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Internal Medicine: A Doctor's Stories
Named one of the Best Books of the Year by Kirkus Reviews and BookPage “Illuminates human fragility in tales both lyrical and soul-wrenching.” ―Danielle Ofri, New York Times Book Review In this “artful, unfailingly human, and understandable” ( Boston Globe ) account inspired by his own experiences becoming a doctor, Terrence Holt puts readers on the front lines of the harrowing crucible of a medical residency. A medical classic in the making, hailed by critics as capturing “the feelings of a young doctor’s three-year hospital residency . . . better than anything else I have ever read” (Susan Okie, Washington Post ), Holt brings a writer’s touch and a doctor’s eye to nine unforgettable stories where the intricacies of modern medicine confront the mysteries of the human spirit. Internal Medicine captures the “stark moments of success and failure, pride and shame, courage and cowardice, self-reflection and obtuse blindness that mark the years of clinical training” (Jerome Groopman, New York Review of Books ), portraying not only a doctor’s struggle with sickness and suffering but also the fears and frailties each of us―doctor and patient―bring to the bedside.
288 pages, Hardcover
First published August 27, 2014
147 people are currently reading
3238 people want to read
About the author
Terrence Holt
5 books22 followersTerrence Holt taught literature and writing at Rutgers University and Swarthmore College for a decade before attending medical school. Many of these stories have appeared in different forms in literary journals and prize anthologies, including the Kenyon Review, TriQuarterly, Zoetrope, Bookforum, and the O. Henry Prize Stories. A contributing editor for Men’s Health, Holt teaches and practices medicine at the University of North Carolina in Chapel Hill.
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Displaying 1 - 30 of 166 reviews
May 12, 2018
Before there was effective chemotherapy, children with leukemia died quite quickly, it was not a painful death, but it was of course, devastating for the family. This is a story of a German oncologist come to the US, whose background is not entirely known. He was a researcher and experimented with chemotherapy on these children for whom there were no therapies. All the children died. One little boy bled to death over a period of two hours. Torture, trauma and even more devastation for the family than can be imagined.
In The Brothers Karamazov, there is a long poem where the Grand Inquisitor confronts Jesus.
‘My God,’ I remember saying. ‘It’s the Grand Inquisitor.’ All of a sudden I was thinking about Dostoyevsky. I’d never been able to make head or tail of that part of the book, but the question that introduces it had always stuck in my mind. It goes something like this: If you could usher in the Millenium—end all human suffering, forever and ever—if you could do that, but only by torturing to death a human infant, would you do it? Could you do it?
“I didn’t understand, when I read it the first time, if there was any point to the question: it just seemed another of Dostoyevsky’s grotesque Christian paradoxes. But that was before I met Schott, before I came face-to-face with someone who had also heard the question—and answered it.
The oncologist, Schott, is asked how many children he has experimented on and how many died. Many, many, but all died, except one, Schott tells him. Then two weeks later he hangs himself.
Much later, it is discovered that the one child that survived was Schott's son. He did all his terrible works in the hope of saving all of them.
Now we call it "drug trials" and for those in the same position as the little boy, no effective treatment and an imminent mortality, it is a lifeline. Do you think that terrible things result from the chemotherapy sometimes, terrible tortuous deaths? I do, but they are considered an acceptable risk and they are never reported in the media.
This story resonated with me because there was an English guy here with a big Bertram fishing boat who caught tuna. He was a bear of a man with ginger hair and a bushy golden beard and a loud laugh. He had oesopheagal cancer. He bled out once and was saved. The second time over two hours he ex-sanguinated. All therapies had stopped working and he'd been sent home to die.
Next day, wrapped in a sailcloth, sailing out on his own boat, his wife watched as he was buried at sea.
This book is fictionalised short stories, very well written, of difficult situations the author as an internist experienced - a man who cannot be convinced he has cancer, a woman whose claustrophia takes precedence over the oxygen mask that will save her life, and other stories. It's all very low key and there is much to make one think. A solid 4 star read.
One story in particular has me still thinking. The author is working in a psych ward with patients who eat garbage and needles. He comes to the same conclusion r. d. laing did, that the people are perfectly sane. It is their reactions to the situations that they find themselves in, these people in particular how they feel about their bodies, that they feel can only be solved by actions that are definitely not normal. This would equally apply to anorexia and Body integrity identity disorder (BIID). I wonder too, (I'm not at all pc) if it doesn't also cover some people's gender dysphoria? So because I'm still thinking on this, and that's what the best books do, it's 5 stars.
February 21, 2017
This is a stunning collection of beautifully crafted medical stories. While not exactly a memoir, the book is deeply informed by the author's experiences as a physician trained in internal medicine.
Holt, who has a PhD in English literature, a Master's of Fine Arts Degree, and is currently Assistant Professor of Social Medicine at Cornell, writes on his university profile page that he is "especially interested in how we confront our mortal condition, or fail to, and the roles narrative [the stories we tell ourselves or about ourselves]serves in that vexed recognition."
INTERNAL MEDICINE provides readers with a collection of characters, many of whom are in tenuous states due to cancer, heart failure, or even self-inflicted injury (as a result of mental illness). As readers, we are also invited to view patients through the eyes of Dr. Harper, seemingly Holt's alter ego, who struggles with exhaustion, awkwardness, his own fears about mortality, and even horror at some of the conditions he encounters.
Potential readers should be warned that there is little that is light about this book. In these stories, Holt illuminates dark places, not always making clear to us what is there, but certainly underscoring the mystery of living with/in a body.
This is one of the finest books I've read this year--one that begs a second reading and discussion with others.
For the brave who wish to meditate further on being human, pair this book with any of the following: Gawande's BEING MORTAL, Louise Aronson's A HISTORY OF THE PRESENT ILLNESS, and Henry Marsh's DO NO HARM.
