Medical Internship

Intern: A Doctor’s Initiation – Sandeep Jauhar

The writer tells what it’s like to work as an intern in hospital wards for internal medicine in New York City. The memoir was published in 2008.

Dr. Jauhar describes the exhaustion brought on by the stress and overwork expected of first-year interns. The ordeal of internship is designed to be terrible in order to weed out the uncommitted and to engender in young doctors a loyalty to the profession. It calls to mind how the torment of boot camp makes people loyal to the Marines.

Med school requires rote memorization of huge amount of material. Med students learn to associate a list of symptoms and observations into a most likely diagnosis. As the saying goes, “When you hear hoofs, think horse, not zebra.”  They can then recommend treatment, especially with the help of an iphone. But many of them are at a loss when presented with something unexpected. So the internship is supposed to throw at them unexpected constellations of symptoms, pre-existing conditions, and acute trauma.

This book is most illuminating when he giving of examples of not having time to give attention to patients because he is being summoned to deal with other urgent cases down the hall. He goes on at length about his lack of confidence in his decision-making in situations that could quickly evolve into harm, injury, disability, and death. These stories prove that patients have to fight for attention so they had better advocate for themselves and their own, if their own are incapable.

Dr. Jauhar notes that he wrote columns for The New York Times that brought attention to the problem of overworked interns delivering sub-standard care. But he didn’t seem to suffer any lasting fallout to his reputation from his colleagues. One would have expected that he would end up doing insurance exams for the rest of his professional life. He also notes in passing that many residents reject becoming primary care physicians because the PCP work life is so busy, harried, and holistic. In contrast, working a specialty like cardiology has regular hours and a more specific set of symptoms and conditions to focus on.

This book is also a second-generation immigrant memoir. He writes about the pressure to succeed he felt from his parents, immigrants from the Punjab to Southern California. His father went from ill-paying post-doc to ill-paying post-doc and became cynical about the American Dream. Of his father Dr. Jauhar says, “He adopted the habit of distilling life's problems into simple aphorisms dealing with faith, persistence, the value of work—Booker T. Washington stuff.”  He instilled in his two second-generation sons the drive to study hard and succeed as respectable professionals. Dr. Jauhar does not discuss much any prejudice he encountered himself, not even the mild and transient dismay he must have felt when patients assumed he was a foreigner of some kind.

Sure, Dr. Jauhar spends a lot of time self-doubting his ability to withstand the internship and he talks too much about the appearance of women he encounters. The main appeal of the author for the lay audience is that he’s not a guy from an affluent medical family who’s known all his life that he’s going to be a doctor. He takes various academic twists and turns before he ends up in med school.

The reader will give him credit that he got a PHD in physics before he went to med school so his systematic thinking skills were trained. And perhaps because of the second-generation experience, he developed emotional intelligence, common sense, and social skills, which we all know doctors often lack. He’s not the same kind of kind of guy as the cocky residents with their macho posturing or the overbearing snots disguised as respectable middle-aged doctors, the kind of doctors and nurses that “don’t believe in” covid vaccines or depression, or believe that women and minorities “don’t feel pain like we do.”

It the kind of book that reminds us to respect credentials but not to be overawed by experts. We potential patients and caregivers have the duty to ourselves to get educated about DNR’s and informed consent for our own sakes and for others. We have to clarify to ourselves just what our values are. We need that clarification of values to be able to make decisions before we are sick and frightened and not thinking as clearly as usual. We don’t want to be the goober who will say to a doctor, “You’re the doctor, you decide.” Is this informed consent process really about me the patient, or is the doctor trying to cover his ass?