A Med School Memoir

As you may have guessed by the name of my blog, I’m quite a fan of medical memoirs. It’s not exactly the most robust literary sub-genre–only a few titles are released every year, to my knowledge, and they’re rarely much to be excited about. Being a sucker, I tend to snatch up the latest med memoir as soon as I see it on the shelf of my local megabookmart, but I’m rarely satisfied; most med memoirs are essentially the same story–4 years of med school, residency, etc.–with only slightly different details interspersed throughout, and once you’ve read one, you’ve read them all (or, at least, most of them). Sure, there are classics of the genre–Becoming a Doctor, by Melvin Konner, is my personal favorite–but in general, med memoirs, much like pre-meds in general, tend to blur together in a drab smear of sameness.

So, when I saw Intern: A Doctor’s Initiation, by Sandeep Jauhar, I plucked it off the shelf with a bit of trepidation. I’ll admit, I wasn’t expecting much. The cover (yes, I occasionally judge books by them: sue me) suggested another boring tale of a man in a white coat rehashing the same basic ideas and concerns presented in the last 1,000 med memoirs I’d read. When I flipped the book over and scanned the back cover, however, there was a glowing blurb from none other than Melvin Konner himself. That was enough to convince me to invest in Dr. Jauhar’s book, and I immediately purchased it and ran home to begin reading it.

(What I didn’t realize at the time was that Dr. Jauhar is a regular contributor to the Tuesday Science section of the New York Times. If I had known that from the outset, I wouldn’t have hesitated for one picosecond to pick up the book, considering that I practically salivate in anticipation at the arrival of each Tuesday’s NYT.)

Once I began reading, I was immediately engrossed–and pleasantly surprised–by the author’s clean prose and honest storytelling. Since I typically have pretty low expectations for the writing in most med memoirs, I was impressed by Dr. Jauhar’s ability to weave a gripping personal narrative about love, family, and medical education out of bits and pieces of essentially unrelated case studies and tangents on medical ethics. For anyone who is remotely interested in medical education, this book is likely to become required reading.

Intern is an engrossing and enjoyable read from start to finish. At the beginning we are introduced to Sandeep Jauhar, a grad student on his way to earning a PhD in Physics from UC Berkeley. Not content with merely having a doctorate from one of the nation’s foremost research institutions, however, he longs for something else; while he’s unsure what career would best suit him, he describes an early fascination with the humanities: ideas, literature, “big questions of human existence, about which medicine apparently had nothing to say.” For a short while, he considers applying to law school, though that notion soon passes. Dr. Jauhar’s plans for the future, prior to starting medical school, are characterized by confusion–few things are clear except that he knows he doesn’t want to be a phyician; as the son of Indian immigrants, however, Dr. Jauhar’s family has a not-so-subtle opinion of what he should do:

“[My father] wanted me to become a neurosurgeon–one trained at Stanford, no less. To him, that was the apogee of professional attainment. He understood well the privileges of being a doctor. Whenever he was on the phone with the airlines or with the bank, he always identified himself as Dr. Jauhar, even though he wasn’t a physician. (”It really gets their attention,” he’d explain.) My mother, too, wished for me to become a doctor. For her, medicine represented an honorable path to influence, power, and wealth–all the things that had eluded my talented father. But I wanted nothing to do with my parents’ dream. In immigrant Indian culture, youthful rebellion is saying no to a career in medicine.”

After growing frustrated with his research into Quantum Dots, and contemplating a dark vision of the future in which he is not assured of anything except a life of post-doctoral research positions, Dr. Jauhar considers the success of his brother, then a medical student at the University of Chicago. He visits his brother in Chicago and witnesses the exhilaration his brother feels from medicine. Longing for the same sort of professional satisfaction, Dr. Jauhar decides to become a physician as well.

What follows is a whirlwind of storytelling. He briefly touches on his experiences in medical school, along with his early flirtations with journalism–which help to explain how Dr. Jauhar landed such an awesome gig at the Times–before we’re dropped into the meat of the memoir: Internship.

The first chapter devoted Dr. Jauhar’s internship is entitled “bogus doctor,” which refers to a password he was given on his first rotation. At the same time, “bogus doctor” might also refer to how he must have felt after seeing the first patient of his internship. He describes performing a physical exam an older woman “who could have been invented by Mario Van Peebles.” Her history of “various intestinal ailments” warrants that he perform a rectal exam. He describes the ensuing exam in unflinchingly graphic detail (which I will spare my readers from repeating here), before going on to describe his reaction:

“Then it started. My tongue curled up and my eyes started watering. A dry heave welled up in my chest and I felt my legs start to go. I took a deep breath and tried to think of something, anything–dead kittens!–but I heaved and a tear rolled down my cheek… It was all I could do to chuck the gloves into the waste bin before I vomited.”

This type of honesty and willingness to share embarrassing moments is what makes memoirs–medical or not–worth reading. Fortunately, Dr. Jauhar’s memoir is full of these types of emotionally raw and potent moments.

