Cover of book: Internal Medicine

Terrence Holt
Internal Medicine

Doctors’ stories have become a mainstay of nonfiction writing. Think of Atul Gawande, Jerome Groopman, Theodore Dalrymple and, closer to home, Karen Hitchcock. But Terrence Holt calls his doctor’s stories fiction.

Holt wrote and taught literature for years before turning to medicine. Now he is active in the field of narrative medicine, which uses storytelling to cultivate empathy and help health carers to see the patient behind the symptoms. Holt’s especial interest is in doctors’ autobiographical writing, as a means of challenging the perception of doctor as hero and coming to terms with the limits of their power to heal.

These first-person stories draw their inspiration from Holt’s own years as a junior doctor in a busy US hospital. Rather than case studies, they are “assemblages” through which Holt seeks to make sense of his experience. He calls them “parables”, not in the gnomic sense, but as stories condensed and refashioned to achieve a clarity impossible in the manifold lived moment. In the process, identities and circumstances have been altered beyond any resemblance to their originals. His patients’ stories, he insists, are not his to tell.

If these are parables, the ethical situations they illustrate are far from clear-cut. The resolution and insight that their telling has brought to Holt himself can elude a general reader. But that ought not count as a criticism, since the stories’ moral complexity is what gives them grit and makes them memorable. Near the end of one, in which a liver transplant saves a patient who has overdosed on painkillers, the junior doctor wonders whether the young woman deserves her second chance, “while others sicken and die waiting for transplants that never come”. But then, he reflects, “Maybe no one earns a second chance. Who would be worthy of it?”

Exhaustion, though, is the keynote. It’s commonplace for junior doctors to work back-to-back shifts and unbroken weeks on end. Holt’s doctor responds to his pager and makes his rounds in a haze of near-delirium that blunts his capacity to feel. The erosion of compassion through overwork comes through sharply in the story “Heart Failure”. Marie, suffering a chronic illness, is “a fat little woman with a tremulous manner… I hated her.” She mistakes the doctor’s revulsion for shyness.

“Residency passed like a bad dream,” says the unnamed doctor, “and on awaking I found I cared again. Perhaps too much.”  FL

Black Inc., 288pp, $27.99

This article was first published in the print edition of The Saturday Paper on September 13, 2014 as "Terrence Holt, Internal Medicine".

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