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Intern: A Doctor's Initiation, by Sandeep Jauhar
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Intern 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 his every assumption about medical care today. Residency―and especially its first year, the internship―is legendary for its brutality, and Jauhar's experience was even more harrowing than most. He switched from physics to medicine in order to follow a more humane calling―only to find that his new profession often had little regard for patients' concerns. 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.
Jauhar's beautifully written memoir explains the inner workings of modern medicine with rare candor and insight.
- Sales Rank: #124181 in Books
- Brand: Jauhar, Sandeep
- Published on: 2009-01-06
- Released on: 2009-01-06
- Original language: English
- Number of items: 1
- Dimensions: 8.29" h x .91" w x 5.52" l, .64 pounds
- Binding: Paperback
- 320 pages
From Publishers Weekly
Jauhar, a cardiologist who directs the Heart Failure Program at Long Island Jewish Medical Center, completed his internship a decade ago, but still remembers his confusing, tumultuous medical apprenticeship at the prestigious New York Hospital the way soldiers remember war. The son of an embittered immigrant plant geneticist who found the American university tenure system racist, Jauhar dithered over career choices and completed a doctorate in physics before embarking on medicine. Jauhar feels responsible when he botches the blood pressure check on a patient who later dies during an aortic dissection and when he misses the high blood sodium level of a man who then suffers irreversible brain damage. He wonders if he and his colleagues have discriminated against a cardiac patient because of his weight, and helps an advanced cancer patient's wife decide against the futile insertion of a breathing tube. As his internship progresses, he romances his future wife (an affair he describes with the passion of one buying a used car); cracks under self-doubt and the expectations of his traditional Indian family, and suffers a serious depression. He regrets that as a doctor he is sometimes impatient, emotionless and paternalistic. Although Jauhar carefully elucidates complex medical terminology for lay readers, his thoughtful, valuable memoir will be most relevant to medical students and interns experiencing similar crises. (Jan.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
Review
“In Jauhar's wise memoir of his two-year ordeal of doubt and sleep deprivation at a New York hospital, he takes readers to the heart of every young physician's hardest test: to become a doctor yet remain a human being.” ―Time
“Brutally frank . . . The inside look at the workings of the medical internship system is fascinating.” ―William Grimes, The New York Times
“Jauhar's stories are timeless [and] interesting.” ―Barron H. Lerner, The Washington Post
“A vivid portrait of the culture of a New York City hospital, with its demanding hierarchy and sometimes indifferent cruelty.” ―Vincent Lam, The New York Times Book Review
“Very few books can make you laugh and cry at the same time. This is one of them. Sandeep reveals himself in this book as he takes us on a wondrous journey through one of the most difficult years of his life. It is mandatory reading for anyone who has been even the slightest bit curious about how a doctor gets trained, and for physicians, it is a valuable record of our initiation.” ―Sanjay Gupta, CNN medical correspondent and author of Chasing Life
“Intern will resonate not only with doctors, but with anyone who has struggled with the grand question: ‘what should I do with my life?' In a voice of profound honesty and intelligence, Sandeep Jauhar gives us an insider's look at the medical profession, and also a dramatic account of the psychological challenges of early adulthood.” ―Akhil Sharma, author of An Obedient Father
“Told of here is a time of travail and testing--a doctor's initiation into the trials of a demanding yet hauntingly affirming profession--all conveyed by a skilled, knowing writer whose words summon memories of his two great predecessors, Dr. Anton Chekhov and Dr. William Carlos Williams: a noble lineage to which this young doctor's mind, heart, and soul entitle him to belong.” ―Robert Coles
“Intern is not just a gripping tale of becoming a doctor. It's also a courageous critique, a saga of an immigrant family living (at times a little uneasily) the American dream, and even a love story. A great read and a valuable addition to the literature--and I use the word advisedly--of medical training.” ―Melvin Konner, M.D. Ph.D., author of Becoming a Doctor
“In this era when medical shows abound on TV, Jauhar demonstrates the power of the written word in the hands of a sensitive, thoughtful observer and an experienced, gifted writer. Intern is a compelling, accurate and heartfelt chronicle of what that year is really like. It will be the standard by which future such memoirs will be judged.” ―Abraham Verghese, author of My Own Country and The Tennis Partner
“Excellent, well-written... Jauhar captures vividly the uncertainty, fear, and extreme exhaustion that dominates the (residency) experience... As one reads this emotionally powerful story, it becomes clear that the culture in which the interns work is profoundly important to their experience.” ―Katharine Treadway, The New England Journal of Medicine
“This insider's account of life on the ward forces us to contemplate our own mortality. And we emerge from it all with a greater respect for medical professionals and their patients.” ―Peter McDermott, America
“An exceptional accomplishment... beautifully written and incredibly insightful... by far the best memoir of medical student or resident days yet published.” ―Kenneth Ludmerer, author of Learning to Heal: The Development of American Medical Education