Dr. Jauhar begins his internship, like many others, with a desire to be a different breed of doctor. As he begins his rotations in the Cardiac Care Unit, he knows he wants to be the kind of doctor who listens intently to his patients, the kind of doctor who puts his patient’s needs ahead of everything else, a doctor who cares, basically. The flame of this noble idealism is soon doused in the torrential downpour of human suffering that are the hospital wards where he works. His efforts to practice medicine on his terms are continuously met by tough decisions, impractical solutions, and a short supply of time. Eventually, mounting pressures, exacerbated by the loss of his first patient, add up to a sad realization which he records in his diary:

“Do doctors care? I don’t know. I don’t see a lot of caring. Maybe I myself don’t care, or care selectively, which is hypocrisy, which I despise. No, I don’t see much attention to the psychosocial aspects of medicine. There is lip service, but by and large, no one seems to pay it much mind. Like this morning. Steve had no interest in holding Camille’s mother’s hand, in asking her why she was crying. It was pretty obvious why, but I think she would have appreciated it, if only as a gesture to recognize her pain. I myself didn’t make an effort, not because I was uncomfortable but because there was so much to do. I thought it best to spend my time doing what needed to be done.”

Dr. Jauhar is aware of the callousness with which patients can be treated, and yet he is powerless to change the system. It is a common story in medicine. He struggles to reconcile his desire to help his patients with the stark reality that no matter how much he cares, he is simply too short on time and energy to give all his patients the treatment he would like, or as he puts it, “there was a constant tug-of war between desire and duty. Your desire was to get the hell out of the hospital and have a life; your duty was to be a good doctor.” It is this conflict between desire and duty that eventually drives Dr. Jauhar into a depression that lasts for the better part of his intern year.

Not long after beginning his intern year, the cognitive dissonance he feels about the disconnect between his intentions and the reality of hospital practice is compounded with a sense of intellectual dissatisfaction. He had imagined a profession where his critical thinking skills would be constantly challenged, but he ends up with “cookbook medicine,” about which he laments: “if internship was supposed to stoke intellectual curiosity, I never saw it. Like me, most of my classmates seemed disengaged, mentally exhausted.” All these frustrations build to a head after a few months and Dr. Jauhar suffers a crisis of faith. He reconsiders his decision to specialize in internal medicine, and plays with the idea of switching to a residency program in psychiatry, or even forgoing medicine altogether for a career in journalism.

As an unrelenting idealist, Dr. Jauhar could have been crushed by his intern year. In addition to a struggle with depression, Dr. Jauhar suffers from a debilitating neck injury. All these things taken at the same time could have proven disastrous for anyone else. Luckily, he was saved. Without a doubt, the strong support network provided by his family helped, as did his burgeoning relationship with his fiancée, who helped him through the toughest times by providing a healthy supply of optimism and a gentle dose of reality by reminding him that internship is a hard time for everyone, not just him.

Eventually he sees the light at the end of the tunnel. By the beginning of his second year, his injury has healed and his depression has receded. But just as a healed wound might leave a scar, his outlook on medicine has changed in the process. By this point in his training, he has suffered sleepless nights, outrageous stress levels, not to mention countless extraordinary events, both bizarre and heartbreaking. There was the HIV positive patient who threw his IV pole at the staff because they wouldn’t give him his percoset; there was the elderly patient suffering from dementia who called him the “vilest obscenities” while standing in a “slurry of feces;” and in perhaps the most emotionally devastating story in the book, there was a young couple who struggled through the dying husband’s last days trying to decide when to sign a DNR order. By the end of his residency, he resigns himself to the fact that his medical philosophy has been complicated by his experiences. After witnessing a resident argue at length with an attending over whether or not to perform surgery on a chronic drug abuser, Dr. Jauhar reflects:

“At one time, I too had felt passion like this resident. I too had felt deeply disturbed by a surgeon’s refusal to operate. Now, listening to this discussion, I wondered if the resident wasn’t just a bit naive. It was a transformation that troubled me.

“In some ways, I probably ended up becoming the kind of doctor I never thought I’d be: impatient with alternative hypotheses, strongly wedded to the evidence-based paradigm, sometimes indifferent (hard-edged, emotionless), occasionally paternalistic.”

At the beginning of the memoir, it would be hard to imagine Dr. Jauhar becoming the type of doctor he describes here, but by the end, we see there is no other way. His internship was a baptism by fire, a “classic apprenticeship of immersion,” from which it is impossible to emerge unchanged. And it seems Dr. Jauhar sees that as a good thing. Despite the long hours, the stress, the difficulty, the personal sacrifices, in the end, Dr. Jauhar comes to the conclusion that “there probably isn’t a better way to learn medicine.” Not exactly an triumphant declaration of faith in our current system of educating physicians, but coming from Dr. Jauhar, that sentiment is actually kind of reassuring, in it’s own way.

Intern is a highly enjoyable read, mainly because it works on a few different levels. Dr. Jauhar is open and honest about his years as an intern, which allows the reader an intimate look into one man’s life–his hopes, his fears, his loves, his hates, his emotional highs and lows–and in that respect it works well as a memoir. At the same time, it works well as an lay introduction to important topics in medicine, such as informed consent, difficult patients, and the current state of our medical system. In that respect, it’s not as in-depth as books like How Doctors Think, or Better, but that was not the aim of his book, either. Finally, for those who are curious about just how grueling medical training can be, Intern is an enlightening look at the toil of post-graduate medical students. I definitely hope to read more from Dr. Jauhar. If he ever decides to write a memoir about his experiences in medical school, or his experiences as an attending, I will be the first one in line at the bookstore the next time around.

If you’re interested, Dr. Jauhar has posted an excerpt from his memoir on his blog.

Tags:   book review · books · Intern · memoirs · Sandeep JauharNo Comments