Singular Intimacies: Becoming a Doctor at Bellevue

by Danielle Ofri MD

A “finely gifted writer” shares “fifteen brilliantly written episodes covering the years from studenthood to the end of medical residency” (Oliver Sacks, MD, author of The Man Who Mistook His Wife for a Hat)Singular Intimacies is the story of becoming a doctor by immersion at Bellevue Hospital, the oldest public hospital in the country—and perhaps the most legendary. It is both the classic inner-city hospital and a unique amalgam of history, insanity, beauty, and intellect. When Danielle Ofri enters these 250-year-old doors as a tentative medical student, she is immediately plunged into the teeming world of urban mysterious illnesses, life-and-death decisions, patients speaking any one of a dozen languages, and overworked interns devising creative strategies to cope with the feverish intensity of a big-city hospital.Yet the emphasis of Singular Intimacies is not so much on the arduous hours in medical training (which certainly exist here), but on the evolution of an instinct for healing. In a hospital without the luxury of private physicians, where patients lack resources both financial and societal, where poverty and social strife are as much a part of the pathology as any microbe, it is the medical students and interns who are thrust into the searing intimacy that is the doctor-patient relationship. In each memorable chapter, Ofri’s progress toward becoming an experienced healer introduces not just a patient in medical crisis, but a human being with an intricate and compelling history. Ofri learns to navigate the tangled vulnerabilities of doctor and patient—not to simply battle the disease.

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

260 pages, Kindle Edition

First published January 1, 2003

Reviews

[Alison · Rating 5 out of 5]

Ofri is a good writer. She captures the essence of medical training....you fumble your way through, not sure you are learning anyhing until you come out on the other side and realize you do in fact know something! Some parts made me laugh because even if I didn't have that exact experience, I had an experience like it. (Searching madly for the stool developer while the intern night float, only to return and find out mid-rectal exam that her patient has passed away. Then trying to figure out exactly how to declare someone dead--should be straight forward, right?)

[Ann · Rating 4 out of 5]

Ofri's account of becoming a Dr. at Bellevue is fascinating. From learning to tell a patient she is HIV positive, to watching a patient die unexpectedly from unknown causes, to trying to get an IV into an IV drug user, Ofri describes her journey from intern to physician. I learned about the workings of a large inner city hospital, and this differed quite a bit from books on similar subjects like _Hospital_ by Julie Salamon. What stood out here, in contrast with Salamon's book, is Ofri's voice and personal commitment to each of her patients. Salamon is trying to give a big picture look at the workings of a complex inner city hospital of many nationalities; the diversity that Ofri describes is highlighted through individual human stories.

[Liz · Rating 5 out of 5]

Interesting read. The author is clearly a right-brain thinker as well as a left brain physician, so it was interesting both how she interpreted her experiences and also how she told them.

[Mary Kamrath · Rating 4 out of 5]

Having read and enjoyed many medical memoirs, I found this book to be one of the best in that category. Dr. Ofri is a great storyteller with just the right amount of story and medical jargon. She made me feel like I was part of the situation in each chapter. I highly recommend this book if you are interested in the medical field.

[V · Rating 5 out of 5]

From the multitude of physician autobiographies I've read prior to and during medical school, Danielle Ofri's book is probably the one that has resonated the most with my own mindset and experience of medicine. Very personal at times and not balking at the challenge of showing weakness as a person and a physician - a truly wonderful book!

[Glenn · Rating 4 out of 5]

Reading Danielle Ofri’s “Singular Intimacies,” there were two particular things that struck me. The first was the overwhelming doubt that seemed to track through the whole story—doubt about her abilities as a professional, doubt about her ability to reach out to her patients, and more general doubts about the ability of the medical profession itself to serve well those it was required to serve. We think of doctors as somehow above this; they are seen, I think, by most people as being almost “god-like,” or if not quite god-like, then at least different than you and I. Perhaps not susceptible to the same mental quandaries as regular folk…

But “Singular Intimacies” puts the lie to that. Doctors both above and below Dr. Ofri’s station make mistakes, miscommunicate, mis-diagnose…all in the course of a normal day. And yet, with her keen observers sense, Dr. Ofri sees that despite that doubt, and despite her own flaws which she delineates mercilessly, doctors continue to heal, to deal with the awful realities of failure, and to learn, despite working in conditions that would shatter most of us.