Holt, who has a PhD in English literature, a Master's of Fine Arts Degree, and is currently Assistant Professor of Social Medicine at Cornell, writes on his university profile page that he is "especially interested in how we confront our mortal condition, or fail to, and the roles narrative [the stories we tell ourselves or about ourselves]serves in that vexed recognition."
INTERNAL MEDICINE provides readers with a collection of characters, many of whom are in tenuous states due to cancer, heart failure, or even self-inflicted injury (as a result of mental illness). As readers, we are also invited to view patients through the eyes of Dr. Harper, seemingly Holt's alter ego, who struggles with exhaustion, awkwardness, his own fears about mortality, and even horror at some of the conditions he encounters.
Potential readers should be warned that there is little that is light about this book. In these stories, Holt illuminates dark places, not always making clear to us what is there, but certainly underscoring the mystery of living with/in a body.
This is one of the finest books I've read this year--one that begs a second reading and discussion with others.
For the brave who wish to meditate further on being human, pair this book with any of the following: Gawande's BEING MORTAL, Louise Aronson's A HISTORY OF THE PRESENT ILLNESS, and Henry Marsh's DO NO HARM.
May 10, 2018
Terrence Holt's collection of short stories detailing the vagaries of an Internal Medicine residency is exciting, interesting, and heartfelt. Using the structure of nine short stories that begin on the first night of call and end with the conclusion of residency, Holt examines many facets of the toll taken by medical training.
In a move designed to preserve the dignity of his patients, Holt uses a fictional character in a fictional hospital with fictional patients. Nonetheless, the stories ring true, forming some nebulous distinction that lies between fiction and non-fiction. The patients, nurses, pharmacists, and doctors all feel like they might be the type of person you would encounter within the four walls of a hospital, and their stories feel genuine.
The subject matter also changes slightly throughout the stories. There are tales that tell the resident's struggles with his own workload, ones that humanize the suffering of patients when he finds himself seeing nothing but charts, medications, and diagnoses, ones that show the frustrations of working in medicine. What is left is an incredibly well-rounded set of stories that leave you empathizing with the resident as he is shaped by his chosen path.
The writing here is truly sharp and effective. Nothing is too glamorous or overwrought, rather the prose is a pleasant mix of the complexities of medicine (I enjoyed a lot of the medical jargon, but it wouldn't ruin the read if you were unfamiliar with the terminology) and simple language. The only area I found myself wanting to know more about was the resident's personal life. I believe the mystery is intentional, as we are meant to see that this is the majority of the character's life, and his truly personal life lies on the periphery.
For any of my fellow medical students, I would highly recommend this book that really humanizes medicine in a way that can be forgotten amongst the lists of symptoms and mechanisms of action. For the lay individual, this is a fine read to see exactly what medical training can entail and what might be going on in your doctor's head.
In a move designed to preserve the dignity of his patients, Holt uses a fictional character in a fictional hospital with fictional patients. Nonetheless, the stories ring true, forming some nebulous distinction that lies between fiction and non-fiction. The patients, nurses, pharmacists, and doctors all feel like they might be the type of person you would encounter within the four walls of a hospital, and their stories feel genuine.
The subject matter also changes slightly throughout the stories. There are tales that tell the resident's struggles with his own workload, ones that humanize the suffering of patients when he finds himself seeing nothing but charts, medications, and diagnoses, ones that show the frustrations of working in medicine. What is left is an incredibly well-rounded set of stories that leave you empathizing with the resident as he is shaped by his chosen path.
The writing here is truly sharp and effective. Nothing is too glamorous or overwrought, rather the prose is a pleasant mix of the complexities of medicine (I enjoyed a lot of the medical jargon, but it wouldn't ruin the read if you were unfamiliar with the terminology) and simple language. The only area I found myself wanting to know more about was the resident's personal life. I believe the mystery is intentional, as we are meant to see that this is the majority of the character's life, and his truly personal life lies on the periphery.
For any of my fellow medical students, I would highly recommend this book that really humanizes medicine in a way that can be forgotten amongst the lists of symptoms and mechanisms of action. For the lay individual, this is a fine read to see exactly what medical training can entail and what might be going on in your doctor's head.
December 31, 2022
The author was brutally truthful about his feelings and patients and I needed someone to face me with the harsh reality like the way he did.
August 5, 2016
I find it odd that in a post-James Frey world, someone can publish a work of stories he straight-up admits in the introduction are fiction as memoir. It's not just that the names are changed: Holt says he's combined and invented; he even gives himself the name "Dr. Harper" in one of the tales. I understand that the labeling of this book was 99% likely to be the publisher's decision, not his, but it messed with my perception of these stories from the beginning.
I also feel that, as fiction as opposed to a straight-forward recounting of the facts, these tales are just not that interesting. There are patients with odd symptoms, à la an episode of House, and some generally fairly weak philosophizing. Maybe it was just the introduction setting me up, but I never believed any of it -- by which I mean, I never engaged with any of it, as fiction or as fact. Holt, or "Harper," comes off as fallible, which is nice, but otherwise entirely lacking in personality. The few other characters -- the no-nonsense nurse with the backpack; the crazy-haired, crazy-talking intern from the psych ward -- come off as either stock or unbelievable. This book was so close to being the type of thing I love, and then there was just...a false note, and it wasn't.
Atul Gawande does this sort of thing much better anyway.
I also feel that, as fiction as opposed to a straight-forward recounting of the facts, these tales are just not that interesting. There are patients with odd symptoms, à la an episode of House, and some generally fairly weak philosophizing. Maybe it was just the introduction setting me up, but I never believed any of it -- by which I mean, I never engaged with any of it, as fiction or as fact. Holt, or "Harper," comes off as fallible, which is nice, but otherwise entirely lacking in personality. The few other characters -- the no-nonsense nurse with the backpack; the crazy-haired, crazy-talking intern from the psych ward -- come off as either stock or unbelievable. This book was so close to being the type of thing I love, and then there was just...a false note, and it wasn't.
