Intern: A Doctor's Initiation - Hardcover

Jauhar, Sandeep

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4,447 ratings by Goodreads

9780374146597: Intern: A Doctor's Initiation

Hardcover

ISBN 10: 0374146594 ISBN 13: 9780374146597

Publisher: Farrar, Straus and Giroux, 2007

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"In Jauhar's wise memoir of his two-year ordeal of doubt and sleep deprivation at a New York hospital, he takes readers to the heart of every young physician's hardest test: to become a doctor yet remain a human being." ― Time

Intern is Dr. Sandeep Jauhar's story of his days and nights in residency at a busy hospital in New York City, a trial that led him to question his every assumption about medical care today.

Residency―and especially its first year, the internship―is legendary for its brutality, and Jauhar's experience was even more harrowing than most. He switched from physics to medicine in order to follow a more humane calling―only to find that his new profession often had little regard for patients' concerns. He struggled to find a place among squadrons of cocky residents and doctors. He challenged the practices of the internship in The New York Times, attracting the suspicions of the medical bureaucracy. Then, suddenly stricken, he became a patient himself―and came to see that today's high-tech, high-pressure medicine can be a humane science after all.

Jauhar's beautifully written memoir explains the inner workings of modern medicine with rare candor and insight.

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About the Author:

Sandeep Jauhar, MD, PhD, is the director of the Heart Failure Program at Long Island Jewish Medical Center. He writes regularly for The New York Times and The New England Journal of Medicine. He lives with his wife and their son in New York City.

