Terry Prone: Books by practising medics really ought to be prescribed reading

The trio of young doctors — two men and one woman — in Austin Duffy’s latest novel know a different hospital to the hospital that patients know. Stock picture

If holidays are still ahead of you, and you’re looking for something other than the egregious ‘beach book’, you could hardly do better than the new one from Austin Duffy. Although Duffy’s day job is as a HSE consultant oncologist, this novel isn’t about cancer. The Night Interns is about three young aspirant doctors working in an acute hospital in Dublin. Or perhaps they should be described as “surviving,” given the level of pressure they’re under.

That pressure comes from the hours they have to work, the constantly interrupted sleep they get, and the variety and intensity of demands made of them. The two men and one woman know a different hospital to the hospital patients know: This is an institution with dingy back corridors grimly half-lit and work staircases linking floors. 

The narrator, one of the three, sees the woman as bright, competent, and risk-taking and the male colleague as showing much less promise and much more capacity to weasel out of challenges. The reader isn’t clear how good the narrator’s judgment is, given his ever-present fear and all-pervasive exhaustion, but ends up rooting for all three members of their unchosen band.

This scenario has been explored by other writers, notably and recently Adam Kay, the British comedy writer/comedian who used to be a doctor before he abandoned that profession, earning his living instead by TV writing and performing. A couple of years ago, Kay wrote a riotously funny bestseller called This is Going to Hurt about his experiences as a young doctor in the NHS. The book was based on diaries he kept during that period of his life and manages to be funny and sad at one and the same time.

Kay belongs in a tradition of mainly non-fiction doctor/writers kicked off by Richard Gordon, who wrote the books that became the enormously popular Doctor in the House movie series. Gordon’s books varied between light-hearted fictionalised personal experience and equally light-hearted histories of medical oddities, including his account of a surgery conducted back in the pre-anaesthetic days when speed was of the essence, because if you were amputating a patient’s leg while that patient was conscious, their agony was unspeakable and vocal.

Gordon’s quintessential tale from this period involved a surgeon highly regarded for his phenomenal speed.

In this particular instance, the major surgery was completed in under five minutes. Admittedly, the surgeon did slash the hand of a bystander, who died some days later from infection, as did the patient, together with an assistant surgeon who dropped dead when he saw the injury to the bystander. Gordon ruefully noted that while the operation was technically a success, it did have a 300% mortality rate.

On the face of it, the Gordon/Kay books and those written by Austin Duffy have much in common: Unpredicted complications, bulldozing stress, tragic outcomes, and ridiculous/comic situations. But The Night Interns — to be published by Granta Books on Thursday — is much more. It is about skewed perceptions, visceral fears, and, above all, a constant and overwhelming conviction that something terminally damaging is about to happen to the patients or the young doctors involved.

No beach book, this. That said, any of Duffy’s three novels are worth reading this summer, ideally in order of publication. 

Whether he’s writing about how it feels in the very early stages of Alzheimer’s or about the dark cloud cast over other lives by a colleague’s suicide, Duffy does his business quietly, without showy touches. The reader ends up marked by the reading experience, holding the paperback, finished and closed, unwilling to immediately rejoin the real world.

Doctors double-job as novelists arguably more often than any other profession except perhaps the legal discipline and, even then, lawyers or former lawyers tend to write throwaway thrillers, rather than heart-stopping works of literary merit. Doctor-writers, of course,
include our own Oliver St John Gogarty, who managed to be a poet, playwright, and novelist as well as a medic and lifelong adventurer.

Now and in Gogarty’s time, the doctor/writer has unequalled access to humanity at its most pathetic, most vulnerable. Axel Munthe, a Swede who spent much time in Capri, and wrote about the clinic he established there in The Story of San Michele, movingly described treating the local prostitutes and dealing with issues such as inherited infantile syphilis.

Munthe’s book was not a novel — the first successful physician/novelist was probably Somerset Maugham, whose Liza of Lambeth looked at the short harsh life of a teenage factory girl in late 19th century London.

Maugham’s novels became somewhat less melodramatic as his career progressed, with Of Human Bondage a heart-cramping study of an emotional controller.

AJ Cronin, a Scot, has been described as “the prototype doctor-novelist”, although his output was patchy. While his bestseller — The Citadel,  published in 1937 — managed to spark extensive discussion about the medical ethics affecting his characters while also generating a successful movie.

Mark Harris, who recorded the wartime experiences of five famous film directors in Five Came Back, noted that the next Cronin story, “about a young British nurse who lets her sister take the fall after her carelessness causes the death of a child, was contrived and soapy.

“Three writers had worked on the screenplay, but none of them could do much to fix the scene in which an elderly gossip who threatens to expose the young woman conveniently goes over a cliff in a bus, or a preposterous last act that punishes the guilty sister by having the 1918 flu epidemic sweep through London.”

Phenomenal output

Cronin’s phenomenal output of more than 5,000 publishable words a day may have contributed to him not always hitting the spot, but his work was so durable that, only five years ago, a new collection of short stories he wrote in the 1930s was published.

His contemporary in the US was Frank G Slaughter, who wrote almost 60 books — most were novels but some were popular medical histories — and sold almost 70m copies of them.

“He became so successful in the early stage of his writing career,” writes Ira Rutkow, whose Empire of the Scalpel, a history of surgery, has just been published, “that at the completion of Slaughter’s wartime service as an army surgeon he closed his surgical practice in Jacksonville, Florida, and devoted himself to literary pursuits.

“Year after year, Slaughter produced one or two novels, writing several thousand words a week.”

That option — of closing down the medical practice and working only on fiction — is not available to physician/novelists in Ireland. Which is not necessarily a bad thing, at a time when we have a shortage of professionals in medicine. In addition, keeping the day job does maintain a close connection with the realities on the hospital floor.

Austin Duffy is currently a full-time medical consultant. Readers must hope he continues to find enough time to continue to produce a jewelled novel every couple of years.