Atul Gawande does this sort of thing much better anyway.
September 14, 2014
Internal Medicine by Terrence Holt is an exquisitely crafted gem of a book. The nine stories comprising Internal Medicine loosely reflect Holt’s experience as an internal medicine resident, describing the shocks and changes, both subtle and profound, he undergoes in becoming a doctor. The doctor in the stories is named “Harper” and the patient cases are compositely drawn so that Internal Medicine occupies a grey area in between fiction and non-fiction. Holt transforms medical cases “according to the logic not of journalism but of parable, seeking to capture the essence of something too complex to be understood any other way.”
Unlike other doctors-come-writers (Gawande/Hosseini), Holt wrote and taught writing for a decade before trading his pen for a stethoscope. And as a writer, he’s a virtuoso. His understated, precise prose style places the reader immediately in the exhausted, overworked shoes of a hospital intern, without melodrama or artifice, while at the same time evoking atmospheres of mystery, claustrophobia, and dread akin to Poe or Hawthorne. This blending of the physical and the metaphysical makes these stories fascinating and addicting. In the most heart-rending story in the collection, “The Surgical Mask,” Harper visits a home hospice patient who is dying of cancer disfiguring her mouth and nose. Surrounded by a gallery of her own lush oil paintings as well as a chorus of raucous, exotic birds she has rescued, she cannot talk coherently and wears a square, white surgical mask. The mask invokes a paralyzing anxiety in Dr. Harper so that he is unable to examine his patient or even do his job. This calls to mind Nathaniel Hawthorne’s great short story, “The Minister’s Black Veil” in which the mask itself — the symbol of what lies beneath — takes on its own preternatural power. Holt's best story, "The Surgical Mask" also examines the limits of human suffering and helplessness; as stories go, it’s sublime.
Both human and humane, Internal Medicine beautifully spans the gap between doctor and patient, between data and meaning, between science and art. If fiction is a lens revealing greater truth, readers can glean much about the hopes and frailties of doctors and patients, that we are all, finally, heir to.
Unlike other doctors-come-writers (Gawande/Hosseini), Holt wrote and taught writing for a decade before trading his pen for a stethoscope. And as a writer, he’s a virtuoso. His understated, precise prose style places the reader immediately in the exhausted, overworked shoes of a hospital intern, without melodrama or artifice, while at the same time evoking atmospheres of mystery, claustrophobia, and dread akin to Poe or Hawthorne. This blending of the physical and the metaphysical makes these stories fascinating and addicting. In the most heart-rending story in the collection, “The Surgical Mask,” Harper visits a home hospice patient who is dying of cancer disfiguring her mouth and nose. Surrounded by a gallery of her own lush oil paintings as well as a chorus of raucous, exotic birds she has rescued, she cannot talk coherently and wears a square, white surgical mask. The mask invokes a paralyzing anxiety in Dr. Harper so that he is unable to examine his patient or even do his job. This calls to mind Nathaniel Hawthorne’s great short story, “The Minister’s Black Veil” in which the mask itself — the symbol of what lies beneath — takes on its own preternatural power. Holt's best story, "The Surgical Mask" also examines the limits of human suffering and helplessness; as stories go, it’s sublime.
Both human and humane, Internal Medicine beautifully spans the gap between doctor and patient, between data and meaning, between science and art. If fiction is a lens revealing greater truth, readers can glean much about the hopes and frailties of doctors and patients, that we are all, finally, heir to.
February 3, 2017
I'm not sure exactly why the New York Times felt this was a "work of genius". The stories he delivers, of patients, seem designed to tell you nothing more than his deep discomfort at developing a rapport with anyone. He cringes, he bumbles, he's afraid, he's disgusted, he has nurses and interns telling him to be more present, to treat, to freaking BE a doctor.
But he seems oblivious to reform, and I could forgive him for that. However, he then chooses gloss over his clear deficiencies in kindness and warmth by recounting how much his patients seemed in awe of him, and worshipped him. Instead of owning his deficiencies, which you sense he wants to do, he instead falls back on excuses and a pressing desire to tell you, the reader, that he must be truly amazing because a woman about to die respected his authority.
None of the stories were anything medically spectacular, nothing honestly intriguing. Simply people about to die who then... died. But along the way there was cold pizza to eat and patients to run away from and nurses who seem to run the place and diagnose the patients while this man lingers over his feelings of repulsion of sick people. Man, just become a radiologist already.
Now Joe Bellagio - the intern that actually gave a damn about his psych patients? The one that introspectively analyzed why his patients presented with such horrific symptoms? The one who cared even about the guy who killed his kids in a fire? I want to read HIS story.
But he seems oblivious to reform, and I could forgive him for that. However, he then chooses gloss over his clear deficiencies in kindness and warmth by recounting how much his patients seemed in awe of him, and worshipped him. Instead of owning his deficiencies, which you sense he wants to do, he instead falls back on excuses and a pressing desire to tell you, the reader, that he must be truly amazing because a woman about to die respected his authority.
None of the stories were anything medically spectacular, nothing honestly intriguing. Simply people about to die who then... died. But along the way there was cold pizza to eat and patients to run away from and nurses who seem to run the place and diagnose the patients while this man lingers over his feelings of repulsion of sick people. Man, just become a radiologist already.
Now Joe Bellagio - the intern that actually gave a damn about his psych patients? The one that introspectively analyzed why his patients presented with such horrific symptoms? The one who cared even about the guy who killed his kids in a fire? I want to read HIS story.