Chapter 1
I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather sandals slipped on the rounded irregular rocks. The hospital was an old building browned by the passage of two centuries, with spidery cracks in its fa�ade. Founded in 1771, New York Hospital is the second-oldest hospital in the United States, a mecca for doctors and patients from all over the world. I had been in the building once before, six months ago, for a residency interview. I spun through a revolving brass door, nearly running into the burly security guard reading the New York Post. He looked up from the tabloid just long enough to point me in the direction of the elevator.
The tiled corridors were dark and dull, mixing shadow and light.
I darted past the chapel, past the caf�, around the information desk, which sat in the middle of the huge atrium like a fort, and entered a bank of elevators. Hanging on a wall was a portrait of a gray-haired lady in a blue dress sitting in dignified repose before an open book. She was a graduate of the medical school, class of 1899, ninety-nine years ago, who built a medical college for women in Northern India, on the banks of the Ganges, near where my father had his early college education. Nearby was a metal tablet in bas-relief: “She cared for all in need. For each, she made time to guide, to teach, and to heal.”
When I arrived on the fourth floor, other interns were still filing into the auditorium. A woman handed me a manila folder, and I went inside and sat down. The orientation packet contained several essential documents: a house-staff phone card, directions for obtaining autopsies, instructions on how to use the hospital dictation system, and the residency contract. I leafed through it quickly. My salary was going to be $37,000 a year, about eight dollars an hour, I calculated, given the number of hours I was going to be working, but I didn’t mind. Though I was a year shy of thirty, it was more than double what I had ever made.
My classmates, though younger than I, appeared older than I expected, casually dressed, all thirty-five of them, in khakis and polo shirts, faded jeans and sequined tops. Some of them evidently knew each other, because they were already chatting in small, insulated groups. They were from some of the best medical schools in the country: Harvard, Yale, Cornell, Columbia. Though I too had gone to a top school—Washington University in St. Louis—I had been feeling insecure about the prospect of working with them. For months I had feverishly been reading Harrison’s tome on internal medicine and review articles in The New England Journal of Medicine to prepare for this day.
Someone in the front row stood up and turned to face us. It was Shelby Wood, the hospital’s residency director. He was a serious-looking man of medium build, with straight brown hair and a long, aquiline nose. He was wearing a white coat and a fat blue tie that might have been in fashion twenty years earlier. My elder brother, Rajiv, a cardiology fellow at the hospital, six years ahead of me in his medical training (though only two and a half years older), had warned me that Dr. Wood was a bit of a grouch, but had added that he was also fair and decent and a strong advocate for his house staff. Wood, I was to learn, hailed from the old school, where you were expected to live and breathe medicine, stay late in the hospital, neglect your family for the sake of your patients, and emerge on the other side a seasoned physician.
He cleared his throat and began to speak. His voice was deep but incongruously soft, and because I was sitting in the back of the sixty-seat auditorium, I only managed to catch snippets of his remarks. It was going to be a busy year, he said, as thirty-five heads stared motionlessly back at him. We were expected to devote ourselves fully to medicine. “You don’t learn French by taking classes at Hunter College. You learn it by going to Paris, sitting in the caf�s, talking to people.” Likewise medicine: we would learn it by living it. “You are now ambassadors for the profession,” he said gravely. “So don’t let the students hear you complain. It sets a bad example.” If everything went as planned, he added, by next June we’d be ready to supervise the next batch of
interns.
I glanced over at the pretty brunette sitting next to me. She looked back at me, rolled her eyes, and opened her mouth in mock panic.
Then Wood dropped the bomb. Every intern starting on the wards or in the intensive care units was required to come to the hospital every single day, including weekends, for the first six weeks. The only exceptions were interns starting in the outpatient clinic, which was only open from nine to six; they would have no evening call and weekends off for the first month. I later learned that this regimen was a long-standing tradition at the hospital, the most efficient way to get everyone up to speed. To me it seemed brutal, like a kind of hazing, not to mention a violation of residency work-hour limits set forth by the Bell Commission in New York in the mid-1980s. Uneasy murmurings reverberated through the auditorium as new interns rustled through their packets. I scanned the master schedule before breathing a sigh of relief. Along with six classmates, I was slated to start in the clinic.
“We are here to help you,” Wood said, raising his voice over the light chatter. “You should feel free to call on us anytime, day or night. The only mistake you can make is not asking for help.”
I was reminded of a residency interview in Chicago a few months earlier. The interviewer, a portly senior physician with an abundance of facial hair, had posed the following scenario: A nurse pages me in the middle of the night to tell me that a patient who just had hip surgery is short of breath. What would I do? “Go see the patient,” I said. I had enough sense to know that there was only one right answer to that question. Walking to the room, what would I be thinking about? “Pulmonary embolism,” I replied. Blood clots in the lung are a feared complication after hip surgery. When I arrive in the room, the patient is in distress. His heart is beating 130 times per minute and the oxygen tension in his blood is low. Now what? I went over the treatment options in my head—blood thinner, supplemental oxygen, arterial blood gas—but it seemed the examiner wanted me to say something else. I’d heard about the notorious “July phenomenon,” in which hospital mortality supposedly increases every summer with the entry of new and inexperienced hospital staff. “I’d call a senior resident,” I finally answered. Why? “Because I could be missing something.” My interviewer nodded; I had passed the test. Like all residency directors, he was looking for a soldier, not a cowboy.
Now it was late June, and we were the new hospital staff. For the rest of that first morning, we sat through a series of tag-team lectures. A woman from the blood bank talked about blood transfusions. A pathologist talked about the importance of autopsies. A psychologist spoke about work-related stress and told us that confidential counseling was available. A lawyer from risk management, the department that defended the hospital against lawsuits, informed us that at some point in our careers every one of us was likely to be sued, and that we could even be sued during residency. She offered some advice: Document your decision-making; document when a patient refuses treatment; never admit wrongdoing; never talk to an opposing attorney; and, finally, be nice to your patients. Doctors who were nice to their patients were rarely sued, even in cases of egregious malpractice. I looked around the room, trying to gauge the reaction of my classmates, frankly surprised that such a cynical thing was being taught on the first day of residency. No one’s eyes met mine.
At the midmorning break, I went outside. Stepping through the humid air was like sweeping away static. The sidewalk was buzzing in a kind of Brownian motion, with pedestrians sidestepping me as though I were a moving obstacle. A long line snaked from an aromatic hot dog stand. Buses and taxicabs were letting people off in front of the hospital. An ambulance whizzed by on the main thoroughfare, sirens blaring, lights flashing. The noise fed my sense of wonder. I had grown up in a quiet Southern California suburb, craving the excitement of a big city. Berkeley and St. Louis had their pockets of vitality, but nothing like this. Even the smell of the neighborhood—a mix of pizza, garbage, cigarette smoke, and fragrant fruit—was rich and seasoned, like wisdom wafting through the air.
I had only arrived in Manhattan a few days earlier, moving into a one-bedroom apartment about a block away from the hospital. On the plane flight in from St. Louis, the pilot took a detour because of airspace congestion, he told us, flying into LaGuardia from the south, not the usual flight pattern. As we passed over the World Trade Center and then soared low over the city, I craned my neck to look down at the broad swath of Central Park. The brown buildings on its outskirts were arrayed like divers ready to jump into a pool. Down there, I had imagined, all of the metropolis’s unique charms were waiting for me: the old, stained sidewalks; the stealthy characters playing junkyard instruments on subway platforms; the deliverymen hurtling through traffic lights on their rickety ten-speeds, i ™ ny plastic bags swinging from the handlebars. The first time I had been to New York was the summer before medical school, when I spent a couple of weeks with my brother and his wife in their tiny one-bedroom apa...

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