Books

Book review: ‘Internal Medicine: A Doctor’s Stories’

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“Why didn’t anyone tell us it would be like this?”

In a story from Terrence Holt’s “Internal Medicine: A Doctor’s Stories,” the wife of a dying hospice patient poses this wrenching question to her husband’s young physician, Dr. Harper. Though she asks the question twice, Harper – a resident in training – is unable to come up with an answer. In the silence that echoes between doctor and patient, the reader can imagine a parallel question emerging within Harper.

“Why didn’t anyone tell me that being a doctor would be like this?” he must be asking.

Holt, an internist and geriatrician at UNC-Chapel Hill, is an acclaimed short story writer. His earlier collection, “In the Valley of the Kings,” was nominated for the PEN/Bingham Prize in 2010. Holt is interested in how the physician’s encounter with a patient can change perceptions of himself as a caregiver and a person. In Harper, Holt has created a narrator to help him explore this question.

In “Internal Medicine,” an older Harper reflects on his residency in a busy teaching hospital. In stories from oncology floors and ICU’s, hospice visits and psych wards, he reveals what happened to him as he confronted suffering.

In detailed descriptions of his surroundings, Harper remembers the off-kilter feel of being a new doctor. As he tries to evaluate one patient, nurses interrupt with concern about two others. Respiratory therapy worries about someone’s oxygen. The ER calls with a pneumonia patient. The lab pages about Ms. X’s liver tests. Forty relatives lurk outside intensive care waiting for an update on Grandma. Harper is under assault and about to be overrun, and he describes the intensity and anxiety brilliantly.

As he learns to triage others’ needs, he reacts predictably to the patients whose demands provoke his feelings of inadequacy. He confesses it all: his anger at a patient who lied about a Tylenol overdose, his contempt for a woman with heart failure addicted to Xanax, his impatience, his exhaustion, his sense of being beyond caring. He reduces his patients to diagnoses and personalities. There’s “a liver” in bed 12 and “a whiner” on cardiology, and somebody dying in the ICU whom Harper views as little more than paperwork.

By the time he is an advanced trainee, Harper has selected the only rational response to residency. He creates rules to distance himself from his patients: Don’t tell them your children’s names; if they give you presents, leave them in the garage; plus, never hold female patients – no matter how bad off they are. To survive, Harper acknowledges,he’s had to “pull in the antennae, lean back and watch the scenery go by.”

Harper is a great storyteller. The exhaustion, anxiety and anger have been well described previously, though rarely as arrestingly. Still, there’s something else that distinguishes this from other doctor books, and that is Harper’s deep desire to be able to talk to patients and families in a way that makes a difference to them.

Certainly, Harper fights the good medical fight. He tries mightily to save life and limb. More troubling than trying to remember the right antibiotic or the correct diuretic dose is simply trying to find the right words as he stands with patients at times of pain and loss.

As Harper struggles to reach across the void between well doctor and sick patient, he reveals “what it’s like” to be a doctor. Readers will be grateful to Terrence Holt for introducing us to Harper, who has exposed himself and us to the very heart of doctoring.

Dr. Elizabeth Dreesen, trauma medical director at UNC Hospitals in Chapel Hill, writes The N&O’s Our Lives column.

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