The Intern Blues: The Timeless Classic About the Making of a Doctor – A Year-Long Diary of AIDS, Child Abuse, and Medical Training

by Robert Marion

While supervising a small group of interns at a major New York medical center, Dr. Robert Marion asked three of them to keep a careful diary over the course of a year. Andy, Mark, and Amy vividly describe their real-life lessons in treating very sick children; confronting child abuse and the awful human impact of the AIDS epidemic; skirting the indifference of the hospital bureaucracy; and overcoming their own fears, insecurities, and constant fatigue. Their stories are harrowing and often funny; their personal triumph is unforgettable. This updated edition of The Intern Blues includes a new preface from the author discussing the status of medical training in America today and a new afterword updating the reader on the lives of the three young interns who first shared their stories with readers more than a decade ago.

Genres: Medicine, Medical, Nonfiction, Memoir, Science, Biography, Health

528 pages, Paperback

First published January 1, 1989

Reviews

[Petra X · Rating 3 out of 5]

The title is incorrect. The diaries were written in 1985, over 30 years ago, and are very dated indeed. They are also for the most part boring. The three doctors, two male and one female, kept diaries for a year and the book reads like a transcription of them without any meaningful editing.

The uninteresting parts were the personal ones. They weren't very interesting people and they didn't have interesting partners or lives, just very ordinary. Social life has changed a great deal - there is no longer the pressure on women (at least the average American one not from a religion that considers sex before marriage a crime and restricts women's ability to earn a living according to want the men who 'own' her allow). Cell phones and social media aid communication in a way that couldn't be envisaged in the '80s. It was a different world back then.

The diaries were also very repetitious - too much work, not enough sleep, not eating properly, partner not being as sympathetic as they might be.

The interesting parts were the details of the very sick babies (all the doctors were in paediatrics) and children. The amount of work required to keep some babies alive was tremendous, a moment by moment monitoring, nursing care and treatment. And this is where the book really shows how dated it is. There are many more treatments and diagnostic tools now as well as accurate and continual electronic monitoring and reports.

All in all, it just wasn't interesting enough to recommend that anyone devote time to reading it when there are so many 5 star books out there.

[India M. Clamp · Rating 3 out of 5]

A journal-based account of the pediatric internship survived by Dr. Robert Marion where meconium flows and life in the Bronx is explored and retold with putrid details for the children with veils. Sad and true account for those with the luck of being on the left of the bell curve. Is “habitum malus” a way of life in the Bronx?

Updated version does not make this classic any less than the original. The Bronx and its instructive patients remind me of neurologist Oliver Sacks and his Awakenings via L-DOPA. Yet the delta by Dr. Marion is AIDS babies immortalized in text sans rose colored filter. Sadly “Restitutio Ad Integrum” does not come easily.

“My first case was a little 18-month-old with a really bad case of cervical adenitis...and I thought, wow, here I am, a real doctor, with real pathology. Did an LP...commonly called a spinal tap, a test in which a needle is inserted...into the spinal canal.”
---Robert Marion, MD

Little souls of innocence birthed into an environment where child abuse, drug use by families and caregivers runs rampant. Imagine a little girl at three undergoing a private exam who fails to react---as if the intrusion is quotidian and commonplace. On the positive side this helped her into a future safe place from male relatives.

“The Intern Blues: The Timeless Classic About the Making of a Doctor” is somber and Dr. Robert Marion gains compassion in leaving the negatives at the end of the day. The Bronx imparts the lessons needed to become a good physician yet the strength comes at the end of the shift and walking away. Must read for any intern. Buy.

[Mbgirl · Rating 5 out of 5]

Man, I devoured this book. Pediatric first year, learning and barely living in a hospital. Very educational, felt like I was in the trenches, living the harrowed, sleepless, bothered, and tense life of a first year. Scut university....attendings questioning away. Orders written and patients assessed all night long. All of these sorts of books have influenced me greatly, personally and professionally.

