Sandeep Jauhar, M.D., Ph.D. is currently director of the Heart Failure Program at Long Island Jewish Medical Center in New York. Thus, one can assume that he is an accomplished cardiologist and administrator. It was not always so. This memoir flashes back to 10-15 years earlier when the author was casting about for a career, finally settling on medicine almost by default; it follows him to medical school (at Washington University in St. Louis) and then centers on his first year of residency training at Cornell's New York Hospital in Manhattan -- the internship year.

We learn in the introduction to the book that the author will speak freely of self-doubt about career choice, constant anxiety and feelings of inadequacy, exhaustion, and disillusionment. Which indeed he does. But Jauhar first discusses his family background: born in India and emigrating with his family to the USA at age 8; father holding a Ph.D. in plant genetics, now writing academic textbooks and still regretting that he had not been able to afford his dream of becoming a doctor; mother helping to support the family as a lab technician; older brother, Rajiv, a mentor and competitor, charming, self-assured, and unquestioningly headed for a medical career; sister, Suneeta. Sandeep (the author) undertakes graduate work in theoretical physics but as he nears completion of his doctoral degree, realizes that he probably does not have what it takes to be successful in the field. When his girlfriend, Lisa, becomes seriously ill, he begins to (re)consider medicine as a career. Against the advice of his parents who are now convinced he is a dilettante, he applies to medical school and is accepted.

Disillusionment began during the first two years of medical school: "In graduate school I had never learned to memorize . . . But now I couldn't rely on logic and reasoning; I had to commit huge swaths of material to memory" (32). He considered quitting to become a journalist, a profession that had always intrigued him, but which had been discouraged: "my father made it clear that journalism and writing were never to be considered career options because they offered no security" (33). Yet, amazingly, he was awarded a summer fellowship just before starting medical school that placed him in the Washington, DC office of Time magazine; the contacts he made then allowed him to work as a student reporter for the St. Louis Post-Dispatch during medical school and led ultimately to his ongoing and current position as a contributing medical essayist for the New York Times.

Internship for Jauhar unfolds as a series of anxiety-provoking encounters with patients and humiliating encounters with his physician superiors. Feeling inept and inadequate, he stumbles along and worries that he is harming patients. There is too much to keep track of, too many "little things that I find burdensome" (91). "Having so much to do was bad enough, but not knowing why you were doing what you were doing was terrifying . . . Patients were needy, their demands overwhelming . . . Everyone seemed to know how the place worked except me . . . The ecology on the wards was hostile; interactions were hard-bitten, fast paced" (112-113). He is in constant doubt and conflict about his career choice. Even his private life is affected -- his girlfriend Sonia, still a medical student, comes from a medical family, is strongly motivated and secure in her career choice, which aggravates his own sense of insecurity. (Reader, he married her.)

Midway through internship Jauhar suffers a herniated disk. He tries to tough it out without taking time off but his stint as "night float" at Memorial Sloan-Kettering hospital, which specializes in treating cancer patients, proves too difficult-- up all night trying to tend to the severely ill and "taking care of patients about whom you knew next to nothing" (154). He takes a brief leave followed by a reduced schedule. He recognizes that his problems are emotional as well as physical -- he is depressed. But gradually, as his neck problem improves, as he recognizes that medical professionals are actually able to help patients feel better -- his neurologist and physical therapist had "provided hope and comfort to me at a vulnerable time" (181)--, as he makes a house call to a dying patient, as his essays are published in the New York Times, and as the season moves to Spring, his depression lifts and he looks forward to his work.


Sandeep Jauhar, by background and inclination, is not your typical medical professional and this book is atypical in some respects as well. To an unusual extent, the author dwells on his confusion, doubts, and feelings of inadequacy during medical training. While there is much discussion of the objective difficulties facing novice physicians, what comes through most strongly is a personal struggle to achieve a sense of self-worth and fulfillment in the world of work. The author seems strikingly honest and self-deprecating, articulating the doubts and anxieties that many young physicians-in training-experience but are afraid to voice, sometimes even to and among themselves. Depression is not uncommon among medical students and residents and one wonders how effectively it is recognized and treated. Surprisingly, even though Jauhar acknowledges he probably had "clinical depression," he does not tell us that he sought professional help for it.

It is worth noting, however, that Jauhar's ambivalence about entering and remaining in medicine is not universal among those who enter the profession, as shown even in this memoir by contrasting attitudes of his girlfriend/wife Sonia, and of his brother, Rajiv. Jauhar is certainly thoughtful and motivated to be a competent, caring physician. This is clear in the brief description of his home visit with Mr. Gonzalez, where he forgets to bring any of his medical "tools" and is limited to talking with the wife and sitting by the patient's bedside, stroking his hand. "I felt curiously at peace . . . even though I hadn't prescribed any medicine or assisted them in any tangible way, I had learned so much about the Gonzalezes . . . the sort of thing I had once looked forward to doing when I became a doctor" (177).

Also of interest is the author's critique of the "night float" system and the reduced hours mandated for resident physicians by state and federal law. While criticizing the exhausting schedules that used to prevail in residency training, Jauhar is leery of the new system where patient care is discontinuous, fragmented, and important information gets lost. His view of the way patients at Memorial Sloan Kettering were treated are not kind and are reminiscent of the criticisms made by Evan Handler when he was a patient there (see annotation of Handler's Time on Fire: My Comedy of Terrors). Finally, the book emphasizes once again the importance for medical professionals to maintain what physician-author Perri Klass has called "some corner of my life which was all my own" (see annotation of Klass's Baby Doctor: A Pediatrician's Training) -- for Jauhar and Klass that corner is in writing.


Farrar, Straus & Giroux

Place Published

New York



Page Count