Cover Image: I've Seen the End of You

I've Seen the End of You

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W. Lee Warren is a Christian Neurosurgeon who treats patients that have GBM, a brain tumor with a basically 0% ten-year survival rate. At the start of an operation he says a prayer. His moment of silence acknowledges the immensity of the task. “The place I’m going is holy, and the job I’m doing is sacred and dangerous and beautiful and delicately violent.”  

     Warren’s writing captivated me in the beginning. “Brain tumors don’t just steal your life. They let you know they’re eating up bits of who you are, taking away your ability to engage in the few and precious remaining moments you have on this planet. They hurt you, main you, wipe out your command and control centers like enemy missiles before the ground invasion. Shock and awe on your nervous system.” He writes of his battle between faith and knowledge. “How can I pray for God to heal someone of something no one ever survives? How do I ask God for something he never does?”      

     The battle continues. “The ICU is a place where in every room, desperation and hope slug it out to see who’ll be the champ. Beeping monitors, hissing ventilators, and humming IV pumps push their notes into the air, mingling with the stale hints of iodine and body fluids and waning faith.”  

     Warren gives clear simple explanations of complex tests and diseases. You can tell he enjoys his patients, just not the news he sometimes has to give. He knows how to tell a good story and let you into the patients’ lives. He even describes Nutella, “a heavenly hazelnut delight,” as one of God’s ways of saying how much he loves us.” 

     By the second half, the story became very heavy. The writing became more philosophical than medical or personal drama. The writing sometimes tipped toward the cliché : ”... following a road in the dark and encountering obstacles and difficulties but somehow still knowing that the only way out is to keep walking.” “Believing there will be a light, even just a crack in the door, is how we keep moving.” “Life is a series of beautiful moments interspersed by great trials.”  It felt like the book was getting preachy by the end.  

     Thanks to Netgalley and the publisher for providing an ARC of this book in exchange for an honest review.
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Quite the page turner, and very heartfelt. While I personally may not share the same beliefs, I can see where the writer is coming from.
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“The most important surgery I would ever perform would be the stitching together of my faith, my doubt, and the things I thought I knew.”
– Dr. W. Lee Warren

Dr. Lee Warren knows much about glioblastoma, a form of brain cancer, because he’s a brain surgeon who cuts it out. The bad thing about glioblastoma for Dr. Warren is that it’s almost always fatal. So when he sees glioblastoma show up on your brain MRI, he has to be the one to tell you something. To be honest. Yet still give you hope.

And choosing which words to say is a heavy weight on him.

It bothers him so much that he wrote this book about how to deal with it. About how to “pray for God to heal someone of something no one ever survives.” And I highly recommend it.

If the intersection of doubts and faith weigh on you as well, Dr. Warren’s words may help you, too.

It’s a book of stories, but it contains a faith thread from beginning to end. When we believe God is good, yet we see bad things happening, we can question our faith in who God really is. Dr. Warren wrestled with this as he worked on one patient after another, and lost one patient after another.

But then a deep tragedy occurred in his own life. And all his doubts surfaced to a new level. “Did I really believe, or did I believe I was supposed to believe?”

Instead of insisting on certainty in every aspect of his faith, he made peace with his doubts. He even came to see the necessity of doubts. “I have learned that doubt is not the enemy of faith. The enemy of faith is often the things we think we know.”

Thinking we’ve already arrived, that we already know it all, can be the end of us. But doubting? Doubting can keep us pushing forward to learn more.

Dr. Warren says,

“Doubt is not fatal if we recognize it for what it is: a smudge on the lens. When we realize that, wipe it clear, and put the glasses back on, we’ll be okay. The things we think we know are more like cataracts. They can obscure and blind us to the truth of God’s work around us that is plain to see when our eyes are healthy.”

While there are things we can know and rely on as foundational truths, there are other things we think we know but that aren’t reliable. Those are the things I’d rather doubt than *know* because they prevent me from seeing the real truths.

But how can we know the difference between the two? That’s our work to do. This book helps. 

My thanks to WaterBrook Multnomah and Net Galley for the review copy of this book.
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So actually only God can see how and when we will die in the end.

The author, W. Lee Warren MD, says as much by the end of his book “I’ve Seen the End of You”, but as a brain surgeon, he certainly had a pretty good idea how and when his patients would die, especially with certain brain cancers, or with a gunshot to the head.

