Sanjay Gupta, Atul Gawande and Sandeep Jauhar - What do they have in common? They are all ambivalent doctors with a passion for media and communications. Dr. Gupta is a neurosurgeon with a published book under his belt, a glamorous reporting job with CNN, and a generous female fan following, Dr. Gawande is a sought after surgeon and a renowned writer and author of many popular non-fiction books pertaining to the medical field.
Another one to join this growing clan of doctors, is Dr. Jauhar, a thriving cardiologist and the director of the Heart Failure Program at Long Island Jewish Medical Center, also a medical journalist. Since 1998, he has been writing regularly about medicine for the New York Times. His writing has also been published in Reader's Digest, Lancet and the New England Journal of Medicine, and he has appeared on CNN, CNN Headline News and National Public Radio. Dr. Jauhar’s memoir “Intern: A Doctors Initiation” published by Farrar, Straus and Giroux (December 26, 2007), is a refreshing look at the alluring and lucrative medical profession.
This memoir 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 every assumption about medical care today. Residency—and especially the first year, called internship—is legendary for its brutality. Working eighty hours or more per week, most new doctors spend their first year asking themselves why they wanted to be doctors in the first place. This book is also a love story of sorts and more significantly the story of an immigrant family with strong cultural traditions and modern ambitions.
Like many others, Jauhar’s parents were also distressed when Jauhar earned his PhD in Physics from the University of California in Berkeley, with thoughts of becoming a lawyer, academic or writer. For them these were not lucrative professions. They should have been relieved when he answered his calling and decided to become a cardiologist, yet they were concerned about him “changing horses in the middle of the stream.” Jauhar was determined. For him, “Physics was an enterprise of reflection, ideas. Medicine was an endeavor of prescription, of action. Becoming a doctor, I hoped, would bring me back into the real world. It would make me into a man.”
Jauhar’s internship was even more harrowing than most: he switched from physics to medicine in order to follow a more humane calling—only to find that medicine put patients’ concerns last. 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.
“I was an Intern a decade ago, but I still remember it the way soldiers remember war,” writes Jauhar in his memoir, recounting the first year of his medical residency – navigating the pitfalls of nights on call, calling codes, informed consent, treating depression other than his own, and generally coping with patients so exhausted, frustrated and scared that patients and doctor alike just want to go home.
Jauhar writes with dexterity about various incidents, cases, medical staff and patients he encountered during his residency years. These little stories, spice up the otherwise bland subject of medical residency, making it interesting to a non-medical reader. These incidents also elucidate the difficult lives of doctors, whom many forget are also human beings who need to train themselves very hard to be emotionally detached from their patients in order to be rational and provide better service.
This is a profession that is physically demanding as well, especially with the nightfloats and the on call schedules running into a continuous 36-hour stretch. “On call nights, the ward was like a sleeping village, and you were the night watchman on patrol with your penlight and stethoscope,” muses Jauhar, “Sometimes I worried about how I was going to get through another night on call, until I realized that my patients were helping me. Their bodies had the homeostatic reserve, the capacity to self correct, to compensate for my mistakes.”
After struggling with the difficulties surrounding the internship, Jauhar gradually arrives at a curve in the road, “The month long rotation in the ICU was a turning point. Like a phase transition, the transformation was almost imperceptible, yet the results were striking. When I got back to the wards I discovered a level of comfort I could never have imagined as an intern, or even early on in my second year.”
He successfully endures the rigors of his residency and is near the end when he looks back at his experience. “What a strange experiment I had conducted! Bailing out of a promising physics career in my mid-twenties to go to medical school. And then a clinical residency in internal medicine when I wasn’t even sure I wanted to be a doctor. It had been a foolhardy mission, and yet it occurred to me that I would do it all over again,” reminisces Jauhar.
With it’s many case histories full of vivid detail, many of them quite gory, this book is an interesting read for all lovers of the hit NBC show ER, and for that matter anyone who is interested in the trials and tribulations in the life of a doctor.
Reviewed by Visi Tilak
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