“Here Jauhar's skills as both storyteller and compassionate physician are at their best; his encounters illustrate the complexity of real-life clinical decision-making. ...The overall feeling that emerges is that of struggle: patients struggle against the illogical oddities of a broken health care system and less frequently they struggle against their clinicians, but most often they struggle along with their clinicians to reach an acceptable or at least meaningful compromise with the injustices that come with illness. Certainly there are no easy answers, and few writers have conveyed this truth more forcefully than Jauhar. ...Those who enjoy good writing for its own sake will savor the crafted texture of this narrative. ...Jauhar captures the essence of how it feels to be a present-day physician in residency training. ...So long as training to become a physician remains a dynamic process, memoirs like this will continue to serve an important role in exploring and explaining this process to the patients that physicians serve and, perhaps no less, to physicians themselves.” ―S. Ryan Gregory, MD, The Journal of the American Medical Association
“Jauhar, like most of us, is neither a saint nor an apostle of medicine. He is a little sarcastic, a little bitter, a little naive, a little smarter, and a little stupider than everyone else; in short, the character he writes for himself is the perfect protagonist for a medical internship. As he flinches from the gauntlet run, the grace of his prose allows us to feel every blow. To this young physician, it brought back visceral feelings, and I hope this is not the last literary gut punch we receive from Jauhar.” ―Noah Raizman, The Lancet Review
“This is no made-for-TV sitcom: Dr. House wouldn't last a night in Dr. Jauhar's world.” ―San Diego Union-Tribune
“Following in the path paved by doctor-writers like Lewis Thomas and Richard Selzer, Jauhar writes with grace, precision and passion. What makes him such a stimulating companion is his willingness to couple candid insights into the state of modern American medicine with equally revealing glimpses into the soul of a young doctor.” ―Shelf Awareness
“Jauhar's candid account of his stressful journey is enlightening, educational and eye-opening. After ten successful years in the profession, the author dolefully admits that he is unfazed by the 'small injustices' in hospitals today. Required reading for anyone seriously considering a career in medicine.” ―Kirkus Reviews
“What sets Jauhar's internship story apart from the norm is his candor.” ―Booklist
“Honest and vivid... A well-written medical memoir.” ―Library Journal
About the Author
Sandeep Jauhar, MD, PhD, is the director of the Heart Failure Program at Long Island Jewish Medical Center. He writes regularly for The New York Times and The New England Journal of Medicine. He lives with his wife and their son in New York City.
Most helpful customer reviews
42 of 45 people found the following review helpful.
Couldn't put the book down.
By Ahnjoe
As a physician, I don't have much time to read a book for leisure, but I couldn't put this book down.
You don't have to be in the medical profession, or have gone through internship to appreciate this book, but it definitely brought back memories from my own training. I wish I had kept a journal during my internship and residency.
Will this book be our generation's version of House Of God?- I'm not sure, but one thing is for sure, it is a great read, well written, and a lot better than the sweater I got for christmas!
70 of 81 people found the following review helpful.
Honest account of South Asian cultural baggage........
By uppereastsidegal
Multiple reasons led to my desire to read this book. I have been reading Dr Jauhar's articles in the NYT for the past decade. My father and Jauhar's in-laws, the Sharmas, were physician colleagues at the same local NJ community hospitals. I interacted with them at one point and I even met Dr Jauhar briefly at his in-laws house in 2002. Jauhar also is part of what I label as a new American breed - "the South Asian American physician elite". They are educated at the best undergraduate schools, go to top medical schools, train at premier residencies and fellowships and marry someone just like themselves. No surprises here.
I feel my review adds a very different perspective than the ones written here over the past 3 years. Like Jauhar and his wife, I am the offspring of the first wave of South Asian immigrants who came to the US in the 1960s and 1970s. Many, if not most, South Asian immigrant parents not only put a premium on education and money making careers, but pressure their kids to go into medicine. There is a South Asian fixation, bordering on pathological, to become a doctor and to marry one. I have never seen this in any other community. This is the environment that Jauhar and I grew up in.
I believe a significant part of Jauhar's early conflict, ambivalence, insecurity, and doubt about becoming a physician comes from the cultural baggage South Asian American kids carry. We are driven to succeed at any cost, constantly compared to a more accomplished sibling, relative, or friend (in this case his brother Rajiv), and made to feel ashamed if we are not. Nothing is good enough. I think many South Asian American physicians have dealt with some of the same struggles and experiences Jauhar have, but became doctors anyway. It just happens to be that Jauhar had the balls to talk about it openly in a book. I commend him for this effort, because most second generation South Asian American physicians are too concerned with image and status to do so. We as a community overall are quite shallow and will not be honest with ourselves and each other about the downside of our drive to succeed!