This is a very interesting book, because it is not written by the person dealing with these often fatal situations.  This book is written by the brain surgeon treating them.

Dr Lee Warren tells the stories of several patients.  He tells about the symptoms that brought them to see him.  He tells about the diagnosis, the probable outcome, the treatments prescribed, and even the attitude of the patient.  He tells about the end of them, or of the survival in some cases.  These are fascinating stories, and the Doctor gives his insights in each case.  He gives us the inside story, from the doctor’s point of view, not just the facts, but also the emotional problems of being a brain surgeon.

Through it all, Dr Warren discusses his struggles with his faith.  This Doctor prays with his patients, even when he is pretty sure he has seen the end of them when he looks at their brain.

Although I didn’t have brain cancer, I had cancer that returned two more times.  I was close to death a couple times, but survived.  I understand the challenges of cancer and going through treatments.  I understand the struggles with faith, although I never blamed God for the cancer.  I also know that God healed me through an exceptional cancer doctor.  I know there are some doctors, like Dr Warren, who take a personal interest in their patients, and do everything they can to help them.   My experiences made me want to read this book.  I am glad I did!

Dr Warren wrote this book to help people keep their faith when they deal with serious illness.  He wrote this book to help reduce their emotional pain, and help them hold onto hope.  He also wrote this book so he, himself, could confront his faith and decide if he still had faith in God or not.

Late in the book, there is a huge twist to his story!  Doctor Warren experiences a death he didn’t see coming.  He was blindsided by life and death.  In the ending of this book, the Doctor wrestles with his faith, and finds it strengthened.  His faith is restored.  I was really happy to see that!  

I highly recommend reading this book!
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I've Seen the End of You by W. Lee Warren, M.D. is a sincere look at the complexities of being a physician. Told from the perspective of a neurosurgeon, this book does a great job and making a window into this profession and the emotional impact of it. As the wife of a physician, I appreciated the author's book and felt that it rang true to what I've observed. I highly recommend this book! I received a digital copy of this book from the publisher with no obligations. These opinions are entirely my own.
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In I've Seen the End of You, a modern day version of the Book of Job,  Dr. Warren struggles with the problem of explaining the existence of human suffering in a divinely governed or morally ordered world. This is the perennial theodicy problem which is at the heart of every major religion. Basic to all religious belief is the conviction that one will receive benefits from the sacred realm in keeping with one's moral behavior. Worship and sacrifice will lead the Gods to return blessings in equal measure.  If  people engage in behaviors that are pleasing to the Gods, they will be rewarded.  Bad behavior will result in punishment. Retributive justice decrees that those who do good will receive good from the Gods, and those who do evil, evil from the Gods..

As Dr. Warren, in his role as a scientist grounded in empiricism notes throughout the book, the issue here is the following: Does human experience validate this religious dogma? Or, does experience prove just the opposite?  That is, sometimes good people are punished and evil people are rewarded.  Does experience teach us that these dogmas are pious frauds? Although religions would like to operate on the principle of retributive justice, experience, at least on earth, is to the contrary. Bad things such as glioblastoma do happen to good people and good things  (e.g., living a long and healthy life) happen to bad people. In addition, most religious believers would not want to deny to God: (1) absolute goodness (omnibenevolence), (2) absolute power (omnipotence) and  (3) absolute knowledge (omniscience). Experience teaches that there is evil and suffering in the world. Why would an all powerful, loving, and good God not do something to help combat suffering that is the result of genocide, war, and even cancer? This is the heart of the theodicy problem.  How can we reconcile the existence of an all-powerful and loving deity with suffering and injustice on earth? Dr. Warren faces the theodicy problem daily in his role as a neurosurgeon but even personally as a parent, in the loss of his son at a young age. 

Dr. Warren notes that there can be several responses to the theodicy problem.  One needs ultimately to decide which solution works best for them. For Dr. Warren, faith in God gives him hope and comfort in dealing with the theodicy problem. Suffering is only temporary, even if it lasts a lifetime in this world. If you have faith in God you will have access to salvation and eternal life. From a cosmic perspective, earthly suffering is short lived. Yes, it looks like the good die young but it is only a small glimpse of the entire cosmos.  Although people look like they suffer now it is only temporary. In return for suffering in this life, people will be rewarded in the next. Dr. Warren has faith that he will be re-united with his son in the next life. Dr. Warren's faith is admirable and Jobean. He faces the theodicy problem daily in witnessing the suffering of good people diagnosed with glioblastoma and continues to have unwavering faith in God.