October 14, 2018
Another valuable lesson learned: when reading blurbs, trust those from critics, not from writers. This was a bland book of essays about medicine and the human condition, written in a sort of philosophical poetic style. For people who like that sort of thing, this is the sort of thing they like.
One story has stuck with me: a patient who was admitted for tests, and it was cancer with no possible treatment. It was one of the first times the young doctor had to give news this bad, but he prepared and screwed up his courage and spoke to the patient, an older man. Patient was shaken but took it well. The next day the doctor came in to see him and patient was sunny and cheerful. "So doc, when are you letting me out of here?" "Mr. Soandso, remember our conversation yesterday? We're making arrangements for you to go into hospice." "Hospice! But that's for someone who's dying! What are you talking about?"
He explained again, and the guy acted as though he was hearing it for the first time. Again, shaken up.
Next day, same thing.
A social worker managed to get in touch with the guy's brother who confirmed that he had no short term memory, from years of drinking.
One story has stuck with me: a patient who was admitted for tests, and it was cancer with no possible treatment. It was one of the first times the young doctor had to give news this bad, but he prepared and screwed up his courage and spoke to the patient, an older man. Patient was shaken but took it well. The next day the doctor came in to see him and patient was sunny and cheerful. "So doc, when are you letting me out of here?" "Mr. Soandso, remember our conversation yesterday? We're making arrangements for you to go into hospice." "Hospice! But that's for someone who's dying! What are you talking about?"
He explained again, and the guy acted as though he was hearing it for the first time. Again, shaken up.
Next day, same thing.
A social worker managed to get in touch with the guy's brother who confirmed that he had no short term memory, from years of drinking.
February 25, 2015
Terrence Holt has written a poignant and unforgettable memoir about some of his experiences as a resident physician in the early days of his career.
Dr. Holt describes his feelings of uncertainty, frustration and trepidation when faced with some very difficult medical situations. Yet his calm, thorough diagnosis of patients’ medical issues as well as his appreciation of their fears allowed his compassion to show. His genuine care for the welfare of his patients is evident in his writing.
Part of the book description provided on the book jacket aptly encompasses this unforgettable memoir: “Internal Medicine captures the doctor’s struggle not only with sickness, suffering, and death but the fears and frailties each of us—patient and doctor alike—brings to the bedside. In a powerful alchemy of insight and compassion, Holt reveals how those vulnerabilities are the foundations of caring. Intensely realized, gently ironic, heartfelt and heartbreaking, Internal Medicine is an account of what it means to be a doctor, to be mortal, and to be human.”
Dr. Holt describes his feelings of uncertainty, frustration and trepidation when faced with some very difficult medical situations. Yet his calm, thorough diagnosis of patients’ medical issues as well as his appreciation of their fears allowed his compassion to show. His genuine care for the welfare of his patients is evident in his writing.
Part of the book description provided on the book jacket aptly encompasses this unforgettable memoir: “Internal Medicine captures the doctor’s struggle not only with sickness, suffering, and death but the fears and frailties each of us—patient and doctor alike—brings to the bedside. In a powerful alchemy of insight and compassion, Holt reveals how those vulnerabilities are the foundations of caring. Intensely realized, gently ironic, heartfelt and heartbreaking, Internal Medicine is an account of what it means to be a doctor, to be mortal, and to be human.”
December 28, 2014
The extraordinary writing in these short stories of one doctor's residency is a deeply personal look at both himself and some of the situations he found himself in. In it he shares vignettes of just some of the cases of his residential career - vignettes which are highly descriptive of the exhaustion suffered by doctors in this stage of their training.
It sensitively highlights the tenuous grip on life that we all have - as Holt says, none of us gets up in the morning expecting to end the day in ICU, but those beds are filled every day.
Holt shares much about himself in these stories as he casts his mind back to his own failings as well as those of the medical system we depend upon in the Western world.
It sensitively highlights the tenuous grip on life that we all have - as Holt says, none of us gets up in the morning expecting to end the day in ICU, but those beds are filled every day.
Holt shares much about himself in these stories as he casts his mind back to his own failings as well as those of the medical system we depend upon in the Western world.
October 26, 2014
As a medical professional I found this book to be very well written and a good source of information on the life of a surgeon. Excellent stories that had me flipping the pages fast.
November 17, 2021
This book was so strange. It started out promising and his writing talent is obvious. But I wasn’t connecting emotionally to the stories. He was very detached from his patients and their suffering, and I guess you have to be in his line of work. It was enjoyable to read but then I got to the end and was horrified by the last story. It didn’t follow the rest of the book very well and I didn’t see the point of it.
So I guess he was darker than I wanted. He shows a dark side of medicine and doctor-life and I guess I have enjoyed other medical memoirs more than this one.
His writing was pretty spectacular though. That part, I thoroughly enjoyed.
So I guess he was darker than I wanted. He shows a dark side of medicine and doctor-life and I guess I have enjoyed other medical memoirs more than this one.
His writing was pretty spectacular though. That part, I thoroughly enjoyed.
April 1, 2018
I like this. I really do. The stories are written in a clear, approachable tone (devoid of much of the arrogance and medical jargon that I've come to associate with MD's as a result of my family's work in the medical field). That is, the narrator is someone that is easy to empathize with, even if his experiences are far removed from the reader's. What bothers me is this: I feel cheated by the fact these stories aren't based in the author's real experiences. When I picked it up, I skipped past the introduction and went straight to reading. I assumed that the book was a memoir. It is not. I was already halfway through when I went back to the introduction, and the realization that this book and its events are completely fictional was... Unfortunate. I finished the book - it was still enjoyable, but I felt a little jaded. The humanity of these patients seemed somehow diminished to me, but maybe that's my own fault for not reading the intro. In any case, a good read.
