Intern

[Δημοσιεύθηκε στο British Medical Journal]

Intern is the authentic chronicle of the internship year of a young US doctor, Alan Nourse (1928-1992), who later made a name for himself in science fiction. He recorded his journal on audiotape in real time (I suppose today he might have posted it in a blog), had it duly typed by his ever patient wife, and published it under the name of «Dr X,» anonymising as many details as possible. This wasn’t just to protect patients’ confidentiality: with the zeal and naivety of a neophyte he pulls no punches in describing the blunders, the sloppy manners of staff (his politically incorrect remarks about nurses would probably not pass an editor’s scrutiny these days), the gross mistakes that cost patients their lives, limbs, or babies, and the cover-ups of such mistakes to keep senior colleagues off the hook.

Through the eyes of the intern—the doctor usually first on the spot—we watch the dramas and occasional charades of everyday medical life in a busy city hospital. In 1965 polio was still in the list of daily differential diagnoses, and even tetanus makes an appearance in what must have been this intern’s diagnostic coup. Lumbar punctures were as common as phlebotomies for all sorts of neurological patients. We marvel at the heroism of the physicians and surgeons who had to resort to pneumoencephalography to diagnose intracranial disease and to laparotomy for virtually any abdominal complaint. Recording an electrocardiograph in the middle of the night was considered extreme diagnostic effort; putting a patient with dyspnoea in an oxygen tent was the closest one could get to intensive care. This was not some third world hospital: this was the mid-60s United States of America. Lots of things have changed, but at what cost?

The book’s value lies not just in the author’s literary skills but in his matter of fact approach to his subject. Those were the days of television audience fascination with the handsome Dr Kildare; our intern takes us behind the scenes and shows us the real thing. He marches through sleepless nights in medicine, surgery, obstetrics, and paediatrics, building up the necessary clinical skills with little supervision and without any formal tuition—structured training programmes were introduced only much later. The frustrations of medical life are complicated by the idiosyncrasies of the attending physicians; and the low pay of the intern is no compensation for the long hours of duty. The author adds occasional post hoc comments to explain in retrospect situations that puzzled him at the time.

It is useful, particularly when we are in a low mood about our medical lives, to stop and take stock of the progress that has been made. This book should make us feel grateful for what we have now, compared with what our medical forebears had to put up with (or without). It should be recommended reading for everybody interested in clinical medicine and its history. The book is out of print but should be able to be found through libraries and online book services. My 25 year old paperback copy is certainly not for loan.

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