Internal Medicine: A Doctor’s Stories

by Terrence Holt

c.2014, Liveright; $24.95 / $27.95 Canada; 275 pages

It took you awhile to get the hang of things.

It’s always that way with a new job. Nobody’s born knowing how to work and learning to be proficient takes time, patience, and training. In the new book Internal Medicine by Terrence Holt, it also takes determination, exhaustion, and the knowledge that you can’t fix everything.

Some stories simply can’t be told.

On a March day during his intern year, when he and several dozen people were engaged in a cacophonous “roar and babble” at the nursing desk, Terrence Holt suddenly realized that no description would ever do justice to that which he’d been experiencing. It was “too manifold, too layered” to describe.

In the month after graduation from medical school, he decided to try anyway.

Though the memories are hazy, Holt recalls how asking for assistance from your attending was rumored to be a sign of weakness, even though there were times when the help would’ve been more than merely welcome. Even when nothing can be done, it’s easier when you do it with someone.

Young interns learn to give bad news, which is nearly impossible to teach – especially when the answer to the question “What next?” is “I don’t know.” It’s impossible to teach because sometimes, a doctor does know what’s next. Both parties do, in fact, but he “couldn’t say that either.”

There were times for Holt when patients weren’t “playing by rules” that demanded lucidity and a hospital stay with no problems. Of course, a lack of the former often made the patient blissfully, “eternally unaware” of his impending death, of which Holt admits he was “almost envious.”

No matter how much training an intern gets, he has to learn by himself that there are choices nobody wants to make, but he must. He has to learn that lifesaving can be “a sorry gift I have to offer.” He eventually understands that first impressions don’t last; that a mask shouldn’t mask the personality beneath it; that death often does dual duty; that patients lie; and that, despite what anybody says, “you couldn’t count on second chances.”

In the introduction of Internal Medicine, author Terrence Holt muses about ethics and privacy when writing about patients. Because of those issues, he says, the patients in this book are factional “assemblages, compiled from multiple cases” made to “capture the essence of something too complex to be understood any other way.”

Trust me: fact or fiction isn’t going to matter once you start this exquisite book of essays. You’ll be too wrapped up in living and dying, in exhaustion, fog, and the torment of both author and patient. Indeed, Holt is a poet in a white coat with a literary bedside manner that allows us to absorb the shock of his words as we simultaneously note the beauty of them.

I carried this book around with me for three days because, once it’s started, it’s hard to let it go. If you’ve ever pondered your length between life and death, grab Internal Medicine and hang on.

Terri Schlichenmeyer. Terri is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.