Excerpt from Internal Medicine by Terrence Holt, plus links to reviews, author biography & more

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Internal Medicine

A Doctor's Stories

by Terrence Holt

Internal Medicine by Terrence Holt X
Internal Medicine by Terrence Holt
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  • First Published:
    Sep 2014, 240 pages

    Oct 2015, 288 pages


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Book Reviewed by:
Rory L. Aronsky
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Print Excerpt

The eyes closed for a moment. "All right," she said.

I told the nurse to give her a milligram of Ativan and two of morphine, and to try to get the mask back on her.

Just after nine the nurse reappeared in the doorway of the workroom and shook her head.

"She won't keep the mask on."

I pulled myself to my feet.

The patient was propped up in bed now, leaning forward, her hands braced on her thighs to support her. The posture is called "tripoding"; it's something people do instinctively when they're having trouble getting air. Her shoulders were lifting and falling rhythmically with each breath. She was using what are called the accessory muscles, anything to help expand the ribcage with inhalation. It can buy you a little extra air exchange, but the price, in terms of exertion, is more than most of us can pay for very long. The mask lay in her right hand, hissing.

She didn't seem to notice me as I moved across the room; her gaze was straight ahead, intent on something. Each breath, I thought. Or perhaps something visible only to her through the far wall of the room.

"Mrs. B?"

Her gaze flickered my way, a brief acknowledgment, then back to her inner vigil, intent.

My first impulse was to ask her how she was doing. I stifled it. I reached out instead and took the mask from her. Her hand was stiff; the fingers yielded slowly. Her eyes turned toward me.

"Does this bother you so much?" I held the mask out.

She nodded and drew away. As if it could bite her, I thought.

"More than the way you're feeling now?"

Her gaze clouded a moment. Unfair, I thought. Arguing with a dying woman.

She nodded again.

I sat at her bedside, holding the hissing plastic coil, looking into the mask. Reluctantly, unwilling to place my mouth where hers had been, I fitted the mask to my face, pressed the vinyl against my cheeks. I took a breath.

There was only a smell of plastic, then a high, eerily open sensation of emptiness. I took a breath, feeling my lungs expand; a vivid impression of spaces opening everywhere. I found her looking back at me, the eyes from the depths of her immobile face dark and liquid and alive.

I took the mask off. "It makes you feel confined?"

She nodded, shrugged.

"Have you tried taking deep breaths?" I was still buzzing with the force of the oxygen; my lethargy and sleepiness were all gone. I felt ready to take this woman on and bring her with me to morning.

She looked at me only a moment before turning to the far wall again, shaking her head. It occurred to me that she probably couldn't take deep breaths.

I was still holding the mask.

"Did the sedatives help any?"


"Would you like to try some more?"


I went to find the nurse. We doubled the dose of the Ativan. I watched, this time, as the drugs ran in, saw the relaxation I hadn't believed the stiff skin could show, the subtle slumping of the shoulders. I waited, and when sleep seemed about to take her I slipped the mask over her face. A hand stirred, rose a few inches, wavered, then fell to her lap; she settled back against the bed. I stood there beside her, holding the mask in place, watching. After a minute or two, we checked the pulseox: 94 percent. Her respiratory rate was settling into the midtwenties. Hours of accumulated tension dissipated from my own chest. The nurse and I walked quietly out the door. "Keep an eye on her," I said.

I don't remember what time the next call came. Probably around two. I was back in the workroom, running blearily over the results of the one o'clock draw, fielding pages from the floor. There had been a shift change at midnight, followed by a flurry of pages from the new shift coming on with questions. There was a patient down on 3 West who was refusing his prep for a scheduled colonoscopy.

I heard a knock and an unfamiliar face appeared in the doorway. "Are you the doctor on call?" Shift change. I grunted something affirmative. "Do you know the patient in twenty-six?"

Excerpted from Internal Medicine: A Doctor's Stories by Terrence Holt. Copyright © 2014 by Terrence Holt. With permission of the publisher, Liveright. All rights reserved.

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