Dr. Warren, on the other hand, is also a realist. He discovers from his own personal experiences that there is no retributive justice in the world. We don't live in a rationally ordered universe. We want to be reassured that we live in a stable, orderly world. That we live in a fair world, that people get what they deserve. However, our attempts to impose reason on the world will fail. No everything happens for a reason. We live in a world in which things can happen at random. We don't live in a morally ordered world. There is no link between how people live and what happens to them.  Dr. Warren learns, like Job, that God's authority is ultimate, inexplicable, and not bound by contracts.

For Dr. Warren, it is left to humans to make something meaningful and positive out of the theodicy problem. Why did this happen to me? God cannot help us here. No one can explain why suffering and evil exist. There is not a one size fits all answer to why we suffer. Each person has to answer this question for himself. Each person has to undergo the search for meaning alone. We cannot control what the world does to us, but we can always control how we choose to respond to what the world does to us. 

Dr. Warren discovers for himself that religion can help us in how we respond to suffering. Perhaps, God can be found in the miracle of human resilience in the face of the world’s imperfections, even the world’s cruelty. In people who manage to make a meaningful life in spite of experiencing the worst of tragedies. Theologian David Ray Griffin once said “I believe God is all-powerful but his power is not the power to control; it is the power to enable." 

What does he mean when Griffin says, 'God is all powerful but his power is not the power to control?' According to rabbi Harold Kushner, God designated two areas of creation over which He ceded control.  The domain of nature and natural law. As we noted earlier, the natural world follows its own laws. Hurricane Katrina was not God.  It was blind, uncaring nature. Glioblastoma is blind, uncaring nature in the form of a mutation.  The second area that decreed off limits to God's  intervention is the human freedom to choose between good and evil.  The book of Job celebrates God's awesome power but recognizes self-imposed limits on that power. God can’t prevent some things from happening but he can enable us to cope with them.”  What would be your answer to "Why me?"
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I was not sure I would be able to read this book as I have experienced firsthand, the heartache and loss associated with GBM.  While reading about the experiences of Dr. Lee and his patients was extremely emotional for me, I was also acutely aware of how much care and compassion Dr. Lee had for his patients.  It is rare for faith and science to converge without questions and without spiritual and intellectual struggle.  Dr. Lee paints an honest and straight-forward picture of what those struggles looked like in his own life both personally and professionally. Dr. Lee gives his readers permission to acknowledge our doubts while simultaneously encouraging us to continue to fight for our faith.
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Here is my problem with a star rating system:  for me, this book was average which meant it kept getting set aside while I read other books that I was more interested in.  But there's nothing specifically wrong with the book.  Someone else could validly rate it much higher.  I did appreciate Warren's honest questions about God's presence in suffering; I also really appreciated both the answers he came to and his willingness to let mystery remain.  But, it remained a book I could pick up and put down, so I end up giving it just three stars.
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While very well-written, I've Seen the End of You, by W. Lee Warren, M.D. didn't really resonate with me. Dr. Warren is a brain surgeon who tells very moving stories of patients he's treated (although he's changed some details in order to protect their privacy). As you'd expect from the title, he often realizes during the course of treatment that his patients are not going to survive. He literally thinks to himself, "I've seen the end of you."

As a man of faith, Dr. Warren says he's struggled at times to reconcile his beliefs with the almost insurmountable odds brain tumors and other injuries and traumas present. That he's able to continue his work as a healer and hold onto his faith is highly admirable. 

I did feel that the author sometimes seemed to wander and repeat himself. The book might have been more tightly edited.

Nevertheless, it's a recommended read for anyone who is concerned about facing the end of life--your own or someone else's--and that pretty much includes all of us. The author knows that faith doesn't shield us from the very worst things that can happen, but he does give us hope by pointing out that hope still exists.
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I received a copy of this book in exchange for my honest review.   Thank you NetGalley.

What a beautiful, touching read.    You won't regret reading this book, seriously.    It really stuck with m.e
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This is my favourite type of book.  This memoir also had a helping of theology. 