[Laura · Rating 4 out of 5]

Well, I finally finished reading this. It took some time, as it is a thick book and I've been pretty busy with school, but I got through it. I thought it was an interesting book and there was a lot I liked about it. From a medical standpoint it was fascinating to read about conditions I had never heard of before. I like how the author explained medical terms in bold; many of them I was already familiar with and the format made it easy for me to skip the explanation and pick the story back up. I liked reading about the different environments in which the interns worked, their feelings on dealing with sick and dying patients, and the effect their internship had on their personal relationships. I loved the sections written by "Mark" as he made me laugh. I think it is crucial for a doctor to maintain a sense of humor, how else could they deal with all the tragedy that sometimes surrounds them?

There were a few things I wasn't crazy about, however. I think it would have been interesting to read about interns in other departments, not just pediatrics. If it covered a broader spectrum, each intern in a different department for example, one could see that the stress and hardship of interning is not found only pedatrics. Maybe if one intern had been in the ER and another in geriatrics, or in regular ICU, I would have enjoyed the book more. Finally, "Amy" drove me crazy. There were times I was temped to skip over her sections entirely. She complained constantly, always thinking she was being treated unfairly, always whining about not being able to spend time with her baby, always griping. I kept thinking, "this woman should not be a doctor!" When she complained that her co-workers were upset at her for trying to rush out the door every day, I felt sympathy towards them, not her. I thought she was selfish, self-centered, and bitchy. Definitely not a doctor I'd want! I wasn't surprised at all to read how she ended up, and think that was probably for the best.

[Christine · Rating 3 out of 5]

Well, this series of journal entries confirms that I will not become an MD in this lifetime. Considering how I get grumpy if I haven't eaten for 4 hours, I don't think I could make it through the grueling internship. Sorry, mom.

[Sarah · Rating 4 out of 5]

Fascinating. I can't imagine being that consistently sleep deprived and having to make as many life or death decisions as these doctors do...

[Kyvan · Rating 4 out of 5]

Reading about the medical world is much different than the idea most people have about it. This book is such a raw and honest account of what it's like to be an intern. Wanting to enter the medical field myself, I thoroughly enjoyed the accounts in this book. For anyone who is considering or just interested in medicine.

[Mazola1 · Rating 3 out of 5]

What do you suppose it would do to you if for a year you worked over 100 hours a week, sometimes for 36 hours in a row, got paid practically nothing, had life and death responsibility thrust upon you while you were unsure of your ability to handle it, were frequentl awakened in the middle of the night to do mindless scut work, and saw death, pain and grief on a daily basis? The Intern Blues gives answers to that question from three young doctors doing a pediatric internship in big New York hospitals.

Their answers are remarkably similar -- it warps, embitters, stresses and changes. Each intern dreaded and then hated the year, complaining of the long hours, hard work and lack of sleep. Each learned something about how to take care of patients under difficult circumstances, and each gained a measure of self confidence, knowledge, and clinical judgment.

Dr. Marion calls internship "arguably the most vital transformation in all of medicine," turning green medical students into "battle-hardened" residents. In a sense, that's true. Skills are learned, confidence and the ability to make decisions independently are built, insecurities overcome. Along with that, cynicism and bitterness become constants of the young doctor's personality. Like most interns, these interns saw way too much death, and way too much suffering. They saw children with dreadful diseases that would claim their lives after a few short years of terrible, but useless, suffering. They saw children born with AIDS, with parents who abandoned them, children molested, beaten, burned by their parents. The transformation from clueless student to capable doctor was described by one of the interns turning fresh, "well-mannered and even-tempered with warmth in our hearts and great expectations" into "tattered, unshaven, smelly, cynical, snarling survivors of a long and somewhat meaningless struggle with ourselves and the rest of the world."

Dr. Marion calls his own internship the hardest and most devasting year of his life, and says that some of its pain, anger, exhaustion and anguish is still with him. The audiotaped diaries of the three interns that make up this book bear him out, each telling the same tale in general, although the specific, painful details vary. Dr. Marion says that everyone who lives through internship is forever changed by the experience, they learn about medicine and the human body, and truly become a physician.

