The making of the doctor

, writing about how he learnt to take a knife to the human body for the first time. And now you have Sandeep Jauhar, a New York-based cardiologist writing Intern: A Doctor's Initiation, about his traumatic internship, the eighty-hour work shifts, the perpetual exhaustion, the feelings of inadequacy and fear of causing harm or death to patients out of ignorance or inexperience.

Breaking into a profession, any profession, isn't easy "" I suppose, even first-time brick-layers have difficulty learning the ropes. But Jauhar's book is premised on the belief that the initiation into the medical profession is the most difficult. It's certainly high on drama, both for the apprentice-doctor (the first annual examination, the first time he inserted an catheter or attempted a resuscitation, the first death) and the reader (who can never get away from the feeling that he could well have been one of the many patients that Jauhar encounters).

Then there's the drama inside Jauhar's mind "" a to-be-or-not-to-be-a-doctor debate that continues, irritatingly at times, well into half of the book. Jauhar was doing his doctoral dissertation at Berkeley tracing quantum dots when a girlfriend's affliction with lupus gave him pause "" should he take up medicine? At the time he was also fast growing dissatisfied at the esoterism of high physics. "I just wanted to get out of the ivory tower ... Becoming a doctor, I hoped, would bring me back into the real world. It would make me into a man."

To be sure, most of us feel something of the same tearing sense of indecision, of wanting to take up this career and that one too (a wife or husband too, probably, but in this one area Jauhar seems to have had an easy time since he met his future wife Sonia, a medical student, and of the same caste and district in India as his own family, barely a few months into internship). But with Jauhar it seems to go a little too far. A few days into medical school and Jauhar is on the phone to his cardiologist-brother to say that he wants to quit. He continues to have ambivalent feelings for medicine well into the second year of internship, finding fault with almost every aspect of medicine "" the rigours of residency which made it difficult to give consistently high-quality care, the callousness of the senior doctors to pain and suffering, and so and on. One feels almost sympathetic towards his exasperated father, who keeps warning him not to "change horses in the middle of the stream".

Thankfully, the drama is tempered with irony and humour, as Jauhar describes how the "system" absorbed him, after a point he stopped obsessing about everything and became a "man", how he became the very image of the "cookbook" doctor that he set out determined never to become, one who nonchalantly inserted tubes into his patients and made life and death decisions with equanimity.

What comes after forms the third part of the book. This section is more measured, more philosophical as Jauhar takes up, one by one, issues that affect the medical system, not just in the US but in India or any other country.

The question of honesty "" should a doctor tell a patient that there's a very high probability of the tumour in his body being cancerous? Isn't it time we questioned the paternalistic view of doctors?

What to do with difficult patients? How does the doctor's suspicion that a patient was faking symptoms affect his treatment of them? The doctor being as much a part of society as the patient, is he immune to prejudices of colour, race, weight and how do these affect his service?

The most worrisome of the many questions Jauhar tackles is whether there is any justification for the many invasive tests "" the CAT scans, the X-rays, the ultrasounds, the blood reports "" that doctors in hospitals do all the time? Do they serve any purpose, especially for a terminally ill patient?

INTERN
A DOCTOR'S INITIATION

Sandeep Jauhar
Penguin
Rs 350, 299 pages