July 23, 2016
The author tells us in a prologue that this is a work of fictitious non-fiction. His aim is to accurately represent the experience of a man becoming a doctor, without violating HIPAA, and without relying on specific cases or milieus that could lend themselves to lawsuits. As a work of fiction, it accomplishes its goal of educating the reader about hospital/medical hierarchies, & presenting the doctor's complex perspective on pain, suffering & death.
As someone already highly critical of modern medical institutions, this book did nothing to allay my fears that everything about the system is wrong, from the hazing that we call residencies, to the professional detachment (desensitization) that is worn like armor to shield doctors against the emotional burden of witnessing pain day after day after day.
Holt’s Internal Medicine drives home the fact that “best” medical practices today are bad for the patient, bad for the families of patients, and bad for the doctors. I can think of no other profession where the system itself demands you remain sleep-deprived, psychically unrested, exposed to near constant suffering & death, and physically separated from your friends, family and loved ones. Any sane employer would tell you this is a recipe for terrible employees: they would be prone to errors in judgment, demonstrate an impairment in fine motor skills, become embittered by their long hours & their inability to commune with those loved ones in whose arms they may find a smidgen of respite. In this hellscape the healers have no time to heal themselves. Do we value Health at any cost?
As someone already highly critical of modern medical institutions, this book did nothing to allay my fears that everything about the system is wrong, from the hazing that we call residencies, to the professional detachment (desensitization) that is worn like armor to shield doctors against the emotional burden of witnessing pain day after day after day.
Holt’s Internal Medicine drives home the fact that “best” medical practices today are bad for the patient, bad for the families of patients, and bad for the doctors. I can think of no other profession where the system itself demands you remain sleep-deprived, psychically unrested, exposed to near constant suffering & death, and physically separated from your friends, family and loved ones. Any sane employer would tell you this is a recipe for terrible employees: they would be prone to errors in judgment, demonstrate an impairment in fine motor skills, become embittered by their long hours & their inability to commune with those loved ones in whose arms they may find a smidgen of respite. In this hellscape the healers have no time to heal themselves. Do we value Health at any cost?
December 28, 2014
After reading books by Atul Gawande and Richard Selzer, both of whom write about their own actual experiences as doctors, I was a little put off by the author's explanation that these were not true-life stories, but rather fictional "parables" that he uses to illustrate truths about events that surround disease and death and doctors. The narrator is not the author and is not based on a real person. The patients and their cases are completely made-up. But once I got into the book, none of that mattered. The stories might be fictional, but they ring true.
Holt's writing style is almost old-fashioned sometimes, as when he writes: "Whatever the preacher was saying, he was done. There was a long, dreadful pause, and then the static arrangement of the mourners began to dissolve, currents of dark suits and dresses dispersing among the graves..." But this is not written like a page-turner nor is it action-oriented; rather, it is more like a quiet reflection or meditation.
The author doesn't always explain every medical term he uses, but he explains enough to convey what's going on. And although not every patient survives--in fact, most of them don't--he doesn't write melodramatically. What he does do is present a believable account of what is is like to be a resident who is just learning his craft. I found myself thinking, "At last, someone is honest about how doctors really view their patients!" Not because he thought anything bad, but because what he thought was so human.
Holt's writing style is almost old-fashioned sometimes, as when he writes: "Whatever the preacher was saying, he was done. There was a long, dreadful pause, and then the static arrangement of the mourners began to dissolve, currents of dark suits and dresses dispersing among the graves..." But this is not written like a page-turner nor is it action-oriented; rather, it is more like a quiet reflection or meditation.
The author doesn't always explain every medical term he uses, but he explains enough to convey what's going on. And although not every patient survives--in fact, most of them don't--he doesn't write melodramatically. What he does do is present a believable account of what is is like to be a resident who is just learning his craft. I found myself thinking, "At last, someone is honest about how doctors really view their patients!" Not because he thought anything bad, but because what he thought was so human.
April 11, 2016
Just OUTSTANDING! I could not put it down. The only negative was that I wanted more of Dr. Holt. What honesty amidst a mood /feel embedded in the writing that reflects the hospital. He grabs the exact tornado of controlled chaos that hospital ward, station inputs, operating suites, E.R. and corridors of wait ARE. He cores the point of contact medical care at its hospital placement. His code chapter alone should be read by every citizen or resident of the USA who plans to enter a hospital some day. That's everybody- because you may not be conscious but you'll end up there in majority case without the planning.
I read non-fiction in this genre consistently and at least 5 a year for doctor "voice".
This one approaches the reality of death, bad news told and received- and the possible length of the dying process itself (within hospice at home OR in the hospital)- the best. And he does it by example, not preachy tenets.
Dr. Holt is a hero for his emotional self-exposure. I want him to write some more chapters because he gets it.
I read non-fiction in this genre consistently and at least 5 a year for doctor "voice".
This one approaches the reality of death, bad news told and received- and the possible length of the dying process itself (within hospice at home OR in the hospital)- the best. And he does it by example, not preachy tenets.
Dr. Holt is a hero for his emotional self-exposure. I want him to write some more chapters because he gets it.
July 9, 2023
This book is a series of short stories based on the author's stint as a resident during his training as an MD. The intent of the stories is to capture the essence of residency. My interest in the book is the fact that my daughter is currently halfway through her residency. The author conveys the gruelling toll on the residents. Never clear to me the benefits of this system except to save the hospitals money. I must warn potential readers, that if medical procedures make you queasy, like me, this will be a tough read.
April 18, 2015
I was super excited when I picked this book up. And even now, a few days later, I still am. Half way through I thought Holt found a way of making me regret my doctoring dream, but at the end I found myself wanting it more (if that's even possible).
