By Terri Schlichenmeyer [Courtesy Image]
It took you a while to get the hang of things. But you did — eventually.
It always is that way with a new job. Nobody is born knowing how to work, and learning to be proficient takes time, patience and training. If Terrence Holt’s new book
“Internal Medicine: A Doctor’s Stories” is any indication, it also takes determination, exhaustion and the knowledge that you can’t fix everything.
Some stories simply cannot be told.
On a March day during his year as an intern, when he and several dozen people were engaged in a cacophonous “roar and babble” at the nursing desk, Holt suddenly realized that no description would ever do justice to that which he had been experiencing. It was “too manifold, too layered” to describe.
In the month after graduation from medical school, he decided to try anyhow.
Though the memories are “hazy,” Holt recalls how asking for assistance from your attending physician was rumored to be a “sign of weakness,” even though there were times when the help would have been most welcome. Even when nothing can be done, it is 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 at times “I don’t know.” It is impossible to teach because sometimes, a doctor does know what is coming next. Both parties do, in fact, but he “couldn’t say that either.”
There were times for Holt when patients were not “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, they have to learn by themselves that there are choices nobody wants to make, but they must. They have to learn that lifesaving can be “a sorry gift I have to offer…” They eventually understand that first impressions do not last; that a mask should not 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” 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 is not going to matter once you start this exquisite book of essays. You will be too wrapped up in living and dying, in exhaustion, fog and the torment of both author and patient. 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 started, it is hard to let it go. If you have ever pondered the length you have between life and death, grab “Internal Medicine” and hang on.
The writer is a syndicated book reviewer.