Dr. Marion says that "in the process, through the wearing down of the intern's spirit, that person also loses something he or she has carried, some innocence, some humanness, some fundmental respect," and asks at the end "Is it all worth it?" I suspect he thinks maybe it isn't -- that the price is too high. And his description of the process, coupled with the stories of these three doctors who went through that ordeal, raises some difficult questions. What struck me was that maybe some people aren't cut out to be doctors, and others are, and that this year brings that reality out.

Two of these doctors endured and hated the hard work, but decided that they'd learned to take care of patients, and this was something they could do and wanted to do. The other seemed not only to hate the work, but to hate his patients. He says one patient nauseated him. While not praise-worthy, that's not all that an unusual of a response. But the way this intern talks about this patient is, calling his child patient a "disgusting, horrible bag of piss-poor protoplasm." While it's tempting to think that this intern to developed a morbid sense of humor to cope with the horror and stress of internship, I think I wouldn't like to have this guy as my doctor. Maybe only those who survive internship with a basic sense of decency left intact should be licensed as physicians. In a sense, internship tests not only the intellect, but the heart. We should all be lucky enough to be treated only by those doctors who survive both tests.

[Elin · Rating 5 out of 5]

Again, reading this book makes me really happy not to be doing my internship or residency in the US. No way could I be on-call every 3rd night and then function normally! I mean really, you expect your doctor to be smart, edaucated and to make the right decisions - it's just that they haven't slept for 36 hours....

As far as I understand the 3 young doctors in this book finished their internships in the late 80's so I hope their experience is not the same as that of interns today!

[Andrew · Rating 4 out of 5]

I discuss the book here:
https://www.youtube.com/watch?v=6Vdw_...

A good collection of memoirs of 3 interns working in various clinics. Some of the content, about 1/5, addresses the personal lives of the interns which I was not interested in, but I understand the editors intention to show how the job affects all aspects of the intern's life. The book portrays the intern fairly negatively, not in the sense of criticism, but in the sense of despair. Not only are the hours grueling, but the working environment can be hostile not only from residents who oversee the interns, but also the patients and their parents. I believe two out of the three interns work in pediatrics. One thing that was interesting was the reasons for entering pediatrics given by at least one of the interns: children are less depressing when they get ill because they tend to recover more quickly and better (more resilient) than adults. On the other hand, the neonate ward with pre-term babies (usually underweight and other problems) often die and the book shows these events to hit the interns (and sometimes nurse-staff) quite hard.

I also detect a little bit of activism by the editor (who was a doctor connected with the interns and compiled the book). The editor speaks every now and then throughout the book in his own chapter. He talks about the conditions of interns, and eventually describes legislative action taken to limit the hours of interns per week and per day. Throughout the book the interns often fall asleep on the job, even when working on a patient. I cant quite fathom why this has been acceptable to government health regulators, Medical license boards, and Doctor unions. I can also assume that the gauntlet inflicted on interns comes from generational trauma ("I had to endure it, I survived, so you must too"). Hopefully some sense has entered the minds of these boards.

I was interested in reading the book because I was curious about the medical field. I was hoping the book went into more depth about the cases - for the most part it was quite terse on diagnosis procedures. On the other hand, the book does a great job of showing how terrible conditions are for these interns, as well as letting me pick up some doctor lingo (or 'internese,' as they called it).

One easy take-away from this memoir collection would be: The next time you're in the hospital, such as the ER, ask how long your doctor has been on shift. If its more than 24 hours, or if s/he appears sleepy, ask to be seen by someone else. Doing this would benefit both the medical profession as a whole, and the care you receive in particular.

[711Isabel B · Rating 5 out of 5]

I have been totally blown away by the contents of the book, "The Intern Blues," by Robert Marion.
Dr. Marion enlisted three medical interns (doctors in their first ear of residancy), torecord their experiences in a tape recorder. The three interns did just that, and the outcome was amazing. Even though it has been very unchanged though out the entire book, somehow it has held me captive.