Holt's writing style is catching, and his outlook on the world of medicine, even though sounds a little cynical, is very honest.
Holt's writing style is catching, and his outlook on the world of medicine, even though sounds a little cynical, is very honest.
December 30, 2017
great stories, mesmerizing and well written.
June 28, 2023
"There was something in Hawley's career, in its old-school devotion to service, that seemed to have about it is own element of expiation. Was there some debt he had tried to repay? I believe so, although of course by then it was too late to learn what it was, or if he had managed to settle it.
But in the years since, I've come to understand what he tried to tell us, why he chose to tell us in the way he did. It was part of that expiation, which was also why he didn't care if we thought him foolish. I understand this now, almost as well as I know how tedious you find me, now that I'm the one telling pointless stories. I don't mind. There are many mistakes we are doomed to repeat, again and again and again. This is only one of them."
Dr. Holt explicitly says that this is a fictionalization of his experience, written in the first person, but with liberties taken in creating fictional patients who are often composed of multiple real patients. The first half of the book felt much more memoir-like, with many short vignettes around particular encounters. The last few stories felt more solidly like short story fictionalizations, written to explore fundamental questions that the experience of being within healthcare inevitably raises.
Holt himself is not presented in a necessarily positive light, and he leans into the uncomfortable, discomforting parts of medicine. Very rarely do the stories have neat, happy endings, or with a clean moral to take away. Instead, I was often left rereading the final few paragraphs, unsure how to resolve the complexities he raises and leaves at our feet. I found his writing evocative, particularly in capturing the chaos, the confusion, and most especially the constant tension of compassion and callous always dually present within medicine.
But in the years since, I've come to understand what he tried to tell us, why he chose to tell us in the way he did. It was part of that expiation, which was also why he didn't care if we thought him foolish. I understand this now, almost as well as I know how tedious you find me, now that I'm the one telling pointless stories. I don't mind. There are many mistakes we are doomed to repeat, again and again and again. This is only one of them."
Dr. Holt explicitly says that this is a fictionalization of his experience, written in the first person, but with liberties taken in creating fictional patients who are often composed of multiple real patients. The first half of the book felt much more memoir-like, with many short vignettes around particular encounters. The last few stories felt more solidly like short story fictionalizations, written to explore fundamental questions that the experience of being within healthcare inevitably raises.
Holt himself is not presented in a necessarily positive light, and he leans into the uncomfortable, discomforting parts of medicine. Very rarely do the stories have neat, happy endings, or with a clean moral to take away. Instead, I was often left rereading the final few paragraphs, unsure how to resolve the complexities he raises and leaves at our feet. I found his writing evocative, particularly in capturing the chaos, the confusion, and most especially the constant tension of compassion and callous always dually present within medicine.
September 18, 2021
3.5/5 stars, rounded down. the cases themselves were interesting, although knowing that they were completely fictional put a bit of a damper on the read. the narrator was the main reason why i only liked, but didn't love this--i got the sense that he was always trying to make some great, profound point, but it was lost on me. his conduct as a doctor was also odd at times, where even the nurses were commenting on how he needed to get himself together or focus on the case at hand.
December 9, 2020
Doctors are human...just like us
So many place doctors on pedestals expecting unrealistic behavior from them. Yes they are smart, above average and learning never ends. This book is important to us because while we deal with nuts and bolts they deal with bones and flesh. I give it a 5 star because the vast majority are caring human beings caring for a smorgasbord of human kind.
So many place doctors on pedestals expecting unrealistic behavior from them. Yes they are smart, above average and learning never ends. This book is important to us because while we deal with nuts and bolts they deal with bones and flesh. I give it a 5 star because the vast majority are caring human beings caring for a smorgasbord of human kind.
April 20, 2020
Very interesting! Skimmed a little at the end but overall really enjoyed these stories
January 20, 2023
cool medical stuff and surprisingly poetic. hospitals are very metaphorical. 4.5
January 18, 2025
Probably would have been a 5/5 if the last chapter wasn’t just thrown in there.
March 18, 2015
This review originally appeared on my blog at www.gimmethatbook.com.
A collection of essays about life as a surgical intern.
Terrence Holt, whose In the Valley of the Kings was hailed as a “work of genius” (New York Times) and made Amazon’s Top Ten Short Story Collections of the year, brings a writer’s eye and a doctor’s touch to this powerful account of residency.
Intense, ironic, heartfelt, and heartbreaking, these nine vivid stories put us at the bedside of a patient dying in a house full of cursing parrots, through a nightmarish struggle to convince a man that he has cancer, at a life-and-death effort to keep an oxygen mask on a claustrophobic patient, and in the lounge of a snowbound hospital where doctors swap yarns through the night.
Out of these “dioramas from the Museum of Human Misery”, Holt draws meaning, beauty, wonder, and truth. Personal, poignant, and meticulously precise, these stories evoke Chekhov, Maugham, and William Carlos Williams, admitting readers to the beating heart of medicine. Internal Medicine is an account of what it means to be a doctor, to be mortal, and to be human.
This book was on my “to-read” list, so I picked it up from the library. Attempts to reach the author for a review/giveaway copy were unsuccessful.
It only took a few pages for INTERNAL MEDICINE to become a great read. Told in the voice of a doctor, explaining how he handled difficult cases during his internship, this book is alternately chilling and poignant. The take away message is this: doctors have self doubt and fatigue just like everyone else, despite the brave front they put on.
Each chapter told the story of one patient, and how Holt learned from their situation. One lesson was patience, one was bravery, one was teamwork, and so on. Brilliant details and situations that everyone can identify with are what makes this such a moving and important read.
As I read about the woman whose oxygen saturation was dipping into the 80’s, yet she kept ripping her O2 mask off due to claustrophobia, I ferverently hoped I would never be ill and lingering in the hospital. The intimate details of how the human body betrays us all is what will stay with you, long after the book is finished. Holt’s writing style is easy to follow, and full of honesty.
