Prospective medical students might want to avoid reading The Night Interns . This uncompromising novel about the levels of exhaustion and stress that await them once they qualify could deter them from a career in medicine entirely.
Austin Duffy, a practising oncologist, offers his readers a powerful and intense perspective on the reality of life for newly qualified hospital doctors. He follows three surgical interns — all recent medical school graduates — who are on the rota for the night shift in a sprawling hospital in an Irish city.
They are constantly being paged, rushing from one ward to another to perform basic procedures and tests at the behest of ward nurses. An ECG test for one patient, blood samples from others; cannulas and lines inserted and antibiotics injected.
But there are also dramas. On their first shift they encounter a woman in the final stages of death, watched over by a family who look for reassurance that something can still be done.
Up until then we had only read about it, but here it was happening right in front of us, pre-death in all its glory.
Little in their training has prepared them for these situations yet they have to seem confident in front of the patients: “They didn’t know that we didn’t know anything, and it was probably better that way.” It’s drummed into them from the start — under no circumstances must they call out senior staff. Whatever they encounter during their shift, they have to deal with it (unless someone’s leg or arm was falling off).
Lynda is the most confident of the trio, the one who takes charge of each situation and isn’t afraid to confront nursing staff for failing to take even basic steps before calling out the interns. Stuart is her complete opposite, reluctant to make any diagnosis or decision about treatment in case he makes a mistake.
The unnamed narrator is somewhere in the middle, keen to do the right thing, thrilled when he gets a procedure right yet demoralised by the constant streams of criticism coming from his supervisor. In the hospital hierarchy the surgeons are god-like figures who can do no wrong. Any blame is laid at the feet of their next in line, the registrars and house doctors, and down the chain to the juniors.
In The Night Interns we get a sense of a the pressure chamber within which the medical teams work. The interns bear the brunt of it, and one of their cohort has already committed suicide as a result. But the senior staff are not immune either from bullying, distrust or inefficient systems. They deal with it by transferring their frustrations and resentments onto their juniors.
The experience causes the narrator to question his future:
Being a surgical intern was something to be endured and survived, a staging post on the way to other things, but what these things were remained invisible… and all of the likely eventualities were undesirable.
Duffy drew on his own experience as an intern for this novel so we know the pressures and internal politics of this hospital world are not an exaggeration. Added authenticity comes from his use of medical terminology like “Cheyne-Stokes breathing” and “blood gases” and “Hickman cannulas”
The prose is terse and mainly downbeat with flashes of bleak humour (it’s part of a coping mechanism during times of stress) and moments of pathos and humanity that help prevent this being an unremittingly grim tale.
It’s the kind of narrative that provokes a strong emotional response. It’s hard not to finish this book without feeling angry that young doctors can be driven to exhaustion, death or the abandonment of their career, particularly at a time when there is a dire shortage of doctors in the UK health system. It made me wonder how much better the health system could be if these young doctors were shown more compassion and humanity.
The Night Interns was book number 1 from my #20booksofsummer reading list. There’s an interesting interview with Austin Duffy here in The Guardian in which he talks about his purpose in writing the book.
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