What I found really interesting was that the contents of three different people in their residency all had unbelievably similar stories to tell. All three battled chronic exhaustion, depression, and little time off. Each one had very different life stories, but during their internship in pediatrics, their jobs completely took over their life. Sometimes I had trouble rememerbering which of the interns that I was reading about, because they all sounded so similar.
Even today, residancy is unbelievably hard, but when the book is written (1985,) there were no laws at all regarding limiting residency hours. Now laws state that residents can work no more than 80 hours a week. But back then, residents got one day off every two weeks, and they be on call every third night (that usually meant getting no sleep every third) then being expected to work all day the next day, and the day after.

But all of them survive it.

Now, all three of those interns were doing their residency in pediatrics. While I know that my pediatrician went to medical school, which was hard, I didn't know that they also did a residency. I'm sure that their residency was a difficult one - residencies are still hard today, even with new laws, but back then they were miserable. I'm impressed that my pediatrician did that, survived it and is now a good doctor. I didn't realize that they had to face that kind toughness. I tok for granted their training. And now I know that even pediatricians training is hard.

[Jamie · Rating 5 out of 5]

an extremely intimate and fascinating look at three interns lives. you watch them go through ups and downs as they learn to view themselves as doctors, seeing all the cases they see along the way. the aspect i enjoyed, however, was a look at the medical industry during the height of AIDS, how women had to fight for equality in policies and work to be taken seriously by their peers and patients. it’s all so consuming and depressing and interesting. a great read for those interested in the med field, don’t let the datedness of it deter you. there’s still so much to learn.

[Matt · Rating 3 out of 5]

This book is quite depressing, but I don't think there are any other books like it. Because of that, it's worth reading for anyone who's going to become a doctor, as well as for family members and friends of those individuals.

While requirements and regulations have changed for medical interns (1st year residents), I assume that the job is still incredibly rigorous and demanding. This book illustrates this from a 1st person perspective and shows what it takes become a doctor.

[Kayla Kirkbride · Rating 4 out of 5]

An interesting & insightful, if outdated, look into the life of a medical intern in the US.

[kaz ziemba lee]

This was interesting at the very least. Could say at lot more but let’s keep it short by saying this did not improve my overall perception of those with MDs

[Jordan Tignor · Rating 2 out of 5]

From a medical standpoint, this book was fairly interesting. The interns were faced with a lot of different scenarios and got some pretty tough cases tossed their direction. Yes, a fair amount of the information was out-dated, as the book was from 1985, but it still holds relevance as you can see how procedures and policies have changed over the years.

That's about the only nice thing I have to say.

From a personal standpoint, this book was terrible. Specifically, the three interns it followed were terrible. Sure, they may have been mostly competent and known what they were doing medically, but as human beings, they were utterly reprehensible. The way they referred to their patients was really disheartening, as they were so rude and downright cruel at times. To say they were callous would be an understatement. There was pretty much no compassion or empathy whatsoever. If I had a doctor like that, I'd switch immediately because in my opinion, they were completely out of line for someone who's dealing with people in some of their most fragile days.

I really grew to dread Amy's sections of the book, and at times, I was tempted to skip them. It seemed like everyone was out to get her and her life was so terrible and so hard. The fact of the matter is: she set herself up to fail at times. She made the decisions that led to the negative repercussions. She had no one to blame but herself, and she refused to take responsibility. That in and of itself is so incredibly dangerous for someone who wants to be a doctor.

I read this book because it was on a "Best Medical Memoirs" list that I found. However, I don't think I'd recommend it to anyone. The interns' behavior was just too upsetting for it to really have any merit.

Oh, I was wrong. I have one last nice thing to say about the book. The fact that there was a medical glossary and the author immediately explained some of the medical-ese the interns used was nice. That's about it.

[Imran · Rating 3 out of 5]

Although this book is slow at times, I love the ingenious way it was produced: the transcripted recordings of three pediatric interns. For this reason, the book is exceptionally interesting since you get information unadulterated and in real time. The book takes place before the work hours restrictions but the daily life-decisions, complicated patients, the stress of uncertainty, and the endless work remain true. I’m glad there now are restrictions, however loosely complied with. This book gives me a new respect for the training my mentoring physicians went through.

