Intern: A Doctor's Initiation by Sandeep Jauhar
by Marti Trgovich
Sandeep Jauhar's memoir, Intern: A Doctor's Initiation, begins with doubt. This is a man, after all, who went to medical school on the same whim that causes a free-spirited adult to sign up for a last-minute class at the Learning Annex. Okay, an exaggeration, perhaps—but by the time he begins his internship, the brutal first year of a doctor's residency, he's convinced it's all been a terrible mistake. Awash with reservations, he contemplates quitting internship to become a journalist.
This course of action, though, would have been the terrible mistake—not because Jauhar lacks writing or research skills (he clearly doesn't) —because his strengths lie in his personal experiences, the eye-opening criticisms, and the fresh insight that he brings to the world of medicine.
In short, the guy has balls. Let's say you're a newbie at your job and decide to publish an op-ed piece in the New York Times criticizing your profession and suggesting, however gingerly, that current practices might not be in the best interests of your clients (in this case, patients). Not exactly the best way to nurture a positive work environment, but Jauhar doesn't care. "I criticized a system that left interns in charge of a large number of very sick patients about whom they knew very little," he writes in Intern. "I recounted some of my near-fatal mistakes on the night shift at Memorial, when I'd felt overwhelmed, and had been receiving inadequate supervision."
The beauty of Jauhar's memoir is that while it asks whether his profession does more to help or harm patients, it also chronicles the author's own faults along the way. He tells of a patient with a bedsore that he knew he should look at, but essentially ignored and hoped that someone else would make the inspection, simply because he lacked the time in his schedule. "If you did everything, you felt overwhelmed," he writes. "If you didn't, you felt guilty."
There is bravery in admitting that you are a naive intern who has been left to attend to ICU patients overnight, with no overhead supervision, and are not sure of yourself. It is disconcerting for a layman to think that her mom, dad, grandpa, whomever, has been left in the hands of a recent med school grad whose only intimate knowledge of the patient came from a quick scan of a chart—which is maybe up-to-date, maybe not. Senior residents are always a call away, but Jauhar explains that not asking for help is seen as "a sign of strength." And so, after an initial call to a resident's home (she yells at him for phoning), he realizes that protocol dictates he's in this alone.
He makes mistakes that I won't recount here—that's part of the suspense, along with the patient diagnoses. Like an episode of ER or Grey's Anatomy (sans any McDreamy drama, thankfully), you're not sure who will survive and who won't. It's also worth noting that Jauhar demystifies the "playing God" element that many associate with the medical profession. Medicine can cure, yes, but not to the extent that we'd like to believe: "Most of my patients were going to be fine, despite anything I did, and if they were going to die—well, that was probably going to happen despite me, too," Jauhar admits.
It's rewarding to see Jauhar's transformation by the end of the book: We witness his full arc from clueless intern to confident resident. "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," he writes. "I thought I was going to make big changes, more of an impact, reform the profession somehow, but in the end I adapted to the culture around me." That's modesty, sure, but I'd argue that Jauhar has made a huge difference—simply by questioning the accepted practices and wondering what is in the best interest of the patient. Isn't that what one wants in a doctor?
Marti Trgovich is a freelance copy editor who lives in Brooklyn.
