Why write about a year you want to forget?
Matt McCarthy, MD is an assistant professor of medicine at Weill Cornell Medical College and an assistant attending physician at New York-Presbyterian Hospital, as well as a published author and journalist. Dr. McCarthy’s first book Odd Man Out was a memoir about his year (between college and medical school) playing professional baseball. This year, he published a second book, The Real Doctor Will See You Shortly, about his experience as a first-year resident, or “intern,” at Columbia. Dr. McCarthy has a degree in molecular biophysics and biochemistry from Yale, and a medical degree from Harvard. His writing has appeared in Sports Illustrated, Slate, The New England Journal of Medicine, and Deadspin, where he writes the Medspin column.
I was intrigued by Dr. McCarthy’s writing when I read this excerpt of The Real Doctor Will See You Shortly in The Atlantic. I went on to read the book, which was funny, candid, and intense, all at once. The description of the book on Dr. McCarthy’s website accurately calls it “a scorchingly frank look at how doctors are made” and a tale of a “journey from ineptitude to competence.” In the book, intern Matt McCarthy describes feeling months of guilt for the late diagnosis of a patient, the sickening sound of ribs cracking under chest compressions, sticking himself with a needle while drawing blood from an HIV patient, fishing through feces for the passed illegal goods of a drug mule, and more brutally honest recollections. I spoke with Dr. McCarthy to ask about his writing process, why he wrote this book about intern year, and how he had the courage to be so frank about his experiences.
V: Why did you initially become a doctor? And how did you get into writing?
Dr. McCarthy: As an undergraduate at Yale, I was really interested in chemistry and biochemistry, and I thought I was going to become a biochemist. But I was worried that I was not a talented enough biochemist to actually be able to run my own lab and get funding. I had fulfilled all the pre-med requirements, and so I applied to medical school. It was not something where I grew up thinking I was going to be a doctor. There were no doctors in my family, and if you talk to my parents, they say, “He never once expressed any interest in actually doing this.” But when I was trying to decide what I was going to do with my life, I felt like medicine gave me the widest range of choices. If I wanted to do research and be a biochemist, I could still do that. If I decided that I wasn’t very good at that, I could still see patients and have a very rewarding career. And so I was somebody who kind of stumbled into it because I was pretty good at science, not because I had a passion for medicine or a passion for taking care of people. I think that may be the tone that comes across in my book—that I often found myself feeling, “How did I get here? How did I end up in these totally crazy situations, dealing with scenarios I’d never even considered before?” In terms of writing, my best friends are all writers: a sports writer, a novelist, and a screenwriter. I think I got interested in writing through them, just from seeing what they do and how they do it. I would tell them these remarkable stories from the hospital and they used to say, “People will be interested in these.” That’s when I started thinking about actually writing this book.
V: Before medical school, you played baseball professionally. What was it like transitioning from the academic undergraduate environment to the baseball field, and then on to medical school?
Dr. McCarthy: I found that people who did something other than just go straight through school to become a doctor often brought a really good quality to medicine. They had a different type of bedside manner, because they could relate to people in a way that wasn’t just straight out of a textbook. They could imagine the world of not wearing a white coat and not being a doctor. You also realize pretty quickly in medicine that it’s so much about teamwork. No matter how brilliant you are, you can’t get through a day in the hospital without relying on social workers, nutritionists, nurses, physician’s assistants, residents, or surgical consults. If you don’t understand the concept of teamwork, you’re going to really struggle. I think, having played baseball before, I understood how that works. But otherwise, I felt like a fish out of water in medicine. I put on the white coat and it was just a weird feeling—an unusual sensation—and it took me a while to get used to that.
V: I know one of the hallmarks of medicine and medical school and residency is that you’re always busy, and there’s always something you have to do next. How did you find the time to write? Did you keep a daily diary?
Dr. McCarthy: I kept a journal while I was an intern. After I did my residency, I did infectious disease fellowship. The end of the fellowship was in a laboratory, so I was doing experiments on developing new antibiotics, and the nice thing about working in a basic science lab is that you’ve got a lot of free time. You set up your experiments, and then you wait two or three hours for things to finish. That’s when I started really writing it out, and thinking about what it is that I really want to say about medicine.
