Internal Medicine: A Doctors Stories

Nursing Book Club

Internal Medicine: A Doctors Stories

The Human Side of Doctors

By Terrence Holt (Liveright/W.W. Norton & Company, 2014)
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Reviewed By Christine Contillo, RN, BSN, PHN

Internal Medicine is a collection of short stories by physician and author Terrence Holt, M.D., Ph.D. Holt describes the stories in this collection as “parables” about the years in which a (fictional) medical student first becomes a doctor.

In this collection, “internal medicine” refers not just to the specialty being practiced, but also to the inner transformation of a new physician as the chaos of study becomes the process of caring for patients. This change happens on many different levels: managing the clinical aspects of practice; learning the roles of the staff; honing time-management skills; and other personal and interpersonal challenges.

The process of learning and perfecting all of these abilities never really stops. The patients in these stories are not real, as privacy rules would prevent that, but they are very realistic. Each has a problem that the author may have encountered during his medical career. Of course, the narrator of these tales is not really Holt either, but rather someone learning the same lessons and experiencing the same personal changes.

Residency Distilled

Through these stories, we follow the narrator as he becomes the clinician he was meant to be. Holt manages to distill medical residency into something non-physicians can understand. For that, we must be grateful — some of these stories are undoubtedly easier to reflect upon than to painfully experience.

In one story, “A Sign of Weakness,” an intern on his very first overnight shift is told that he can call for help if he must, but it will be seen as a sign of weakness. He’s also informed that a patient with scleroderma has shortness of breath, is fighting the oxygen mask and has a DNR. What should he do? What can he do? He asks the nurses and asks the respiratory therapist, but he resists calling for help in the middle of the night and waking the supervisor. Ultimately, he learns an important lesson: Sometimes, bad events are just that, but it’s still nice to not feel so alone.

Another story, “When I Was Wrong,” finds the narrator agonizing over how to help a family make a decision about the care of a loved one. What should they be told? How much will they be able to handle? Who can really speak for the patient? We have all seen physicians make the wrong call — none of us can see the future, and predictions are just that — but no one can see into another’s mind with any degree of certitude or know just how resilient a patient might be. We’ve all dealt with medical practitioners who seem ever-confident of their decisions, but Holt lets us see that they are sometimes anything but.

Humanizing Patients

Many of these short stories are not about that “Aha!” moment of teasing out a diagnosis. They are about something much better and even more important: the experience of a provider coming to see the patient in the hospital bed as a human being. It’s no surprise to learn that Holt now specializes in geriatric medicine. Somehow, it seems fitting that he would find it satisfying to deal with complex geriatric issues. Older patients have a world of experience to offer providers like Holt and in turn readers like us.

Each of these “parables” is a work of art and a fascinating lesson about pain, psychology and family. Holt knows that patients are more than just collections of symptoms and he gently nudges us to accept that too.

Christine Contillo, RN, BSN, PHN, is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

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