Beautifully written with powerful chapters.  I couldn't put it down, read it in one sitting.  

W Lee Warren MD is a neurosurgeon and this memoir is about not only his career but also his family and his struggle with his faith. 
 
Highly recommended.
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his is one of those books that you find yourself taking a few deep breaths and eagerly turning pages to find out what will happen next. I have never read a book with this much vulnerability and honesty about doubt, pain, and wrestling with God.

This was such a compelling read. I don't often find memoir type books to be so compelling. But I couldn't put it down. I found myself sticking the book in my purse in case I had an extra moment to read while I was out and about and picking it up at every spare moment I got at home. Perhaps it's the psych major still in me or the person who has been questioning my own faith after a period of incredible turmoil in my life. Whatever it was that compelled me to read, I'm so glad I did.

I've already suggested this to a few folks and will continue to do so. I think it's an excellent read and one that could speak to people in whatever season of life they are in. As other reviewers have stated, you may need to skip over some of the medical details if those things make you squirm. But overall this book is a wonderful read and I hope you'll get a copy for yourself.
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As much as I'm interested in neuroscience, I was skeptical, when I read in the blurb, that this memoir also deals with religion. But I have to say, that for the most part of the book, I found it very interesting how Warren, especially as a doctor who is constantly confronted with deadly diseases, struggles with his belief himself.
This gave a great insight into the work as a neurosurgeon and I really enjoyed reading it, even if that is definitely not the right word to use on this topic. This is not a book for the faint-hearted, because the author doesn't sugarcoat his work and the diagnoses he has to deal with, which are most of the time lethal. But I really appreciate that and his honesty, that's what I expect from a book like this.
The only criticism I have is, that in the end exactly that happened, what had been pleasantly avoided beforehand, that is to say the writing gets a preaching attitude. And also the unavoidable flower that struggles through the asphalt had to serve as a picture (I saw it coming and my plea of avoiding it died away unheard). Also I had some trouble with some of his descriptions/opinions about war and I also wished he would have dealt with the description of mental health problems in a more sensitive way. For me it seemed like not only his profession, but also his faith stood in the way of dealing with these things differently. That was a pity, but overall I would recommend this book and you can also read it if you are an atheist or an agnostic.
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Part memoir and part theology,  I've Seen the End of You is an amazing story of the life of a surgeon who is constantly exposed to life and death just by the nature of his job. Filled with insights for spiritual living, hope, and compelling stories, I could not put this book down until the very last page.
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Wow.  What an inspiring book.  As a nurse of 20 years, I have yet to run into a physician that thinks like the author did.  The stories in the book will cause you to think and ponder about things, including life.  Amazing life lessons are also woven throughout this book.   This was definitely a tearjerker read and I was also able to get some more book suggestions while reading this book.  The author did a great job with the information set in the book.
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I can appreciate the beauty behind this book. As a stroke survivor I know how much of a struggle it can be to navigate the world when you are afraid, and feeling alone. This was a book I wanted so badly to LOVE I wanted to pick it up and breeze through it and find some profound insight into the medical world coinciding with the worlds of faith. I just... didn't. Sadly I just didn't connect with this book in any way that was memorable and I ended up just not wanting to read it.
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When a neurosurgeon sees the MRI of a patient with the most cruel form of brain cancer, they know. They can say the have seen the end of you. But might it just be possible that even once in a blue moon they are wrong? And is that really the point, anyway? 

These are just a few questions Dr W. Lee Warren answers in his book. Through his experiences with patients, the traumatic incidents, the heartbreaking moments, but also the heartwarming ones, Dr Warren gives us a glimpse into the life lessons he's learned through his patients' stories - but also through his own.

Dr Warren tackles the very difficult issues of life with a terminal illness, and how a person can still be filled with hope and faith to a greater power, even under those circumstances. Can you keep your faith even when you can see the end of a person, right there, clearly, on an MRI? Can you cope with random horrible things happening to you and your loved ones with no rhyme or reason?

