In two thousand and something (we’re never given an idea of dates in the book, meaning we’re always slightly disoriented in time, as if we’re drifting in and out of a coma in intensive care), Dr Rana Awdish was admitted to the Detroit hospital she worked in and came pretty much as close as is possible to death. A mass in her liver ruptured during pregnancy, a vanishingly rare event, and her entire blood volume leaked into her abdomen. She very sadly lost her baby, required multiple major operations and went on to accumulate a royal flush of every imaginable medical complication, from septic shock to stroke.
Somehow, against gargantuan odds, she not only survived, but came out of this ordeal neurologically intact, and is now back working as a medic and educator. Dr Awdish’s telling of this story is tense, powerful and gripping, and her writing style is often nothing short of beautiful – evocative and emotional. I actually found some of it harrowing to read, being a former obstetrician who left the profession after a patient of mine had a similar “suicidal spiral of the blood”, but with an even more tragic outcome.
Reading the book, I felt a constant sense of relief that she wasn’t a patient under my care, needing months of microscopic medical management to keep her from the brink of death, until she miraculously and happily pulled through. But also relief because only about half of In Shock tells this story – the rest, though still extremely well written, amounts to a huge customer service complaint about the staff who looked after her.
Her overall thesis is a good one: that doctors must never lose sight of their humanity, that it’s all too easy to disconnect from patients and forget how they must be feeling in hospital, that patients are all humans first and foremost. The examples that led her to this conclusion, however, are often difficult to get fully on board with. She lays into a junior doctor whom she overhears innocently saying to a colleague that she had been “trying to die on them”, and Awdish describes this as a profound absence of empathy.
As she was circling the drain and doctors were trying everything to save her life, she recalls hearing a doctor using the phrase “circling the drain” and you can feel her shaking with fury as she all but calls for his execution. “You really scared me,” says another doctor to her about the night she nearly died, to my mind expressing their human side – cue another angry rant about the language used. Awdish suggests alternative, more caring phraseology at various junctures – but I struggle to imagine many doctors saying, “that’s a really good restatement of the issue” in the acute scenario.
After the first few complaints, I found myself rethinking the doctor-patient relationship. By the end of the book, I felt like a restaurant manager nodding and smiling as the customer identified endless nano-faults with their triple-Michelin-starred meal. In an American accent, naturally.
Perhaps it’s because I read In Shock when our own poor NHS is suffering so very badly – when A&E staff are prioritising which critically unwell patients will get a bed and which will have to chance it in a corridor for an hour or four. Perhaps I am an old-fashioned dinosaur of a doctor, and incapable of accepting certain home truths. But I suspect an element of it is that Rana Awdish was, in her own words, rather too “pathologically controlling” as a patient.
Adam Kay is the author of This Is Going to Hurt: Secret Diaries of a Junior Doctor
• In Shock by Rana Awdish is published by Bantam Press (£14.99). To order a copy for 12.74 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99
