A Strong Dose of Reality

INTERN

A Doctor's Initiation

By Sandeep Jauhar

Farrar Straus Giroux. 299 pp. $25

Autobiographical accounts of medical internships have become quite fashionable.

The trajectory of these works is predictable: Idealistic and naive medical school graduates encounter inhumane conditions, leading them to become angry and resentful interns. Yet somehow, at the end of the internship, they emerge well trained and more human.

The latest contributor to this genre is Sandeep Jauhar, who recounts his internship at New York Hospital. Jauhar's year was surely eventful, full of dramatically ill patients, great saves and tragic outcomes.

On one occasion, he took a woman for a middle-of-the-night CAT scan. All was well -- until she clutched her chest and Jauhar realized she was having a heart attack. Abandoned by the technician, unable to wait for an aide, he rushed her into a freight elevator and to the intensive care unit himself, hoping not to get lost. "Please," Jauhar prayed to God, "just let me get through this night."

Poignant? Yes. Shocking? Well, not anymore.

Tales of internships were once full of genuine revelations. When the anonymous "Doctor X" (later identified as Alan E. Nourse) published "Intern" in 1965, he was outing practices that had previously remained secret among doctors -- in particular, the way physicians sometimes committed errors when caring for patients and then tried to conceal the damage.

Although fictional, "The House of God," published in 1978 by psychiatrist Stephen Bergman under the pen name Samuel Shem, revealed other transgressions. Young male doctors were more concerned about having sex with female colleagues than about saving lives; they ridiculed their patients with derisive names; and they liked nothing more than to "turf" away annoying and time-consuming patients, a phenomenon corroborated by the social worker Terry Mizrahi in her 1986 book, "Getting Rid of Patients."

Modern memoirs have continued this tradition of whistle-blowing, and Jauhar's is no exception. He describes being in charge of 80 unfamiliar cancer patients at night, a situation that practically ensured he was endangering lives. During the winter of his internship, Jauhar became clinically depressed. "A nugget of anger was always wedged deep in my brain," he writes, "ready to explode at the slightest provocation." When examining a challenging patient with severe back pain, he displayed no empathy, instead acting "automatic, hyperrational, and detached."