Although some would say the authors did a lot of whining, I do not for a second believe it was unfounded. From what I’ve heard from friends and family in residency, I know the grueling training (both physically, mentally, and emotionally) has changed little. I just hope I will be able to be stronger through those days ahead.

The best part of this book, in my opinion, is the afterward. It’s and update on the three interns many years later. Being towards the end of medical school and still having residency looming ahead while many of my friends in other professions have settled into family life, I, like many of my peers question, “will all of this be worth it?” Dr. Marion gives us much needed insight through the afterward.

This book is a type of ‘pre-grieving’. I know intern year and residency can be hard but this book allows me to prepare mentally. I do hope though, with the new regulations on internship, that I won’t be chewed up and spit out like these interns.

[Syncretism · Rating 5 out of 5]

This is a book I wish I had found during my second year in med school. My PA program had an internship year, which mirrors residency internship. I think this book would have helped me be prepared for the stress, depression, loneliness, and sleep deprivation that occurred during my internship year. I also think it would have allowed others not in the field to have a glimpse into what I was going through, as no one ever seemed to truly grasp what was happening to me.

Unlike House of God, this book focuses on the negative aspects of internship. It gives people a harsh look into the terrified mind of an intern being left in charge of patients with little supervision, lots of book knowledge, and no real experience. The nightmare like situation of being on call at night hoping none of your patients died. That first time of being thrown into having to notify a family their loved one passed away, having no clue how to broach the subject and desperately not wanting to have to go face them.

Overall, this is an amazing book about the experiences of three interns throughout their first year. It is written for people not in the medical field, so when the jargon that we are so familiar with appears there is a nice brief definition of it.

[Rin · Rating 4 out of 5]

I think what made this book worse (read: best) is that these people were working with young children and it affected them all differently. This book was an accurate description of how medicine can affect a young doctor. I liked them all, but I especially liked Amy because of her family dynamics, And Andy because he seemed the most depressed and home sick. These stories were so realistic but ended somewhat positively. All of the interns felt like they grew into better residents, even if they strongly felt as though they didn't learn anything.

I really appreciate this book. I am so afraid of residency. Of waking up one day and realizing that after all of this time and training, choosing medicine was a huge mistake. I think almost every medical student is. When you are premed, you are so sure that you are going to be a doctor, when you're in medical school, you're not even sure you're going to graduate. Intern year seems like the year where you begin to wonder if everything you've done in the past 8+ years was actually a mistake. I enjoyed these stories. They were very honest and well put together.

[Patricia]

I read this for the project I'm working on about a small town doctor. I was looking for insight into the intern experienc,e which I got. This is regarded as a classic, and though it's dated, 1980s, something tells me the grueling intensity of internship has not changed a lot. My doc was an intern in 1970s in a big city hospital like the 3 interns who tell their stories in Intern Blues. So I suspect their experience was pretty close to his. What I hadn't anticipated was what I'd learn from the method the author used to compile the stories. He had 3 interns record their experience over the course of the year on audiotapes. For the most part, it seemed like he transcribed the material pretty much verbatim, which is what I'm doing with interviews for the book I'm writing. It was fascinating to see how clearly the subject's personalities where revealed in their story telling. I can't say I was particularly fond of any of the three, but by the end, I was at least sympathetic regarding how tough the year had been for them. It was a worthwhile read for my purposes.

[Debi Montana · Rating 4 out of 5]

I love these kinds of books. It is series of short stories, vignettes about the trials and tribulations of becoming a doctor from the viewpoint of the medical student turned intern. What is the most scary to me is the number of important decisions the interns make every day on an extremely limited amount of sleep! That is not a good feeling as a frequent flyer at any one of several Boston teaching hospitals.....
The other side of it is the recognition that doctors go through such rigorous training and still manage to remain passionate about their work over many, many years. This book lets us take a short peek into what it is really like to become a doctor. I really enjoyed this book and look forward to reading others like it.

