Summary:
Matthew McCarthy begins his memoir of medicine internship
year at Columbia University with a glimpse into his first rotation, surgery, as
a Harvard medical student. He had exhibited a talent for surgery and liked it
– an affinity compatible with his dexterity as a minor league baseball player
and sense of team spirit. The reader meets some of McCarthy’s memorable
mentors, and, although he opts to not pursue surgery as a career, McCarthy’s
eye for seeking productive apprenticeships with talented housestaff and faculty
allow him to guide the reader through a year of drinking from the firehose,
also known as internship. Medical training is full of liminal experiences, and
internship is one the most powerful and transformative.
McCarthy’s eagerness to do well, both by his patients and by
his medical colleagues and team, and his candor with revealing his mental and
bodily responses to the stress and strain of the responsibilities of
internship, make him an adept guide. For example, he has gulped an iced coffee
and is churning at the bit to take care of a new admission on his first day of
call in the cardiac care unit (CCU). His resident, called Baio in the book,
tries to tell McCarthy to take it easy. But McCarthy notes, “Our orientation
leaders, a peppy group of second- and third year residents, had instructed us
to exude a demented degree of enthusiasm at all times, which wasn’t difficult
now that my blood was more caffeine than hemoglobin.” (p 15) The previous
chapter had ended with a cliffhanger – a patient life would be placed in danger
because neophyte McCarthy misses the importance of a key clinical finding –
what and how that plays out will wait until McCarthy guides us through the
terror and exhilaration he feels as he begins his CCU rotation.
McCarthy has a good sense of the ironic: the huge banner
advertising the hospital reads “Amazing Things are Happening Here!” Indeed, not
only for patients and families, but also for the many trainees and workers. We
watch McCarthy successfully perform his first needle decompression of a
pneumothorax; he is allowed to attempt it as he notes that he watched the video
of the procedure. But unlike the video, he needs to readjust the needle several
times and add on some additional tubing and water trap, which makes the
scenario more true-to-life than a fictionalized ‘save.’ The author ends the
chapter with congratulations from resident Baio: “Well done… Amazing things are
indeed happening here.” (p 244) As McCarthy’s year continues, many things do
happen, including an infected needle stick, telling bad news to a new widow,
and developing a friendship with a longterm hospital patient waiting for a
heart transplant.
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