Internal Medicine by Terrence Holt, review by Susan Gusho
Internal Medicine by Terrence Holt is an exquisitely crafted gem of a book. The nine stories comprising Internal Medicine loosely reflect Holt’s experience as an internal medicine resident, describing the shocks and changes, both subtle and profound, he undergoes in becoming a doctor. The doctor in the stories is named “Harper” and the patient cases are compositely drawn so that Internal Medicine occupies a grey area in between fiction and non-fiction. Holt transforms medical cases “according to the logic not of journalism but of parable, seeking to capture the essence of something too complex to be understood any other way.”
Unlike other doctors-come-writers (Gawande/Hosseini), Holt wrote and taught writing for a decade before trading his pen for a stethoscope. And as a writer, he’s a virtuoso. His understated, precise prose style places the reader immediately in the exhausted, overworked shoes of a hospital intern, without melodrama or artifice, while at the same time evoking an atmosphere of mystery, claustrophobia, and dread akin to Poe or Hawthorne. This blending of the physical and the metaphysical makes these stories fascinating and addicting. In the most heart-rending story in the collection, “The Surgical Mask,” Harper visits a home hospice patient who is dying of cancer disfiguring her mouth and nose. Surrounded by a gallery of her own lush oil paintings as well as a chorus of raucous, exotic birds she has rescued, she cannot talk coherently and wears a square, white surgical mask. The mask invokes a paralyzing anxiety in Dr. Harper so that he is unable to examine his patient or even do his job. This calls to mind Nathaniel Hawthorne’s great short story, “The Minister’s Black Veil” in which the mask itself — the symbol of what lies beneath — takes on its own preternatural power. Holt's best story, "The Surgical Mask" also examines the limits of human suffering and helplessness; as stories go, it’s sublime.
Both human and humane, Internal Medicine beautifully spans the gap between doctor and patient, between data and meaning, between science and art. If fiction is a lens revealing greater truth, readers can glean much about the hopes and frailties of doctors and patients, that we are all, finally, heir to.