[Carol Waters · Rating 2 out of 5]

I have worked in hospitals most of my life. My personal belief is that the training of interns has long been barbaric and abusive. But these interns knew the score when they accepted the assignment. This book didn't address much about the changes of character that a person undergoes while in training for any profession. There was no pride, no acceptance of limitations or of skills. It seemed more about endurance, survival, and whining. Lots of whining. Had they not heard rumors about how hard this profession is? I would not want any of these whiny babies taking care of my kids. NICU as a waste of time. AIDS clients as a waste of time. Critical care as a waste of time. These folks missed the boat on compassion, humanity, decency, respect.

[Emily · Rating 3 out of 5]

The diary format lends itself well to the tales of these interns, whose stories are equal parts inspiring, exhausting and invigorating. I read this as a senior in high school and it didn't scare me off from pursuing a Pre-Med track in college. What it did do was to give me the first glimpse into the unglamorous backdrop of the medical profession.

I would highly recommend this book for Pre-Meds and family/friends of future doctors. I came away from this book having learned a little more about medicine, a little more about the profession and a lot more about the struggles some people go through to pursue what they want in life.

[Megan · Rating 3 out of 5]

This was an enjoyable read, though outdated. Even though we work fewer hours, do not do call, and are not put in life-or-death situations, I identified with many of the thoughts and feelings of the interns. It was interesting from an historical perspective to see how the AIDS crisis was just beginning to unfold when the book takes place, in 1985 (only 20 children with AIDS across 3 hospitals; the interns only sometimes wore gloves and a worldwide shortage of rubber had just occurred because rubber gloves were becoming needed). Overall, I think what this book does best is bring an understanding to friends and relatives of what the everyday life of a physician in training is like.

[Margaret Heller · Rating 3 out of 5]

The story of what happens to people working 100+ hour weeks with 36 hours at a stretch with no sleep in life and death conditions. It's pretty terrible sounding, but good doctor in training stories. Luckily most of these rules have been changed by now--this takes place in 1985-1986. All these doctors were training in pediatrics (and this is set when I was a baby, so interesting to see what would have happened in my care--though luckily I never had any emergencies after my initial birth by c-section).

Only problem is that if you are pregnant in the third trimester, you will cry multiple times. Too many stories of stillborn babies for pregnancy brain.

[Mitchell Rubiano · Rating 5 out of 5]

Definitely a book to read if you have some level of seriousness in becoming a doctor. The diaries help you to get a true understanding of how grueling being a first-year resident is even though the three interns are all involved in pediatrics.

I only read the first 145 pages of this book and then stopped because even though I wanted to see the transformation the 3 Interns go through there comes a point when you only need to hear so many stories to understand how grueling the residency process is.

The one thing that really shocked me that all readers I think will appreciate is the level of detail that is seen in the diary entries.

[olga tatiana rostkowska · Rating 4 out of 5]

if you like reading about medicine as a system - how the doctors are made, how the decisions are reached - it's very insightful, if a little outdated. made really fun comparison to shows like 'Grey's Anatomy' ;)
follows the story of three interns, with added commentary from their supervisor/support system/advisor attending, throughout the internship year and then has a couple follow-ups in the later years.
real page-turner :)

[Sabra · Rating 2 out of 5]

Pretty dated. Really couldn't stand Amy and how she seemed to feel she deserved special treatment because she had opted to have a child. And the way she referred to the babies in the NICU as "things." That was really disturbing

[Liz · Rating 3 out of 5]

I'm a sucker for medical memoirs, but not sure why I picked one focused on sick and dying children. And the casual sexism among the male doctors, which the author leaves undiscussed, was a bummer too.

[Zoe Haskins · Rating 3 out of 5]

This book was so. so. long. It was really interesting to see how interns worked in an inner-city hospital in NYC, and how their mental health and relationships with their families struggled. It got boring at times and I had to skip pages, but it was very informative and I'm glad I read it.