A great trial attorney once told me that a plaintiff's attorney should never leave a nurse on the jury. His reasoning was that nurses make unsympathetic jurors because the suffering they see in their jobs makes them jaded and insensitive. A kernel of truth lies at the heart of that stereotype. The same kernel of truth provides much of the dramatic tension in Sandeep Jauhar's insightful memoir about his medical training. Dr. Jauhar's story is not only the story of his struggle to learn his craft, it is also the story of some of the thorniest problems confronting modern medicine.
In many ways, Dr. Jauhar was not the typical young, aggressive, and driven intern. Never entirely sure he wanted to be a doctor, he nonetheless succumbed to family pressures, and enrolled in medical school after having earned a PhD in physics, specializing in research on quantum dots. His older brother was already a resident, and was brash, self-confident and assertive -- all the things that the far more cerebral Sandeep was not.
At the outset of his internship, Jauhar was afraid that medical training would make him insensitive, that he would become like many of the interns and residents he saw, who brushed off the suffering and tragedy that they saw every day, and even made fun of their sick and dying patients. He also feared he would never overcome his lack of knowledge and confidence. More a thinker than a doer, Jauhar found it hard to jump in and make decisions and take charge of the treatment of his patients. Jauhar's book tells the story of how his year of internship transformed him from a fearful beginner to a doctor with confidence and skills.
I read Intern not long after reading The Intern Blues. The contrast between the two books is striking. The Intern Blues is raw and immediate. Basically, the contemporaneous thoughts of three interns speaking into a tape recorder, it has all the grit and rough reality of battlefield notes. Intern is a far more composed, nuanced and cooler look at internship, thoughtfully described in hindsight. Jauhar has distilled the experience down to its essence. For example, rather than describing the frantic pace, exhaustion and hard work of internship in hectic detail, he instead writes in spare prose that he slept through a performance of a Mozart concert, and at his apartment, "the mail was piling up; the newspaper went unread; clothes needed to be laundered."
Much of Jauhar's journey and struggle is interior. He agonizes about how the lack of time keeps him from treating his patients as people with feelings, he worries about how his lack of experience and skill causes him to hurt his patients with unnecessary or bungled procedures. He wonders if it's right for doctors to pressure patients into consenting to procedures the patients don't really want, but the doctor thinks is necessary, such as the insertion of a feeding tube or the placement of a breathing tube for mechanical ventilation. Many of these procedures are painful, and often they don't treat the underlying disease, they just make the patient miserable until their inevitable death. As Jauhar puts it, "In medicine, I had learned, there is often a fine line between the barbaric and the compassionate." Dr. Juahar's book illustrates that essential fact, and reminds us that the best doctors are those that learn how to stay on the right side of that line, even as the availability of modern technology and the pressure to "do something" often nudge the doctor in the opposite direction.
While perhaps many, if not most, interns look back on the experience as a year of horror and as something they would not want to repeat, Dr. Jauhar comes to a different conclusion. While many doctors would disagree, Jauhar concludes that although his internship was marked by depression, gratuitous suffering and feelings of hoplessness, "there probably isn't a better way to learn medicine."
Jauhar felt that internship toughened, but coarsened him, that he learned to withstand pressure, to think schematically, to use his hands, to simplify, to make big decisions. Worried at the beginning that his "ruminative nature" would impair him as a doctor, he instead came to see that his unwillingness to act reflexively made him a better doctor. But the biggest lesson he learned was that medicine is "a glorious, quirky, inescapably human enterprise, with contentious debates, successes and failures, villains and heroes, oddities, mysteries, absurdities, and profundities."
Jauhar calls internship "the toughest year of my life," but says that he was glad he went through it, and that sometimes he actually envies new interns for a moment. Maybe that's because internship transformed him the way heat transforms steel. He says that although medical training probably doesn't need to be as painful as it used to be, and perhaps still is, "it probably has to retain a certain degree of wretchedness to serve its purpose." Dr. Jaurhar's wonderful memoir is a rich and revealing look at this wonderful, confounding and all too human wretchedness.