Inside Story

INTERN by Doctor X. 404 pages. Harper & Row. $5.95.

"People think of surgery," writes the author, "as a grim, tense business with the surgeon snapping 'Scalpel!' and 'Clamp!' and everything going along in dramatic silence except for the click, click of instruments. This is just a lot of hogwash. About half the time the surgeon is telling dirty jokes with the fixed intent of embarrassing the scrub nurse. The rest of the time there is bickering, or gossip, or talk about how things were last winter in Palm Springs, or how many suction cups on a squid's tentacles, or whether a woman has an orgasm at the instant she is hanged. Of course, there are times when you just shut up and work."

From this passage it should be quite clear that Dr. X, a physician now in practice, has no intention of deifying the man in white. Some of his colleagues may conclude, though wrongly, that his purpose is to destroy medicine's meticulously protected public image. The book logs the author's internship year at an unidentified metropolitan hospital in the Southwest, just as he recounted it into a tape recorder at odd moments snatched from duty. Its candor conceals nothing but the true names of patients and staff. The result is a rare and unforgettable account of that underpaid, overworked, fumble-fingered and annealing process by which the medical-school graduate at last earns the right to practice.

Some readers will depart these pages vowing to die rather than set foot in another hospital. Many of Dr. X's glimpses of what goes on there are indeed horrifying. An obstetrician funks a difficult delivery, leaving it up to the intern, who has never presided over any birth at all, much less a critical one. An addicted nurse steals morphine from her patients. A surgeon carelessly ties off the wrong artery in a simple operation; gangrene sets in and the patient not only loses her leg but is charged $3,000 in hospitalization and extra surgery charges resulting from the surgeon's error.

Despite such horror stories, the book's effect is reassuring. Once a week, at 7:15 in the morning, the hospital staff convenes for a no-holds-barred critique of its own performance. "I wonder how many laymen," writes Dr. X, "ever even dream that 60 of the city's doctors gather voluntarily for the sole purpose of keeping themselves sharp and on their toes?" For every lapse of skill, Intern cites ten occasions where a brilliant diagnosis, or a skillful stroke of the scalpel, frustrated man's ultimate enemy.

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