Each chapter can be read as a stand alone, and I recommend that–for you will need time to digest the life lessons revealed with each patient’s final outcome. Holt does not hide his fear, his disgust, his anger, and his weariness. He exposes himself – and the entire medical profession – with stories that cannot help but touch your soul. What makes this book so wonderful is that the stories take place during his internship, where each moment is a learning experience and a doctor’s intuition is “make or break”. The spin on each chapter would be totally different if it was written under the guise of a man who was completely comfortable with his medical knowledge, with his ability to heal and comfort. Instead, there are questions and internal monologues, which make the doctor not larger than life, but truly human and with foibles.
The book can be graphic at times, so beware. Seasoned readers of the medical genre will enjoy it, as there are some things that I haven’t read about previously. The scenes and maladies are diverse, and there is a chilling story from a mental hospital thrown in for good measure. The only chapter I had a problem with was the last one: a seemingly out of place fable (told on a regular basis by doctors) about an incident that may or may not have taken place in real life–a rambling and unsatisfying tale told (in this case) by an older doctor in an on call room where others are trying to get some rest. I’m not sure why the author chose to end with this story, as it took the life out of the other eight chapters that went before. Other than that, I have nothing but praise for INTERNAL MEDICINE. This should be on the must read shelf for all those about to enter the medical profession.
A collection of essays about life as a surgical intern.
Terrence Holt, whose In the Valley of the Kings was hailed as a “work of genius” (New York Times) and made Amazon’s Top Ten Short Story Collections of the year, brings a writer’s eye and a doctor’s touch to this powerful account of residency.
Intense, ironic, heartfelt, and heartbreaking, these nine vivid stories put us at the bedside of a patient dying in a house full of cursing parrots, through a nightmarish struggle to convince a man that he has cancer, at a life-and-death effort to keep an oxygen mask on a claustrophobic patient, and in the lounge of a snowbound hospital where doctors swap yarns through the night.
Out of these “dioramas from the Museum of Human Misery”, Holt draws meaning, beauty, wonder, and truth. Personal, poignant, and meticulously precise, these stories evoke Chekhov, Maugham, and William Carlos Williams, admitting readers to the beating heart of medicine. Internal Medicine is an account of what it means to be a doctor, to be mortal, and to be human.
This book was on my “to-read” list, so I picked it up from the library. Attempts to reach the author for a review/giveaway copy were unsuccessful.
It only took a few pages for INTERNAL MEDICINE to become a great read. Told in the voice of a doctor, explaining how he handled difficult cases during his internship, this book is alternately chilling and poignant. The take away message is this: doctors have self doubt and fatigue just like everyone else, despite the brave front they put on.
Each chapter told the story of one patient, and how Holt learned from their situation. One lesson was patience, one was bravery, one was teamwork, and so on. Brilliant details and situations that everyone can identify with are what makes this such a moving and important read.
As I read about the woman whose oxygen saturation was dipping into the 80’s, yet she kept ripping her O2 mask off due to claustrophobia, I ferverently hoped I would never be ill and lingering in the hospital. The intimate details of how the human body betrays us all is what will stay with you, long after the book is finished. Holt’s writing style is easy to follow, and full of honesty.
Each chapter can be read as a stand alone, and I recommend that–for you will need time to digest the life lessons revealed with each patient’s final outcome. Holt does not hide his fear, his disgust, his anger, and his weariness. He exposes himself – and the entire medical profession – with stories that cannot help but touch your soul. What makes this book so wonderful is that the stories take place during his internship, where each moment is a learning experience and a doctor’s intuition is “make or break”. The spin on each chapter would be totally different if it was written under the guise of a man who was completely comfortable with his medical knowledge, with his ability to heal and comfort. Instead, there are questions and internal monologues, which make the doctor not larger than life, but truly human and with foibles.
The book can be graphic at times, so beware. Seasoned readers of the medical genre will enjoy it, as there are some things that I haven’t read about previously. The scenes and maladies are diverse, and there is a chilling story from a mental hospital thrown in for good measure. The only chapter I had a problem with was the last one: a seemingly out of place fable (told on a regular basis by doctors) about an incident that may or may not have taken place in real life–a rambling and unsatisfying tale told (in this case) by an older doctor in an on call room where others are trying to get some rest. I’m not sure why the author chose to end with this story, as it took the life out of the other eight chapters that went before. Other than that, I have nothing but praise for INTERNAL MEDICINE. This should be on the must read shelf for all those about to enter the medical profession.
May 19, 2015
I picked this book up by chance. At first, I could hardly put it down. As someone with no access to the medical world (other than as the occasional patient), this was really eye opening as far as what doctors think and experience. However, about mid-way through, the stories began to blur together. I don't know if this is purposeful --- to a large extent, Holt makes it very clear that patients do blur together and just become symptoms and rooms, and not people. So maybe the story telling was trying to reflect that. It also made me realize that doctors are not heroes or gods. They are overworked men and women doing a job and doing their best in the situations given to them. And their best may in fact not be satisfactory at all. There were a few times were I did not like Holt and/or his behavior. But I don't think it's him so much, as the field/industry as a whole. As a society, we should probably seriously rethink how we think of health care and what we want from it. Because what Holt describes, isn't picture perfect.
Anyway, a few excerpts:
"She was alive and she was dead, somehow occupying both states at once until the passage of time would collapse them into one." p 78
"In too many cases we keep bodies alive in a way that is only cruel, cruel in direct proportion not only to its futility, but also to the manifold distresses, large and small, physical and spiritual, inflicted by technologies that only put off the inevitable end." p 117
**** SPOILER ALERT *****
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This is a bit random, but I wanted to share...