And how? This was the other thing that struck me reading this book. When a person trains to be a soldier, one of the things that is remarked upon is how they are drilled, drilled, drilled, over and over again…until every task, every motion is more than automatic, more like embedded. Working 36 hour shifts, in a more-or-less permanent state of sleep-deprivation, under incomprehensible stress…how could a doctor achieve any meaningful results if their tasks, their life-saving tasks were not eventually as automatic as a soldier turning in formation, loading a gun under attack, finding order in the midst of the chaos of battle?

“Singular Intimacies” follows one extraordinary physician as she struggles to find a way to heal—her patients, her co-workers, herself. And in the end, despite the book’s portrayal of failures and doubts and devastation, there is a sense of coming to terms with the limitations placed upon those that must heal all others, while still finding space to heal themselves.

[Michelle · Rating 4 out of 5]

I really enjoyed this look at internship and residency at Bellevue. I grew to like the author although at first she seemed a little whiny.

[Serena · Rating 5 out of 5]

Working in the infamous New York Bellvue Hospital, in the Psych ER no less is a harrowing experience. Dr Ofri's narrative combines the incredible compassion that it takes to work there, a bit of the danger and fear, and a huge amount of the frustration at the administation of the hospital, and the state of health care in America. I read the book as a person with bipolar, who has come to an ER in crisis. But I am a very educated patient , so I could also see clearly from the clinicians point of view. The frustration of giving someone meds they will never take. But also knowing the deadening those meds can cause. Wishing someone could just make it through just a few more days, knowing that their depression will lift, but also knowing the sheer hopelessness of true despair. A ER doctor is a hard job. A psychiatic ER doctor seems almost impossible.

[Julie Whelan · Rating 3 out of 5]

I read this right after reading Final Exam: reflections of a surgeon by Pauline Chen. It's a different style of looking at the learning and practice of medicine told by giving stories revolving around individual patients. As a medical librarian, I appreciate that it's another well written insight into what my medical students are going through. The beginning about the scary step of jumping into the hospital wards as a third year student is very memorable.

[Julie · Rating 4 out of 5]

In a series of expressive short essays, Dr. Danielle Ofri chronicles her ten years of medical training, as a student, intern, and resident, at Bellevue Hospital Center, the oldest public hospital in the country. A thoughtful practitioner, Ofri is adept at capturing the complexities of modern medical practice. One standout essay finds her questioning the tenets of her medical training when a friend suddenly passes away. Ofri's stories offer a realistic portrait of a physician’s life.

[Chanpheng · Rating 5 out of 5]

Incredible book about becoming a doctor at Bellevue Hospital in NYC. Reminds me of my student days, being afraid of attendings while learning how to think for myself. The author later returned to work at Bellevue and started up the Bellevue Literary Review, where anyone involved in medicine can submit pieces about their frustrations or wonders with medicine.

[Jill · Rating 4 out of 5]

I really enjoyed this book! I thought that the stories were interesting, not only because of the unique medical challenges, but mostly because of the individual's stories. I also really enjoyed that the author shared her perspective/feelings/etc about her experiences.

[Jenni Ogden · Rating 4 out of 5]

Danielle is a wonderful communicator of medical mysteries to lay people. Her stories of her patients and her experiences as a doctor are full of humanity and caring. If only every doctor was like her!

[Jess · Rating 5 out of 5]

wonderful.
collection of short stories about being a physician and training - better look into the life a doctor than any book i have read.

[Lane Patten · Rating 4 out of 5]

Good look at the brutality at medical training both emotionally and physically.

[Jennifer · Rating 4 out of 5]

The author had a very engaging writing style - I actually felt emotional after reading some chapters. Interesting clinical scenarios!

[Jude · Rating 4 out of 5]

The book is well-written and contains "snapshots" of patients the author treated when she was learning to become a doctor.

[Marty · Rating 4 out of 5]

This is absorbing.

[Toby M · Rating 4 out of 5]

Wonderfully written. Very interesting.