Beyond that, I felt the book was just a bunch of ranting and whining about the medical establishment and its shortcomings. I found Jauhar at times to be shallow, cocky, and elitist as well. I also felt he was constantly trying to prove himself to his family and Indian society ( marry the right person and into the right family, do residency and fellowship at the premier programs, and yes, do Cardiology because it is sexy and by default!). I see the same South Asian American formula play itself over and over again everyday. Nothing original here.
If my child was an aspiring physician, I would tell them to go read books written by another breed of notable, passionate, and truly gifted South Asian American physician writers - Gawande, Verghese, and Mukherjee. One comes away from their books (The Emperor of All Maladies, My Own Country, Better) feeling that, despite all the shortcoming of twenty first century American medicine, the beauty of being a doctor is still what it has always been at its core - to teach, to care, and to heal.
10 of 10 people found the following review helpful.
What it's REALLY like to become a doctor
By STEPHEN PLETKO
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"This book is about my residency [apprenticeship in medicine] at a prominent teaching hospital in New York City. The story goes up to the point when I decided to pursue a fellowship in cardiology, my specialty, and thus covers the most formative years of my education as a doctor.
For me it was a disillusioning time: I spent much of it in a state of crisis and doubt. I had trained as a physicist [the author has a Ph.D. in physics] before entering medical school, and ten years of uncertainty about my choice of profession came out all at once...
Because I had lived another, more sedate, professional life [as a physicist], the one I had to endure in the hospital was even more difficult to bear...For much of internship [the first year of residency], I felt buried--in a waking Hell under the weight of my own (and others') expectations...
I am [now] finished with my apprenticeship, and...now work as a cardiologist...For the most part, I am happy...But so much about medicine still troubles me...sometimes I'm still not sure cardiology was the right choice..."
The above is found in the introduction to this well-written book or memoir by Sandeep Jauhar, M.D., Ph.D. who now is the director of the Heart Failure Program at Long Island Jewish Medical Center. He also writes regularly for "The New York Times" (which got him into trouble during his residency).
If you're expecting to find phrases in this memoir such as "Medicine is the greatest profession", etc., you won't find them and are advised to look elsewhere. This is because this book is brutally honest. Jauhar tells it like it is and I got the sense he was not attempting to sugar-coat any of his narrative. As well, I totally believe that others being initiated into medicine go through the same struggles, questions, and observations as Jauhar (but for some reason are afraid to admit them).
Here are a few sentences and phrases that caught my eye:
(1) A lawyer from risk management, the department that defended the hospital against lawsuits, informed us that at some point in our careers every one of us was likely to be sued, and that we could even be sued during residency.
(2) "It's strange that all week [this was intern orientation week] they've hardly mentioned the patients...These are the people we're going to be learning on. It's like they're already invisible."
(3) But as with most of what I learned during then first two years of medical school, I had forgotten it.
(4) It's almost criminal the callousness with which we [that is, doctors] treat some of our patients.
(5) We performed our [medical] interventions [on patients] with such confidence, such arrogance, but most of the time there was no way of predicting whether we were doing the right thing, or even a good thing.
(6) What is the point of all this? All the protocols, chemotherapy, the transplants--what is the point of it if, in the end, the sickest patients, the ones we were beholden to help, or at least not harm, were better off without us?
(7) The sentiments I had heard about neurologists seemed close enough to the mark. Master diagnosticians, they had depressingly little to offer their patients.
(8) I too was learning that deliberate half-truths are a part of a doctor's armamentarium.
(9) Even today, patients continue to be enrolled in experimental drug studies without proper consent, or under tacit intimidation.
(10) In the ICU, sometimes the cure is worse than the disease.
(11) Doctors make fun of patients for many reasons. Sometimes as a defence mechanism, and sometimes just because they can.
(12) 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.
Each chapter begins with an interesting quotation. Here's one of my favourites by Lewis Thomas:
"The great secret of doctors, known only to their wives, but still hidden from the public, is that most things get better by themselves; most things, in fact, are better in the morning."
Finally, there are notes in this book that contain very interesting information. Here's an example:
"Doctors are more likely than members of the general public to commit suicide...Only 22 percent of depressed medical students seek help. Only 42 percent of those who are considering suicide seek treatment."
In conclusion, in my opinion, this is the best book on becoming a doctor that I have ever read. There are two things that make it stand-out from the rest: (1) the excellent, intelligent writing and (2) its HONESTY.
(first published 2008; prologue; introduction; 3 parts or 21 chapters; main narrative 290 pages; notes; acknowledgements)
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