Internal Medicine: A Doctor's Stories

by Terrence Holt

Overview

Named one of the Best Books of the Year by Kirkus Reviews and BookPage

“Illuminates human fragility in tales both lyrical and soul-wrenching.” —Danielle Ofri, New York Times Book Review

In this “artful, unfailingly human, and understandable” (Boston Globe) account inspired by his own experiences becoming a doctor, Terrence Holt puts readers on the front lines of the harrowing crucible of a medical residency. A medical classic in the making, hailed by critics as capturing “the feelings of a young doctor’s three-year hospital residency . . . better than anything else I have ever read” (Susan Okie, Washington Post), Holt brings a writer’s touch and a doctor’s eye to nine unforgettable stories where the intricacies of modern medicine confront the mysteries of the human spirit. Internal Medicine captures the “stark moments of success and failure, pride and shame, courage and cowardice, self-reflection and obtuse blindness that mark the years of clinical training” (Jerome Groopman, New York Review of Books), portraying not only a doctor’s struggle with sickness and suffering but also the fears and frailties each of us—doctor and patient—bring to the bedside.

Product Details

ISBN-13:	9780871408808
Publisher:	Liveright Publishing Corporation
Publication date:	09/01/2014
Sold by:	Barnes & Noble
Format:	eBook
Pages:	288
Sales rank:	809,594
File size:	579 KB

About the Author

Terrence Holt is a writer and an internist specializing in geriatric medicine, teaching and practicing at the University of North Carolina in Chapel Hill.

Table of Contents

Author's Introduction 1

A Sign of Weakness 7

Giving Bad News 29

Orphan 57

The Perfect Code 83

When I Was Wrong 109

Heart Failure 131

The Surgical Mask 159

Iron Maiden 199

The Grand Inquisitor 243

Editorial Reviews

…this book illuminates human fragility in tales both lyrical and soul-wrenching…Holt dissects the medical experience in exquisite and restrained prose.

The New York Times Book Review - Danielle Ofri

★ 05/26/2014
Writing to make sense of his medical residency, Holt, a fiction writer (In the Valley of the Kings) and geriatric specialist at the University of North Carolina, elegantly tells a more far-reaching tale of illness and healing in nine stories. Holt narrates through the voice of a young doctor—a composite figure, as are his “patients”—beginning with the frustrating case of a woman too claustrophobic to wear an oxygen mask and too ill to be without it, whose agonizing death teaches the doctor that no singular heroics are necessary. As a mentor advised, “There was nothing to do. But at least we could have done it together.” There’s also the heartrending story of a cancer-stricken artist in hospice, whose home full of exotic birds and oil portraits offers a rare gift, and the strange yet touching story of a patient who kept forgetting his fatal diagnosis, but would light up at the “few faces in the world he can still remember.” Each exquisitely crafted and evocative tale reveals not only the power of Holt’s storytelling, but the stark realization that for doctors and patients alike, it’s our bodies that “remain the essential mystery we keep trying to solve.” (Sept.)

Publishers Weekly

"Holt, who also holds a master’s in fiction writing and a PhD in literature, is an excellent story teller… [T]he portrait Holt offers is artful, unfailingly human, and understandable."

Boston Globe - Dennis Rosen

"Holt’s new collection of stories, captures the feelings of a young doctor’s three-year hospital residency—the powerlessness, the exhaustion, the chaotic and seemingly endless shifts, and above all, the intensity of being with people in moments of extremity—better than anything else I have ever read… Holt’s unadorned prose and pitch-perfect dialogue contribute to the realism of these stories. At times they have the atmosphere of a hospital version of film noir, the narrator sounding as tough as Raymond Chandler’s Philip Marlowe in his effort to be efficient and unflappable… Anyone who’s considering becoming a doctor, or anyone who wants to know what’s at the core of a doctor’s initiation, should read this book."

The Washington Post - Susan Okie

"Where do the brutal limitations of our mortal selves meet the grace of kindness? Where do simple observations of the progress of lives become a spare human poetry? Perhaps nowhere more so than in the practice of medicine, and in the finest of writing. These are the remarkable occurrences that fill and enrich Terrence Holt's elegant and heart-rending memoir."

Dr. Vincent Lam

"In Internal Medicine Terrence Holt has written a guided tour of a very particular hell, the 'Inferno' of medical training. This is a trenchant and devastating book but, miraculously, not a dispiriting one. Holt's beleaguered resident makes us gaze with him into abysses of every sort of physical, emotional, and spiritual pain, and yet what we feel with him, at the end of every story, is a resilient, exalting love of the world and the people doomed to suffer in it."

Chris Adrian

"In its undaunted vision of our plight and promise as a fallen race, its intricate rhythms of tenderness and pain, the torque of its knowing, Internal Medicine is an uncommon, lovely work of art. I feel myself expanded and enlarged by it. Holt's integrity and intelligence are gifts that alter how we view the wreckage and wonder of our lives."

William Giraldi

"Whether or not you classify this collection of nine stories as nonfiction, they ring true in both details and spirit, starting with a doctor’s evolution from the first night on call as an intern and ending with ethical questions that a physician ponders 40 months later, his residency complete… Dr. Holt never settles for easy answers, and the questions he poses—reflecting the frequent uncertainties of doctors and patients alike—will leave readers thinking long after the final page is turned."

BookPage - Alice Cary

"[T]his book illuminates human fragility in tales both lyrical and soul-wrenching…. Holt dissects the medical experience in exquisite and restrained prose."

Danielle Ofri

★ 2014-07-27
Think you've heard it all about the grueling, fatigue-driven years suffered by interns and residents once they get their degrees? Think again. Holt (In the Valley of the Kings: Stories, 2009) came 20 years later to medicine than most of his peers, choosing a writing career first. Whatever the reasons for that latter-day commitment, the result is a beautiful, riveting book that puts readers on the spot in the ward, in the ICU, making the rounds, talking to families, making hospice calls and participating in the "bedlam" of a "Code Blue" resuscitation. What Holt set out to do was to convey the "un-narratibility" of hospital life ("too manifold, too layered, too many damn things happening one on top of the other") in parables that would condense and transform the experience, as he himself was transformed. To that end, he uses composites of many different cases. In the process, he has created unforgettable portraits of the gravely ill or dying: the obese woman hospitalized for a "tune-up" to rid her body of excess fluids; the young woman who should have died from too many Tylenols but was saved by a liver transplant; the hospice patient whose face was covered by a surgical mask to conceal the loss of most of her lower face to cancer. "Nothing happens in these pages that doesn't happen every day in a variety of ways in hospitals everywhere," writes the author. "I have had to simplify what defied narrative form, and alter or suppress whatever might have compromised the respect patients deserve. But in making sense of residency within the constraints of narrative form and human decency, I have hewed as closely as possible to the lived reality of the hospital." Holt says that he wrote the book over a period of 10 years. Let's hope for a shorter duration before we next hear from this gifted writer/physician.

Kirkus Reviews