronger stylists. Damon Tweedy, too, writes more layered essays.
I haven't read this book, but what really jumped out at me was when you described her writing as, "this happened and then this happened and then this happened." It jumped because that is exactly what happened the first 10 or so times I tried to write about my experiences during COVID. For some reason, I couldn't write it differently. Eventually, with the help of someone else to edit it, I was able to write something that was both more artistic and more therapeutic. I wonder if I looming deadline kept her from getting past the sort of numbed, trauma recollection to a more integrated perspective.
Ah, interesting. As I note above, it's possible that this is an artifact of commercial editing, with an eye toward maximizing sales, not sophistication. The accordion of time is another technique that would add considerable depth to a story like this. Atul Gawande uses that tool masterfully. Not every scene is worth drawing out for several paragraphs. Sometimes we need to press the fast forward button to cover some ground, then linger on the more portentous moments.
Jessica Abel, the graphic novelist, once told my class that prose writers violate a basic principle for cartoonists, namely, that every scene is set in the middle distance. A visual artist instead thinks about zooming up close to the hands writing in a notebook, out to a living room with a character on a sofa, and sometimes to the bird's eye view of a whole town or mountain valley.
We don't want public speakers to drone on with a monotonous tone. Variety is the spice of any story, and this book could use more of it.
Thank you so much for this thoughtful critique! I teach essay-writing classes to medical students and your piece gets at some of the dissatisfaction I've been feeling with the genre of "physician narratives." I will be thinking about this for a long time...
Ah, so glad it landed! I'd love to talk more about your teaching. I taught medical humanities courses for many years and miss it greatly. Have you assigned any Richard Selzer, Danielle Ofri, or Atul Gawande in your classes? The subject is close to my heart, because I wrote my dissertation on doctor characters in American literature. Oliver Wendell Holmes was/is a fine essayist, too, and played a considerable role in convincing the public (through his writing for The Atlantic) that experimental medicine was superior to the old speculative way.
I like your boldness in this review Josh. I don't have the courage to be as critical as you, perhaps that's what separates a reader/writer from an editor. For example, I read Cheryl Strayed's Wild and I was bored multiple times and struggled to finish the book. In the end, my only takeaway was I want to hike the Lake Superior shoreline and I'm glad she got to go on a long hike. But, I declined to criticize it in my Instagram post about it because as a writer, I know how much hard work goes into writing a book, it's a lot! So I don't want to put down someone's work. But I was relieved when you were a little critical of Paul Kalanithi's book - true the premise itself of neurosurgeon who's dying while operating on others sold the book - but the book largely in the middle struggled to keep my attention. I will never forget the last paragraph of that book and how heartbreaking it is.
In regards to In Shock, this book felt important to me because no one, at least not a physician, has called out the backwards culture of medicine before in a memoir-style relatable fashion. We all get sick, but not necessarily a critical care physician who can call out some of the flaws in medicine. I don't think that's been done before (if it has please let me know). It has changed my communication style in the hospital. I have used language that I wouldn't have thought of twice before in communicating with my colleagues and this book made me eradicate some of that language. If a book can change my behavior, I think it's a good book.
I do agree with some of your critiques/missed opportunities while acknowledging that if a book didn't satisfy my desire, maybe that's not what it was set out to do. Your notes on innocence and experience struck me, I have to reflect on this a little bit!
Thanks for reading and for sharing your perspective (and for the initial recommendation!).
As you know, I am also a reader and writer, and I don't want anyone taking it easy on me, either. So I suppose I would rather let it rip than play nice, understanding that I deserve the same scrutiny. I suck at the Dale Carnegie methods that the attention economy requires anyway.
You actually reinforce my closing point. There's nothing at all new about Awdish's critique (though her harrowing experience is far more extreme than most). Rita Charon made it over twenty years ago -- that critique was the basis of her narrative medicine program at Columbia. Penn State Hershey was doing something similar before that by requiring their MD students to study the humanities.
In fact, Danielle Ofri's essay "Merced," included in the 2005 Best American Essays, is an even more gripping takedown of medical arrogance. Ofri's memoir "Singular Intimacies" is almost exclusively devoted to improving medical communication, and her second book, "Incidental Findings," emphasizes her experience as a maternity patient, when the roles are reversed. As Ofri notes, when her OB remarks on an "incidental finding" in one of her test results, nothing is incidental to the patient. Like Awdish, Ofri is able to pull rank at times and be "seen" as a patient because she gets care at the hospital where she works. But she also struggles with the power differential once she dons the patient's gown.
https://danielleofri.com/merced/
Richard Selzer's "Mortal Lessons: Notes on the Art of Surgery" is another classic (published in 1976). Perri Klass's "A Not Entirely Benign Procedure: Four Years as a Medical Student" (1994) takes a feminist look at the macho culture of medical training.
It's really too bad that MDs are not required to take a survey just in medical memoirs, because that is a rich literary tradition of its own!
Josh, I read your essay from several viewpoints simultaneously: that of a potential reader of the book who is not an MD, being fascinated by all the author went through and still lived (overlaid by my own experiences of most serious illness), that of being a daughter of a medical doctor who shared almost everything over the dining room table each day, and that of a person who has also been fascinated by near death experiences and read/ heard interviews with/ and danced seriously close to the edge of death myself.
