Listening to the dialogues of other caring professions about ultimate matters is one of the best—yet frequently neglected—ways to grow in ministry. Pauline Chen’s Final Exam: A Surgeon’s Reflections on Mortality (New York: Alfred A. Knopf, 2007) offers a candid portrait of one accomplished surgeon’s struggles both with the death of her patients and the acceptance of her own mortality.

Chen’s uneasiness with death first became clearly visible when, as a medical student, she encountered the dying and the dead on her earliest rotations on hospital wards. As she confesses,

But dying patients were a different matter. It seemed that to those about me . . . dying patients were clinical events. I tried desperately to be like the older residents—“Great! Another code! Another opportunity to learn!”—but seeing patients die bothered me.

I probably never would have admitted it to anyone back then, but I did not believe that death was merely clinical. In my mind dying had as much to do with fate as biology. I had even thought about my own death in these terms.

Try as I might, I could not act like my residents. That great passing of life was too sacred; it was nearly magical. Death was an immutable moment in time, locked up as much in our particular destiny as in the time and date of our birth (46-47).

Throughout two decades of medical training and clinical practice Chen finds herself entangled with medicine’s “essential paradox”: “a profession premised on caring for the ill also systematically depersonalizes dying” (xiv). As Chen straightforwardly declares, “we physicians have lost insight into our own dysfunctional anxiety and how that anxiety has in turn become immortalized within our medical system” (73).

In ministry the depersonalization of death occurs in both clinical experience and eschatological expectations. The outcomes for both medical and ministerial carers turn out to be strikingly similar. The initial self-protective strategy of self-distancing (ironically paralleling decathexis among terminally ill persons) results in the coldness of isolation, rather than the warmth of compassionate presence. It seems that the patient is not the only one who is “dying” emotionally here.

Among the many powerful stories Chen shares regarding her formation as a gifted and person-centered physician, the final years of her Aunt Grace vividly reveal the importance of relationships in any attempts—whether through medical or spiritual care—to relieve suffering. Chen had long realized that her Aunt Grace, beloved from childhood, was dying. As Chen was discussing with Grace a medical article Chen was writing that included her aunt’s story, Grace weakly gasps: “I only want one thing [in your article]. I want you to emphasize your uncle and cousin. . . . They have been here for me always; they have listened to me always” (138). Grace mediated through caring relationships of service is God’s gift to our human suffering of mortality.

Charles J. Scalise is professor of church history at Fuller Theological Seminary in Seattle, Washington.