In Iron Maiden, there's a patient, Carrie B who has Borderline Personality Disorder. If you don't know, BPD is a highly stigmatized mental health illness. She's in the psych ward due to "a few slices at the solar surface of her left wrist, too superficial (in the intern's assessment to warrant suturing, which is usually the case in the ones that survive." (p 205).
I detest the description of "superficial." I don't know if that's the word the nurse used, if that's the word Holt used, whatever... but superficial has such a negative connotation. Telling anyone with BPD that their wounds are superficial would be a huge blow, and an immediate to lose any trust/confidenc/ability to have a relationship with that person. Couldn't they have just said non-life-threatening? I mean if someone is willing to harm themselves -- in any way -- should it really be deemed superficial? Could they have said the cuts were physically shallow?
In the end, Carrie B had been sticking needles into her chest. NEEDLES. Like 10 of them. Here's a woman who is seriously self-harming, and yet they judge her on the obvious and they judge her wrongly. I don't know why this riled me up so much, but it really did. It seems quite reflective of how we view/judge those with mental illnesses.
Anyway, a few excerpts:
"She was alive and she was dead, somehow occupying both states at once until the passage of time would collapse them into one." p 78
"In too many cases we keep bodies alive in a way that is only cruel, cruel in direct proportion not only to its futility, but also to the manifold distresses, large and small, physical and spiritual, inflicted by technologies that only put off the inevitable end." p 117
**** SPOILER ALERT *****
*
*
*
*
This is a bit random, but I wanted to share...
In Iron Maiden, there's a patient, Carrie B who has Borderline Personality Disorder. If you don't know, BPD is a highly stigmatized mental health illness. She's in the psych ward due to "a few slices at the solar surface of her left wrist, too superficial (in the intern's assessment to warrant suturing, which is usually the case in the ones that survive." (p 205).
I detest the description of "superficial." I don't know if that's the word the nurse used, if that's the word Holt used, whatever... but superficial has such a negative connotation. Telling anyone with BPD that their wounds are superficial would be a huge blow, and an immediate to lose any trust/confidenc/ability to have a relationship with that person. Couldn't they have just said non-life-threatening? I mean if someone is willing to harm themselves -- in any way -- should it really be deemed superficial? Could they have said the cuts were physically shallow?
In the end, Carrie B had been sticking needles into her chest. NEEDLES. Like 10 of them. Here's a woman who is seriously self-harming, and yet they judge her on the obvious and they judge her wrongly. I don't know why this riled me up so much, but it really did. It seems quite reflective of how we view/judge those with mental illnesses.
December 2, 2014
Very disappointed. The sleep deprivation and scheduling stresses I have seen in my daughter, now an internal medicine resident, were well represented in his accounts. This collection seemed random, and I was disappointed that content didn't match up to the descriptive prose promise. While I recognize that much of med school and residency workload pushes dehumanization, I kept wondering when the doctor was going to "show up." He seemed too aloof, and more muddling through than trying to learn or to teach. I had at first thought tjis might be like "The man who mistook his wife for a hat,"but it wasn't that, and the author presumed apparently that we would all read this book with a medical dictionary handy, eould know all hospital jargon, or would google the lingo. I was reading this mostly in an airport and on a plane. It was interesting enough to pass the time, but made me more uncomfortably conscious of why hospital care and patient relations may never begin to meet my expectations of compassion, thoroughness, teamwork, and cross-checking despite advances in medical technology.
March 7, 2025
It was like the compassionate, less cynical version of "House of God" in terms of narrative style and modestly human first-person depiction of being a medical resident. It's a good read for other medical residents, I think, because it normalizes a lot of the strange and disarming aspects of young doctorhood and patient care. Additionally it is written in short stories which makes it easy to put down and pickup months later without missing much (again making it a good book for someone in training or in school). I found this book comforting. It was easy and enjoyable to read.
" 'You didn't even examine her.' That stopped me. She was right. I'd stood there by the bedside, taken her irrelevant pulse, and talked about drug absorption and swallowing, her fluid status, and at this point I couldn't remember what else, but hadn't done the simplest thing to assess the situation. Which would have been lifting up that mask and seeing what lay beneath. 'You're right,' I said. Sometimes I find myself in a situation so confusing that the only thing to do is tell the truth, I think."
" 'You didn't even examine her.' That stopped me. She was right. I'd stood there by the bedside, taken her irrelevant pulse, and talked about drug absorption and swallowing, her fluid status, and at this point I couldn't remember what else, but hadn't done the simplest thing to assess the situation. Which would have been lifting up that mask and seeing what lay beneath. 'You're right,' I said. Sometimes I find myself in a situation so confusing that the only thing to do is tell the truth, I think."
October 29, 2014
I liked this rather meditative set of anecdotes from the hospital. Not much heartwarming subject matter here - stories focus on death, dying, and the strange ways the mind and body can fail. Particularly haunting tales:
"Iron Maiden" - In which a woman in the psych ward demonstrates what lengths psychological pain can drive a person to.
"The Grand Inquisitor" - A second-hand tale, where an older doctor relates the story of an oncologist whose quest to find better treatments for leukemia torments others and himself.
I think this would be a good book for fans of poetry, as the stories all craft haunting images and evocative turns of phrase. They are very efficient tales in that respect - conveying a lot of meat in just a few words.
"Iron Maiden" - In which a woman in the psych ward demonstrates what lengths psychological pain can drive a person to.
"The Grand Inquisitor" - A second-hand tale, where an older doctor relates the story of an oncologist whose quest to find better treatments for leukemia torments others and himself.
I think this would be a good book for fans of poetry, as the stories all craft haunting images and evocative turns of phrase. They are very efficient tales in that respect - conveying a lot of meat in just a few words.
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