[Kristin · Rating 4 out of 5]

I've read at least one of Ofri's other autobiographical works and found this one equally enjoyable. In 'Singular Intimacies', Dr. Ofri uses her interactions with individual people, usually patients, but sometimes other doctors or patient family members, to explain how each shaped her path towards her ultimate goal of being a physician at New York's Bellevue Hospital, a well-known historic institution. Some stories were sad, others uplifting, but all were touching and illustrated the highs and lows of being a young doctor getting her start in the world of medicine. Ofri took a non-traditional path to becoming a physician, completing her PhD. prior to her M.D., so some of her experiences are unique to that timetable, as she joined the hospital mid-year and thus was about a half-year of experience behind where the others in the hospital expected her to be, yet she was undaunted in her pursuit.
Upon completion of the book, I saw where many of the chapters had been published as separate independent works, but it was all woven so seamlessly together that you would think that they had always intended to be part of the same book. Ofri's less-direct path to her M.D. afforded her the opportunity to develop her writing, and it shows. I'm not sure if I've now read her entire body of work, save scientific journal articles, but if not, I'll definitely be on the lookout for those I've missed.

[Stacie Nishimoto · Rating 5 out of 5]

MERCEDES
"I cried for the death of my belief that intellect conquers all."

POSSESSING HER WORDS
"Waiting and holding--two burdens of medicine. Much has been written of the physical burdens of medical training, and there are many. And indeed these were the ones I had feared the most as I began medical school. How would I manage without sleep? Could I possibly memorize those millions of diseases? How would I pass all the medical boards? Those did turn out to be grueling tasks, but it seemed that if I just pushed myself hard enough, they could be surmounted.
But as I moved along from medical student to intern to resident to attending, the challenges became far more profoundly taxing, not just to address, but even to name."

"Waiting is something physicians do not do well. We demand rapid results--from our diagnostic tests, from our patients and, most mercilessly, from ourselves. We are not patient with ourselves. We rarely permit ourselves to wait in solitude, to allow the poetic subtleties and convoluted irrationalities of patient care to sink deep within us. We may know that we are frustrated, or perhaps gratified by a particular encounter, but we seldom offer ourselves the time and space to understand why."

"When we trudge home at night and feel the cricks straining across our shoulders, we usually ascribe it to the many hours we have just spent on our feet. And that is part of it, but another part is the weight of balancing so many patients' stories within us."

IN CHARGE
"In considering becoming a doctor, I'd never imagined hating a patient. I suppose I assumed I'd like most of them, but truthfully I'd never even thought about the issue. Mr. Goode wrenched me from my naivete. And why should hating a patient be unusual? After all, patients are just a subset of humanity. My interactions with Mr. Goode were so profoundly unsatisfying--how would I navigate my way with the inevitable patients of the future with whom I could not connect, or even respect? Could I be a good enough doctor for them? I wondered how much sacrifice I could make for a patient like Mr. Goode. Would I expend my reservoir of good will with the GI consult begging for an endoscopy for Mr. Goode? Would I skip lunch to wheel him to X-ray if he needed one right away? Would I give up a night of sleep tending to Mr. Goode if his oxygenation was dropping? The answer is, easily, yes. I didn't like Mr. Goode but of course I wanted him to live. I was, after all, a doctor in charge."

IMMUNITY
In theory, it sounded so simple. Be straightforward and honest with your patients, we'd been told by our attendings and our society. Straightforward and honest. "Your daughter is going to die." So easy on paper, so obvious in clinical discussions on rounds. But entirely unpronounceable to human beings standing on the ground before you.

FINDING THE PERSON
"In the ICU, whenever one of the interns would prattle on with the microscopic clinical details about an otherwise comatose or terminal patient, the resident would halt the discussion by drawing a rectangle in the air with two fingers. "The big picture," those fingers delineated. It might have looked harsh or cynical to an outsider looking in, but it was the truth. Like Dr. Schwartz who was dying of pancreatic cancer. What did it matter if his potassium was 3.3? What was being gained when we supplemented it to reach 3.7, except that the computer would no longer flag it as abnormal and the nurse would stop paging us for low potassium levels. The big picture. Not to be callous about the patient's comfort or the family's concerns. Not to relinquish the role of doctor. Not to presume any powers over life and death. Not to "play God." But the big picture."