I am writing this to you from my therapist view pint, so please read with a gentle, curious tone.
What you convey to me in your essay is that the author lacks the certain perspective of spirituality that people have come to expect from NDEs. The medical boot camp style training drains that out of most all MDs awareness.
I am not really surprised at all by the lack of circling back.
My 33 years as a psychotherapist has taught me that many people do not have the connection to spirit to reflect on the level that would have been a more nourishing read for you. And in this case, this is a doctor, not a spiritual leader. In the context of her being a doctor, I’m only too familiar with this style of communication from both my Dad and the five pages worth of MDs I have been seen by over the last five years.
Most MDs are taught to report facts to other MDs with all emotion removed. My comparison of a boot camp is sincere, the people who have a personal connection to MDs who may be fortunate enough to hear the emotional and spiritual insights gained. Yet most MDs have their spirit drummed right out of them.
From what you have shared, the humanity the author shares by sharing unfiltered facts is the most honest depiction of what modern medicine is.
I lived through going on “house calls” with my dad in rural Upstate NY. I watched my Dad remain solid, stoic, factual, direct, and yet kind in every interaction he had with patients. Most doctors are forced to keep moving through all their experiences because there is ALWAYS another patient who needs them next.
I’m be interested to go and read this book myself now. And my suspicion is that the author conveyed exactly what they intended, that being a true medical doctors’s view of their profession by portraying themselves without reflection and their training (including the lego situation). And thereby causing the exact response in their readers that you experienced… surprise at the way MDs walk through the world, not being allowed to spiritually reflect, for if they did, they would surely collapse under the weight of it all.
Always appreciate your take, Tey. Thanks for sharing about your father -- he sounds fascinating. All of this is fair enough, but I'd gently suggest that this isn't just a matter of my taste. Some moments, like an NDE, raise questions for readers that a careful writer will anticipate. To my mind, this is part of keeping a reader (a stranger, who can't be expected to understand insider medical culture) in the waking dream of reading.
There's no way to know about the author's intentionality, but I expect we could have a respectful debate about Dr. Awdish's intention to leave the gaps that I've described. I say this for many reasons, chiefly because she seems unaware (as I said in my comments to Istiaq above) that many of her critiques of medical communication have been made by earlier writers, as far back as the 1960s, perhaps further back than that. Hawthorne makes a similar critique of the clinician in "The Scarlet Letter."
Now, it is possible that I'm asking too much of a trade book. And I would not hold it against you if you find me judgy about these things (I am a discerning reader with high standards -- I own that). But Awdish includes another anecdote near the end of her book that is meant to be part of her grand finale, in which a patient shares a myth about God separating light from darkness, then separating that divine light into ten sacred vessels too weak to hold it. So the shards of light were scattered over the earth, and those shards are us, and we're all trying to piece ourselves back together into that dazzling and unified form.
It's a lovely story if you've never heard it before, but it is also one of the classic passages in Zora Neale Hurston's 1937 novel "Their Eyes Were Watching God." It's a pagan story that has been translated into a Judeo-Christian version in Awdish's telling. I expect most readers won't know that, and I expect that Awdish doesn't, either, which rather punctures the intended epiphany in that passage for me.
My Dad was very fascinating. I wrote about him on Father’s Day in 2024.
Thanks for responding back to my thoughts. I do agree that most people who read about NDEs are hoping to gather information of profound spiritual insight, reflections on the meaning of life, and deep changes in the humans who live thru it.
I mostly imagine that this author is not capable of that level of self reflection, and thus the book might read more like a physicians report of situations instead of an insightful self reflection.
The story at the end is one I am familiar with.. and fascinatingly enough has even been retold (with theatrical interpretation) in a movie Jim Henson created back in 1982 called Dark Crystal. It’s been one of my all time favorites for decades.
Really enjoyed this post, Josh. Especially the part about the soul and death. Have you read, "Graceful Exits: How Great Beings Die: Death Stories Of Tibetan, Hindu And Zen Masters" ? I found that had a lot of depth to it that some of these other NDE books haven't quite captured. Practicing states of consciousness while alive seems to change the experience.
I don't know that book, but thanks for the lead! Death is perpetually mysterious, and I find it odd that Awdish acknowledges some mystery in her own ostensible death and recovery, but doesn't probe the spiritual implications of it very much. In fact, I can't tell much about her spirituality at all from the book (there's some vague mention of the divine and of miracles, but no explicit faith, it does not seem, in divine protection throughout her ordeal). I'm not even sure she believes in a soul? Not that a memoir needs to resolve all of its ambiguities, but sometimes meditating on the mystery a little more adds richness.
Great points. There's her "waking up" level. And then there's the "growing up" developmental stage. How much time did she spend taking wider and wider perspectives before she was on the surgery table? I have a hypothesis that being able to access wider than the room at that moment would have required more practice leading up to that moment. And I could be very wrong. Always curious about these types of topics. Which was a sidebar from your main point about writing. :)