V: In The Real Doctor Will See You Shortly, you describe getting stuck with a needle while drawing blood from a patient who is HIV positive. The aftermath of that in your intern year is a really big part of the book. I was telling my mom about it—she’s a physician—and she said that happened to her while performing a spinal tap. I was blown away! Because first, I can’t believe that happened (she also had to take prophylactic medication afterwards). But then the second thing I thought was, how come I never heard about this? You really don’t know how common and shared some experiences in medicine can be.
Dr. McCarthy: It’s interesting, this happens to people all the time. I work with medical residents at Cornell, and one of them was reading my book and said, “This happened to me not long ago.” And someone else said, “Me, too.” And it’s this little weird thing that happens to residents periodically, and we don’t really talk about it much, but you know, it was a major part of my intern experience. It ultimately got me to become very interested in that world of HIV medicine, and I became an HIV doctor partly from that experience and seeing how difficult it can be to take those pills.
V: I was especially struck by the line from a colleague that you repeat throughout the book: “Who are you looking out for, yourself or the patient?” I don’t think it’s often acknowledged that there is this dichotomy that arises during medical training, where there’s a desire to look good in front of peers and superiors that might be at odds with what’s actually best for the patient.
Dr. McCarthy: That was one of the main points of the book. You’re working so hard to have your colleagues respect you, and you want the attendings to like you. You know the patients are going to see you for three or four days and then they’re gone. Your colleagues are going to see you for three or four years. It’s a tough balance. I work with attendings now, but we still have doubts. They’re just for different things. For example, as an intern I used to have doubts about putting in central lines, and physically being able to do procedures. Now, it’s a whole different range of doubts, like, “Have I read the most recent paper on what the right treatment is for this particular organism?” So the doubts never disappear, they just change.
V: You write frankly about the people who trained you, and about some of the patients. Before writing the book, did you go back and talk to those people?
Dr. McCarthy: That’s probably the most important question in terms of actually writing the book: how do you navigate this territory? Because it’s one thing to comply with HIPAA, which lists 18 identifiers that you can’t reveal about a patient. Nobody’s going to reveal them, you would be insane to do that, since there are things like social security number, address, and birthday. But you want to go beyond HIPAA to protect people, and the way to first do that is to get their consent. For example, I went to the guy who was waiting for a heart transplant and said, “I want to write about your story,” and he said “okay.” There were a couple of people I was not able to contact for various logistic reasons. For them, I went back and forth with the lawyers at Random House, discussing how much we want to change the depiction of this person and their demographic. I also told the other interns who were in my pod, who I worked with, that I was writing about our experience. I went to the guy I called “Baio” in the book, and I said, “I’m going to write about working in Columbia.” The hospital is wonderful, but you know, it’s a crazy place just like any hospital. They all had the same reaction, which was, “I think it will be difficult for you to write an honest book without getting fired.” But it turned out that the internal medicine residency directors loved the book, said I nailed the experience, and invited me to speak at the intern retreat at Columbia. That was, to me, the highlight of the responses.
V: Do you think writing has had a role for you in helping you deal with these high stress experiences?
Dr. McCarthy: Let’s say I’m incredibly frustrated with a patient who is yelling at me or refusing something that I’ve recommended. As a writer, what I often find myself doing is thinking about this scenario almost as a third person, as a fly on the wall. I think, what would drive this person to behave this way? What is it about their life circumstances? So rather than just being angry or annoyed, I’m speaking about them as almost a character in my life, and it’s therapeutic because I don’t get so frustrated with them. I think, this is probably someone who had a bad experience with another doctor, or they’ve had some other issue, and so it causes me to think a bit deeper about the patients that I’m encountering.
V: Now that you deal with first-year interns, do you talk to them about ways to prevent burnout, and coping mechanisms?
Dr. McCarthy: Absolutely. We have new interns starting next month, and you know, last year we had an intern in our program commit suicide in August. We are very sensitive to the mental health of our residents. It’s a hard thing to read. Imagine sitting in on rounds and I’m looking around the room, and looking into people’s eyes, trying to see who’s struggling and who’s not. I think as my book kind of lays out the fact that you can’t always tell what’s going on inside. And some of the residents that I worked with read my book and came to me and said, “I had no idea you were struggling this much. I thought you were fine, you were just that guy who seemed like he was doing fine.” In my intern year, out of the 40 interns I started with, five left the program. I think the ones who didn’t survive the program were ones who didn’t have a coping mechanism for these stressful situations. The good news is, at the end of the training, it’s really fun being a doctor. I love my job.