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Internal Medicine by Terrence Holt

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A collection of essays about life as a surgical intern.

Terrence Holt, whose In the Valley of the Kings was hailed as a “work of genius” (New York Times) and made Amazon’s Top Ten Short Story Collections of the year, brings a writer’s eye and a doctor’s touch to this powerful account of residency.

Intense, ironic, heartfelt, and heartbreaking, these nine vivid stories put us at the bedside of a patient dying in a house full of cursing parrots, through a nightmarish struggle to convince a man that he has cancer, at a life-and-death effort to keep an oxygen mask on a claustrophobic patient, and in the lounge of a snowbound hospital where doctors swap yarns through the night.

Out of these “dioramas from the Museum of Human Misery”, Holt draws meaning, beauty, wonder, and truth. Personal, poignant, and meticulously precise, these stories evoke Chekhov, Maugham, and William Carlos Williams, admitting readers to the beating heart of medicine. Internal Medicine is an account of what it means to be a doctor, to be mortal, and to be human.

This book was on my “to-read” list, so I picked it up from the library. Attempts to reach the author for a review/giveaway copy were unsuccessful.

It only took a few pages for INTERNAL MEDICINE to become a great read. Told in the voice of a doctor, explaining how he handled difficult cases during his internship, this book is alternately chilling and poignant. The take away message is this: doctors have self doubt and fatigue just like everyone else, despite the brave front they put on.

Each chapter told the story of one patient, and how Holt learned from their situation. One lesson was patience, one was bravery, one was teamwork, and so on. Brilliant details and situations that everyone can identify with are what makes this such a moving and important read.

As I read about the woman whose oxygen saturation was dipping into the 80’s, yet she kept ripping her O2 mask off due to claustrophobia, I ferverently hoped I would never be ill and lingering in the hospital. The intimate details of how the human body betrays us all is what will stay with you, long after the book is finished. Holt’s writing style is easy to follow, and full of honesty.

Each chapter can be read as a stand alone, and I recommend that–for you will need time to digest the life lessons revealed with each patient’s final outcome. Holt does not hide his fear, his disgust, his anger, and his weariness. He exposes himself –  and the entire medical profession – with stories that cannot help but touch your soul. What makes this book so wonderful is that the stories take place during his internship, where each moment is a learning experience and a doctor’s intuition is “make or break”.  The spin on each chapter would be totally different if it was written under the guise of a man who was completely comfortable with his medical knowledge, with his ability to heal and comfort. Instead, there are questions and internal monologues, which make the doctor not larger than life, but truly human and with foibles.

The book can be graphic at times, so beware. Seasoned readers of the medical genre will enjoy it, as there are some things that I haven’t read about previously. The scenes and maladies are diverse, and there is a chilling story from a mental hospital thrown in for good measure. The only chapter I had a problem with was the last one: a seemingly out of place fable (told  on a regular basis by doctors) about an incident that may or may not have taken place in real life–a rambling and unsatisfying tale told (in this case) by an older doctor in an on call room where others are trying to get some rest.  I’m not sure why the author chose to end with this story, as it took the life out of the other eight chapters that went before.  Other than that, I have nothing but praise for INTERNAL MEDICINE. This should be on the must read shelf for all those about to enter the medical profession.

Want your own copy? You can pick it up [easyazon_link asin=”0871408759″ locale=”US” new_window=”default” nofollow=”default” tag=”gimmethatbook-20″ add_to_cart=”yes” cloaking=”default” localization=”yes” popups=”yes”]here[/easyazon_link].

 

 

 

 

 

 

The Cost of Cutting by Paul Ruggieri, MD

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The Cost of Cutting was a book I picked up for a pleasure read from the library. Ruggieri also wrote Confessions of a Surgeon, which I enjoyed very much. The difference between the two books is that Cost is mostly about the money, and directly blames healthcare/insurance/government for the woes of doctors, and Confessions is mostly about activity in the hospital; more medicine oriented.

Cost will preface each chapter with a medical case and then peel away layers, explaining what the patient needs, how he is supposed to pay for it, how much profit the hospital will make (or not), and then Ruggieri ultimately rails against the system. I found this style of writing to be both good and bad.

I’ll admit, I picked this book up to gain some insight into hospitals and learn more about medical billing. There were a lot more facts and figures about healthcare than surgery, and this made for a rather flat book at times. That being said, I did learn a lot of interesting and scary things, such as: medical equipment sales reps may be INSIDE the surgery suite, guiding the surgeon as he uses robotic arms or the DaVinci system for the first time! Also: Medicare and Medicaid pays such small amounts for hospital stays that doctors can “cherry pick” which cases they will take…or not. The needs of the patient fall by the wayside if that person has no insurance at all, and with the passing of the Obamacare /Affordable Health Act, hospitals are forced to give up profits to handle cases, thereby forcing doctors in turn to take cases regardless of patient needs or wants.

For example: A woman needs surgery, and her doctor sends her to a specialist. The specialist has operating privileges at 2 hospitals. The hospital accountants/powers that be are pushing more surgeries towards Hospital One for profit. thus the surgeon tells the patient she will be going to Hospital One. This woman is upset because she heard bad things about the place, a friend of hers got awful care, and refuses to go there. The surgeon is caught in the middle between his patient’s wish and his boss. In the book, the patient wants to go to her preferred place, Hospital Two, and the surgeon gets upbraided for it. He strongly advises the woman to choose Hospital One, and she does, reluctantly. I’ll let you read how things work out yourself…no spoilers!

This is not how I’d like my surgery/medical care to be handled–would you? And let’s not even get started on hospital billing–how obscure codes control how things are handled by the insurance. Medical billing is a lucrative practice, a long cry from the “old days” when a doctor would give you a handwritten bill. We have all heard about the $300 aspirin or $1000 bandage billed to someone who has been in the hospital.

Ruggieri offers up solutions on how to make things better, and explains why hospitals are all about profits instead of medicine. Even if you have no interest in medical stories, I urge you to read this, simply to gain more awareness of how to protect yourself should you need surgery. Leave everything in the doctor’s hands? The implications are truly frightening.

[easyazon_link asin=”0425272311″ locale=”US” new_window=”default” nofollow=”default” tag=”gimmethatbook-20″ add_to_cart=”yes” cloaking=”default” localization=”yes” popups=”yes”]Want your own copy? Pick it up here.[/easyazon_link]

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