[Val Wilkerson · Rating 5 out of 5]

Thank you Dr. Ofri for writing your story. If you ever want to walk in a doctors shoes read this book.
I found it very interesting. A year ago my husband suffered through a terrible illness. Throughout his illness, throughout a double lung transplant, we dealt with nothing but wonderful doctors and nurses. He passed away from a very rare blood problem. Without these hero's who took care of him I never would have made it through this experience. They looked out not only for him but for me also. Reading Danielle Ofri's story reminded me of each and every one of them, while also letting me know the long hours they went through, and that they go through. This is a real page turner. Thank you for writing your story.

[Jenny · Rating 2 out of 5]

This was one I felt like I would or even should like but didn't. I'm quite interested in health care, and this book goes into a number of meaty topics: the scientific/clinical aspects of practicing medicine, the interactions between providers and patients, and the training it takes to become a doctor. The individual chapters are largely independent, and the book is missing a strong overall narrative, so it feels like there's little depth. The writing is highly descriptive and yet oddly flat. I got bogged down in the unnecessary physical details, which didn't seem to have a purpose. The more emotional sections are almost overdone, especially the prologue and epilogue, which address a grave situation - a seriously ill patient being put under for seven days of treatment, uncertain if she'll ever wake - in a way that's more monotonous than solemn.

The main reason I'm glad to have read this is that it mentions that the author founded the Bellevue Literary Review, which sounds like an interesting source of writing on medicine. But as far as Singular Intimacies itself goes, I'd recommend reading Verghese's My Own Country instead.

[A Busscher · Rating 2 out of 5]

not what I was expecting in regards to the stories that she told. It was all about her and her emotions and how she thought, how she acted, how she responded, how she made it through the struggles of residency. But it was hard to tell her stories from any other doc. views. Also, the fact that the doc started the IVS, the docs ran them down to xray. the docs did this were was all the other staff? Seriously, no way a doc would be running labs, taking their pt for tests. NOPE. Still very interesting to read some of the stories and the challenges becoming a doc take. Emotionally, physically, mentally.

[Nelson B C Ferreira · Rating 5 out of 5]

Must read for physicians

I am a physician many years out of residency. This is a well written book that captures many of the experiences of medical training. More importantly it speaks to the unspoken fears and feelings about becoming a doctor and being a doctor. It brought back a lot of memories and emotions . Thank you to the author for the joyful tearful ride. A very good read for anyone .A great read for physicians.

[Anthony · Rating 4 out of 5]

Ofri writes about the first patients she encounters as a med student, intern, resident, and finally as a full-fledged doctor. Her stories convey the soul and emotion that lies within every patient interaction a medical professional experiences in their work. Good read if you're into stories from the medical world.

[David Parker · Rating 5 out of 5]

A Road Less trodden


The first chapter was not that interesting and I did not like the writing style but now I understand that the three year of medical school is one of confusion and insecurity of not knowing where to be or stand plus the feeling that everyone knows more than you.
She writes about the change in elevation of status personally and from others. How the world looks at her differently. Going to a funeral and people questioning about the disease that caused the death and all she wants to do is grieve.

[Anne · Rating 5 out of 5]

I got this book years ago (after reading Ofri’s Becoming a Physician Essay in NEJM), and finally got around to reading it. I wish I read it before watching Grey’s Anatomy because it does such a great job of painting a picture of what it feels like to train to be a dr, through patient stories and self reflection- without the prime time filler. A wonderful book.

[Nelia · Rating 5 out of 5]

The author is brutally honest about her experiences and reactions during her years of training as a doctor, but the prose is so skillfully written that she brings us right into her stories. A doctor who cries with the family in their loss of a 23-year-old daughter is a rare and special healthcare provider in an age when emotional distance is usual the chosen path.

[Rosanna · Rating 4 out of 5]

Fantastic, well written and compassionate. I really liked how Danielle Ofri was willing to expose her mistakes and humanity. I must admit, I craved one or two happy endings, as most of the stories ended in death.