Intern A Doctor's Initiation

Sandeep Jauhar

Farrar, Straus and Giroux



Trade Paperback

320 Pages



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Intern is Sandeep Jauhar's story of his residency at a busy hospital in New York City, a trial that led him to question every common assumption about medical care today. Residency—especially the first year, called internship—is legendary for its brutality. Working eighty hours or more per week, most new doctors spend their first year asking themselves why they wanted to be doctors in the first place.

Jauhar's internship was even more harrowing than most: he switched from physics to medicine in order to follow a more humane calling—only to find that his new profession often had little regard for patient's concerns. He struggled to find a place among squadrons of cocky residents and doctors. He challenged the practices of the internship in The New York Times, attracting the suspicions of the medical bureaucracy. Then, suddenly stricken, he became a patient himself—and came to see that today's high-tech, high-pressure medicine can be a humane science after all.

Now a cardiologist, Jauhar has all the qualities you'd want in your own doctor: expertise, insight, compassion, a sense of humor, and a keen awareness of the worries that we all have in common. His memoir explains the inner workings of modern medicine with rare candor and insight.


Praise for Intern

"[A] fine memoir of Jauhar's training in a New York City hospital . . . Intern succeeds as an unusually transparent portrait of an imperfect human being trying to do his best at a tough job . . . The story he tells here is antiheroic, full of uncertainty, doubt and frank disgust . . . In addition to telling Jauhar's own story, Intern delivers a vivid portrait of the culture of a New York City hospital, with its demanding hierarchy and sometimes indifferent cruelty. Evocative street sketches bring relief from the claustrophobic wards while echoing the medical inhumanity inside. Jauhar depicts a city rich in energy and youthful beauty, which manhandles its own citizens once illness renders them foul smelling and inarticulate . . . The medical system ultimately wore down Jauhar's most idealistic impulses, and yet allowed him to find a certain peace. 'Medicine, I learned, is a good profession, not a perfect one—and there are many ways it could change for the better,' he writes. 'But most of its practitioners . . . were fundamentally good people trying to do good every day.'"—Vincent Lam, The New York Times Book Review

"Brutally frank . . . Rarely has a more conflicted or unpromising candidate entered the field of medicine, and this mismatch gives Intern its offbeat appeal. There are many accounts of American medical training, but none related by a narrator quite so wobbly, introspective, crisis prone and fumbling . . . In a book filled with colorful medical anecdotes, Dr. Jauhar's own case stands out. Half the time it's not clear whether he should be treating others or others should be treating him, which does in fact happen when he develops a herniated disc midway through his training, complicated by a deep depression associated with a rolling existential crisis. The inside look at the workings of the medical internship system is fascinating, but it cannot compete with Dr. Jauhar's own psychological adventure, a quasireligious journey from agnosticism to robust faith, with occasional dips into outright atheism."—William Grimes, The New York Times

"Interns are the overburdened apprentices of the medical profession, and alas, the people they sharpen their skills upon are us. In Jauhar's wise memoir of his two-year ordeal of doubt and sleep deprivation at a New York hospital, he takes readers to the heart of every young physician's hardest test: to become a doctor yet remain a human being."—Time

"Intern is an excellent, well-written book in which Sandeep Jauhar describes his first 2 years of internship and residency in internal medicine at New York hospital (now New York-Presbyterian Hospital), a prestigious academic medical center in New York City. On one level, the book may be viewed simply as a memoir of one person's journey through the challenging and demanding apprenticeship that is necessary to complete training. Jauhar describes his own unique journey from graduate work in physics to medical school, his ambivalence about his decision, and his struggles with his family during this process. But the majority portion of the book is devoted to a compelling description of the difficult and formative years of his internship and residency. For those of us long past residency training, Jauhar captures vividly the uncertainty, fear, and extreme exhaustion that dominates the experience for most . . . Intern is more than simple a reminiscence of a difficult time, however. As Jauhar describes his experiences, he provides a window into the world of the resident that can give us important insights into the difficulties of this training and the ways in which it can be unsafe and dehumanizing. Much of what Jauhar describes is the inevitable product of assuming an enormous amount of responsibility at a time of relative inexperience and youth. The hours are long, and the work is grueling. He recounts the harrowing experience of being a night float at Memorial Sloan-Kettering Cancer Center, where he is responsible for dozens of severely ill patients who he know only by the 'pass-off'—patient information compressed into a few sentences by the interns who are off-call . . . There is much in internship training that we cannot change. The importance of this book is its ability to give us a sense of what we can change to make the process safer for patients and more humane for the house staff. Many articles have been written about the loss of empathy among physicians. As one reads this emotionally powerful story, it becomes clear that the culture in which the interns work is profoundly important to their experience. An unexpected act of kindness from one of Jauhar's fellow interns, like the kind words from his residency director that lifted his spirits, transformed his experience from one of guilt and isolation to something quite different. But all too often, his attending physicians are unsupportive and sometimes impatiently critical, making an already difficult experience far worse. Janhar states in his introduction that he thinks the book will be especially relevant to medical students. But I believe that it may be much more important reading for residency directors and anyone else who works closely with house staff . . . Intern points to ways in which we, as senior physicians, can affect the training process to make it more humane. In so doing, perhaps we can help our future interns feel more comfortable learning from their mistakes, maintain their spirit of altruism, and hold on to their ideals."—Katherine Treadway, M.D., Harvard Medical School, The New England Journal of Medicine

