The Night Interns by Austin Duffy — survival on the wards
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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Everything I was going to write has essentially been already said here, so I’ll just add my thanks for your review – the more we can appreciate people whose vocation leads them here, the more we’re likely to show that appreciation not just by word but by actions, principally by giving them the means to do their job properly as well as remunerating them as they deserve.
Why is it that we can see this yet the people who are supposed to be in charge and have specialist knowledge and expertise, fail to do so?
I like the sound of this. Did you read Adam Kay’s memoir This is Going to Hurt which highlights many of these issues including the dangers of sleep deprivation and overwork, coupled with constant bullying from senior staff. Clearly it’s a bad working culture which ought to change, but I don’t know if anyone is doing anything about it. Too many junior doctors suffer in silence, take their own lives or leave the profession entirely, which all seems such a waste.
I did read his memoir Kim, the lack of support he received after a traumatic incident was horrifying. Some of the other medical related books I’ve read also speak of the frustrations of management decisions which are all about cost cutting/ hitting targets often with no thought as to the effect on staff or patients.
Not a book I need to read, this issue is forever in the ‘lifestyle’ segment of news and current affairs here, and I find that fascinating in itself. It always consists of the same story: tired doctors adjusting to working hours after the freer lifestyle at university, plus complaints that their training hasn’t prepared them, when in fact, this practical work *is* their training. Learning to make decisions and do stuff on their own, when help, if really needed, is not far away, is part of that.
Junior teachers and other professionals say exactly the same thing. The difference is, we can’t use emotional blackmail and invoke fears about ‘patients at risk who might die.’
And, wearing my ‘old unionist’ hat, if it really is a systemic problem affecting patient health and the retention of doctors, why haven’t junior doctors joined whatever health services unions there are and used their collective voice to get changes? We know the answer to that one, it would offend their sense of status… that hierarchy of ‘gods’ is what they aspire to join.
Junior doctors are unionised in the UK. There have been many strikes over the years, mainly in demand for better pay and limits to working hours. Nothing changes because the Tory government only thinks of things in terms of $$$ and they use gaslighting politics to scaremonger the public by claiming that the strikes are dangerous (they’re not) and immoral. It’s a no-win situation.
Oh, that is excellent! Thanks for setting me straight, I did not know this.
No worries. Just seen a story on the Guardian about an upcoming strike for 5 days from 13 July, which is described as “longest single period of industrial action by junior doctors in history of health service” so it’s clearly an ongoing issue… the story adds that “droves” have left the UK for jobs in countries such as Australia.
Western Australia has been conducting a recruitment drive here recently. It must be very tempting – higher salary, more reasonable hours and a warm climate
Learning by doing is certainly important but there needs to be a recognition by the hospital system that such an approach means wrong decisions can be taken and mistakes can be made. Instead of criticising those juniors if they make the wrong call, they should be more supportive.
As Kim says, those doctors are in a union and they are taking action. The real problem is that the NHS is treated as a sacred cow, it has significant problems but no-one is prepared to take the drastic action needed to fix it
Hmmm. I’m not big on medical dramas,and this sounds unremittingly depressing. I doubt if this one’s for me.
Understood Margaret. It isn’t a cheering book for sure
One of my books of last year. Absolutely agree with your point about compassion and humanity. Young doctors have to find ways to protect themselves and a little help in how to do that would seem necessary rather than a frill.
The upcoming anniversary of the NHS is going to see acres of media coverage, much of which will look at the system through rose tinted lens. I keep wondering which politician will be courageous enough to take the drastic action needed to fix the multiple issues in the system – all that happens is we hear of more budget allocated (which just seems to result in extra layers of management) and more headlines about targets that will never be reached. We really need someone with Aneurin Bevan’s vision and determination
Absolutely agree. Today’s King’s Fund report couldn’t be more timely but I suspect will be conveniently buried.
Like so many other reports…..