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. ( )

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. ( )

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? ( )

Me han gustado todas estas historias de médicos, y en concreto la última me ha parecido una maravilla. ( )

Collection of short stories by a physician who was a published fiction author before going to medical school. The stories all focus on experiences of a doctor doing his hospital residency after completing med school. While the author's introduction makes it clear that the stories are fictional (albeit with some factual elements from his own experience and those of his colleagues), my local public library placed it in their BIOGRAPHY section.
The stories are interesting and well written. They combine medical diagnostic and treatment techniques with insight into the human condition. ( )