Internal Medicine author Terrence Holt. Image by Nathan Gelgud, 2014.

Somehow, probably from watching movies and television, we all know what it means when doctors shout "Stat!" They need something right away. Such shorthand figures into movies and TV a lot because it heightens drama. But in a real hospital, there's a subtext. "Stat" means, "I should have ordered this thing sooner, and now I want to go home for dinner, so get it for me right now." Shouting "Stat" gives you a bad reputation.

Terrence Holt's Internal Medicine gives readers this kind of inside scoop, but he hasn't set out to detail the ways in which hospitals are run. In fact, he reveals, the counterintuitive realization that led to the book's existence occurred on a day when he looked around his swirling, cacophonous workplace and thought, "This is not narratable." Later, while writing Internal Medicine, he kept this in mind. In order to do justice to his forty months as a resident in multiple hospitals, he'd write a series of slightly fictionalized parables, renaming himself Harper. The truth is more complicated than facts.

The book is made up of lots of case studies, each offering a look at a particular patient and a glimpse at Harper's learning curve and the institution of medicine. In the beginning, helpful nurses make firm suggestions to guide him. Soon, he's in charge of rookies, overseeing "orphans," which is what they call interns who are on duty without their supervising residents. Harper struggles with a woman who won't wear an oxygen mask and has to "snow" her, meaning give her so much morphine that she can't resist. He has to tell a patient that he has aggressive cancer, only to have the patient forget the bad news every morning, forcing Harper to retell him. Working in hospice care, he deals with an illness that's like leprosy, but worse.

This can be dark stuff. Death looms over every chapter, practically every sentence. Learning to be a doctor means working a grueling schedule, learning which treatments to use when, and how to work with a staff under constant pressure. But maybe most of all, it means learning to face death, how to tell patients they're going to die, how to tell families their loved ones are almost certainly hopeless, and how doctors stay sane as they have to resign themselves to losing their patients. In these doctor's stories, Holt has distilled this huge subject matter into a series of vignettes that have helped him make sense of his own transformation while giving readers a vivid picture of what can be a very grim profession.