I've Seen the End of You isn't a book about answers. Neither is it a book about medical technicalities. Instead, it's an honest, heartwarming account of a doctor that lays out his own thoughts for the world to see. And maybe, through that, he can give the readers a soft nudge so that they can question their own perspective on life, death, hope, and faith.
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This is a thought-provoking and powerful read. W Lee Warren MD writes about his career as a neurosurgeon, his family and his faith. These are powerful stories of his patient’s journeys after their diagnosis with brain tumours, almost all of them ending in death. It’s sad yet reaffirming. All the stories are told with empathy and honesty, but Joey’s was a standout for me. 
Warren talks about his own struggle to reconcile his faith with the suffering he watches his patients endure. In the second part of the book Warren shares the tragedy the engulfs his own family. It is beautifully written and interspersed with quotes and reflections from the Bible, literature and contemporary culture. 
 It’s not a book I would normally choose for myself, but I am really glad to have read it. Highly recommended.
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Books about brain surgery and fatal forms of cancer usually aren’t my first choice when I look for my next read; however, the title of this book intrigued me immediately. After reading the description of the book, I knew I wanted to read it, and I am so glad that I did. 
I have often wondered if doctors are men or women of faith, and if they were how their faith integrated with the constant presence of science surrounding them. How difficult is it for a doctor to know what science says regarding a patient’s diagnosis and know that a patient will not survive based on the scientific evidence, but then cling to their faith and know that God is a God of miracles and can do the unthinkable? Dr. Warren did an amazing job showing how one can be both a doctor and a man of faith.
My favorite part of this book was how authentic his patients became for me as the reader. I found myself completely engulfed with each patient and the course of their treatment. I cried tears of loss at their passing’s and felt frustration and anger at why God would allow something like glioblastoma to take good people away and tear a family apart. Even now as I think back to the patient’s, I still ache for their loss. 
Throughout the book, Dr. Warren sees many patients all with the same diagnosis. As a man of faith, he knows that this cancer will kill the patient, yet he offers hope and prayers, often praying with his patients before procedures. This one act is so encouraging to me. How wonderful that there are doctors that are willing to go before God’s throne on their knees in supplication for their patients, even though science and all other signs are pointing to their death. This one act shows that Dr. Warren knows who has complete authority over someone’s life. 
As Dr. Warren loses some of his patients, he sees the families that remain thrust into grief. As the Lord would have it, Dr. Warren experiences loss of his own and comes face to face with the feelings his patients and their families are left to deal with. Why God? Why would you take a good person? Aren’t I a good person? How could you do this to me? I love you and I thought you loved me?
This is not my typical read, but I am so glad I read this. I loved the flashbacks to Dr. Warren’s time in the war. Dr. Warren has a genuine voice in his books that not only makes for an easy read, but also a voice of hope and knowledge. Knowledge that we can’t necessarily change our circumstances, but knowledge that we have a God that carry us through those circumstances.
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This book was an emotional rollercoaster.  I teared up and started to cry at least half a dozen times while reading this book.  It pulled NO punches when it came to the question of why God would let these things happen.  It also didn't pretend to have all of the answers.  None of us know why, none of us are guaranteed a safe and happy life when we follow the Lord.  All we are guaranteed is that He will be with us every step of the way.  It's up to us to accept His presence or not.  And we can choose to be angry, to turn our back, to deny.  He won't force himself onto us.  

What this book brought home to me, was that God is the God of second chances.  There was a character who was a drug-user, full of anger and pain and hate, who had an obvious second chance, while a good, God-fearing man had no chance.  The God-fearing man didn't need the second chance, but the drug-user did.  The book didn't say that, but that is the lesson I took from the book.  

Jesus hung out with the sinners, the tax collectors, the fallen women, because they needed Him, needed that second chance.  They didn't deserve it, but they got it.  Which gives me hope.  Doesn't make it seem any less fair when a young father of three dies from brain cancer, but I'm not privy to God's plans.  

This book is HARD reading.  It's honest, but hard to read.  Not just the emotional parts, but also where he's discussing his work cutting away bits of brain and other medical things.  I'm not into bodily fluids and medical stuff.  Thankfully there are people out there who can and do that stuff, because if the world relied on me for that, we would all be in trouble.  

This book may not be for everyone, but it is interesting reading how a neurosurgeon who is also a Christian tries to reconcile his faith with his profession and the sadness that he sees too often.  Recommended for those who are questioning and for those who think they already know.  4, there is hope, stars.

My thanks to NetGalley and WaterBrook & Multnomah for an eARC copy of this book to read and review.
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