"This insider's account of life on the ward forces us to contemplate our own mortality. And we emerge from it all with a greater respect for medical professionals and their patients."—Peter McDermott, America

"Jauhar writes well, and aspects of his saga are interesting. He was not a traditional 'straight arrow' who shot directly from college into medical school; he opted for graduate study in physics first. Stories about Jauhar's parents and his courting of a medical student who shared his Indian heritage are deftly woven into his narrative. Perhaps the most revealing interaction in the book is between Jauhar and his older brother, Rajiv, an interventional cardiologist. If Jauhar is the soul-searching humanist, his brother is a bit of a cowboy, more interested in saving lives than contemplating them . . . Jauhar also writes quite frankly and critically about several former colleagues . . . In the course of this mini-autobiography, Jauhar discusses a series of ethical dilemmas: Is lying to patients ever permissible? Should doctors override the wishes of patients who appear to be making bad choices? Is informed consent as practiced in hospitals essentially meaningless?"—Barron H. Lerner, a physician and the author of When Illness Goes Public: Celebrity Patients and How We Look at Medicine, in The Washington Post

"Perhaps the greatest limitation of medical bildungsromans is that the narrative arc is circumscribed by the natural arc of medical school, internship, or residency—how profound can the drama be if we already know the basic plot? Sandeep Jauhar, now a cardiologist, manages to not hem himself in. His gift for prose breathes new life into a generally tired genre. Although Intern: A Doctor's Initiation centres on his internal medicine internship, his writing moves deftly between his schooling, his life outside the hospital, and on to his senior residency. Jauhar carries the baggage of judgmental parents, a superstar brother, and a prior career track as a physicist. He weaves a romance, a psychological breakdown, and his controversial New York Times writings into a slight but affecting drama. The first lesson of expository writing is to show, not tell, and this is what sets Jauhar apart from his contemporaries. As he describes a paracentesis gone horribly awry, with the ascitic fluid of an HIV-positive patient spilling all over the floor and a nurse essentially kicking him out of the room to clean up, or as we see him saddened by the inexorable fate of a patient suffering through intensive care, he never needs to remind us of his humility. It is plain to see. And when we see a flash of pride as Jauhar wrests control of a code from an overzealous resident and makes a life-saving decision to defibrillate a patient, he does not try to hide that from us. Jauhar, like most of us, is neither a saint nor an apostle of medicine. He is a little sarcastic, a little bitter, a little naive, a little smarter, and a little stupider than everyone else; in short, the character he writes for himself is the perfect protagonist for a medical internship. As he flinches from the gauntlet run, the grace of his prose allows us to feel every blow. To this young physician, it brought back visceral feelings, and I hope this is not the last literary gut punch we receive from Jauhar."—Noah Raizman, The Lancet

"Very few books can make you laugh and cry at the same time. This is one of them. Sandeep reveals himself in this book as he takes us on a wondrous journey through one of the most difficult years of his life. It is mandatory reading for anyone who has been even the slightest bit curious about how a doctor gets trained, and for physicians, it is a valuable record of our initiation."—Sanjay Gupta, CNN medical correspondent and author of Chasing Life

"Intern will resonate not only with doctors, but with anyone who has struggled with the grand question: 'what should I do with my life?' In a voice of profound honesty and intelligence, Sandeep Jauhar gives us an insider's look at the medical profession, and also a dramatic account of the psychological challenges of early adulthood."—Akhil Sharma, author of An Obedient Father

"Told of here is a time of travail and testing—a doctor's initiation into the trials of a demanding yet hauntingly affirming profession—all conveyed by a skilled, knowing writer whose words summon memories of his two great predecessors, Dr. Anton Chekhov and Dr. William Carlos Williams: a noble lineage to which this young doctor's mind, heart, and soul entitle him to belong."—Robert Coles

"Intern is not just a gripping tale of becoming a doctor. It's also a courageous critique, a saga of an immigrant family living (at times a little uneasily) the American dream, and even a love story. A great read and a valuable addition to the literature—and I use the word advisedly—of medical training."—Melvin Konner, M.D., Ph.D., author of Becoming a Doctor

"In this era when medical shows abound on TV, Jauhar demonstrates the power of the written word in the hands of a sensitive, thoughtful observer and an experienced, gifted writer. Intern is a compelling, accurate and heartfelt chronicle of what that year is really like. It will be the standard by which future such memoirs will be judged."—Abraham Verghese, author of My Own Country and The Tennis Partner

"The author examines the challenging, arduous program of medical internship. Jauhar, the director of the Heart Failure Program at Long Island Jewish Medical Center, chronicles in swift prose the often harrowing adventures he experienced as a medical intern. Born to a lab technician and a plant geneticist in a quaint southern California suburb, Jauhar whizzed through his schooling relatively unsure of a career path. After a fleeting interest in psychiatry, the author, while studying in Berkeley, warmed to the idea of following the footsteps of his brother Rajiv, a Manhattan doctor, even though he still considered a career in internal medicine 'so bourgeois.' His tremulous first year as a medical intern became traumatic as he wrestled with by-the-book protocol, the 'unsavoriness' of ornery ICU patients (where 'sometimes the cure is worse than the disease') and grueling rounds at the hospital's ward 10-North—all while harboring a particular queasiness around corpses and rectal procedures. Increasingly at the mercy of relentless fatigue and doctor-patient politics, Jauhar nearly resigned in his second year, but his confident bedside manner and steely resolve won out. The author also found time to romance fellow medical student Sonia, who eventually became his wife. Jauhar's candid account of his stressful journey is enlightening, educational and eye-opening. After ten successful years in the profession, the author dolefully admits that he is unfazed by the 'small injustices' in hospitals today. Required reading for anyone seriously considering a career in medicine."—Kirkus Reviews

"Cardiologist Jauhar, a regular writer for the New York Times and the New England Journal of Medicine, chronicles his first year in medical residency as an intern. Having resisted his family's attempts to persuade him to pursue a career in medicine, Jauhar instead pursues a Ph.D. in physics. But after a friend is diagnosed with the autoimmune disease lupus, Jauhar realizes his chosen major would enable him to have very little impact on people's lives. He decides instead to enter medical school, and upon graduation begins a residency program in a New York hospital. During most of his residency, however, Jauhar wavers in his decision to become a medical doctor. His honest and vivid account of the grueling life of a resident struggling through his first year as a doctor allows readers to see medicine from the point of view of someone wrestling with his career choice. By the end, Jauhar becomes more confident, assimilating into his role as a doctor, and developing a passion for his career in medicine—especially after becoming a patient himself. A well-written medical memoir recommended for most libraries."—Dana Ladd, Library Journal

"Jauhar, a cardiologist who directs the Heart Failure Program at Long Island Jewish Medical Center, completed his internship a decade ago, but still remembers his confusing, tumultuous medical apprenticeship at the prestigious New York Hospital the way soldiers remember war. The son of an embittered immigrant plant geneticist who found the American university tenure system racist, Jauhar dithered over career choices and completed a doctorate in physics before embarking on medicine. Jauhar feels responsible when he botches the blood pressure check on a patient who later dies during an aortic dissection and when he misses the high blood sodium level of a man who then suffers irreversible brain damage. He wonders if he and his colleagues have discriminated against a cardiac patient because of his weight, and helps an advanced cancer patient's wife decide against the futile insertion of a breathing tube. As his internship progresses, he romances his future wife . . . cracks under self-doubt and the expectations of his traditional Indian family, and suffers a serious depression. He regrets that as a doctor he is sometimes impatient, emotionless and paternalistic . . . his thoughtful, valuable memoir will be most relevant to medical students and interns experiencing similar crises."—Publishers Weekly

Reviews from Goodreads



Read an Excerpt

Chapter 1

I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather sandals slipped on the rounded irregular...

Read the full excerpt



  • Intern by Sandeep Jauhar--Audiobook Excerpt

    Listen to this audiobook excerpt from Sandeep Jauhar's book Intern: A Doctor's Initiation. Intern is Jauhar's story of his days and nights in residency at a busy hospital in New York City, a trial that led him to question his every assumption about medical care today. Residency—and especially its first year, the internship—is legendary for its brutality, and Jauhar's experience was even more harrowing than most.



  • Sandeep Jauhar

  • Sandeep Jauhar, MD, PhD, is the director of the Heart Failure Program at Long Island Jewish Medical Center. He writes regularly for The New York Times and The New England Journal of Medicine. He lives with his wife and their son in New York City.

  • Sandeep Jauhar Maryanne Russell
    Sandeep Jauhar