Shem writes a provocative novel about the experiences of a group of elite interns fulfilling their first year of residency. In the midst of raunchy escapades, foul descriptions of odors and patients, and over-the-top characters, there is an array of important medical issues that are broached. One of the most poignant lessons in the book is that doctors don’t cure.

Roy spends the early months of his residency learning that “buffing” the patients charts not only saves him the agony of conducting difficult procedures but it also allows for better patient outcomes. Throughout the novel we are exposed to the vast inefficiencies of too much medicine within the hospital setting. There is Tina, who manages to have all the water in her blood extracted during dialysis, and the young father who comes into the hospital with a “pimple” on his knee and after the care of his private is completely debilitated. The only potential for a cure emerges with Saul the tailor who surprisingly sees his cancer go into remission (only to have it kill him a few months later).

While many of the deaths in the hospital are the result of egregious malpractice, one of the most memorable encounters with death is through Dr. Sanders. Sanders, the House doctor who has terminal cancer, is one of the few patients that Roy learns to love and through this relationship he learns the value of being a good doctor:

“No, we don’t cure. I never bought that either. I went through the same cynicism- all that training, and then this helplessness. And yet, in spite of all our doubt, we can give something. Not cure, no. What sustains us is when we find a way to be compassionate, to love. And the most loving thing we do is to be with a patient, like you are being with me” (156).

Shem introduces a valuable lesson in doctoring through Dr. Sanders death. We learn that not offering a cure is not an outrageous failure, if medicine can serve to comfort patients with bad prognoses. So much of being a doctor is contingent on the relationship that we will someday form with our patients and their families. Doctors are generally not at the front lines of medical and pharmaceutical discoveries; they instead work in the trenches, delivering patient care.

As a pre-medical student I fear that I will be disappointed by the limitations of medicine. The generic reason why anyone wants to go into medicine is to help people; it is a noble goal and most commonly a difficult one. With the recent death of Senator Kennedy, there was a lot of media coverage on cancer treatments and the limited advancements that have been made over the past decades. In spite of billions of dollars being placed in research many diseases still remain a mystery. I want to effect healthcare and hopefully provide patients with a better quality and length of life. I agree with Dr. Sander’s view that we can give a lot to patients simply by showing that we care and spending time with them, but I often wonder if palliative care will leave me disappointed.

Even if cures become more widely available and medicine makes huge advancements the importance of good bedside manner and patient interactions will never lose its importance. At the end of the day doctors are providing a service to patients and whether or not that service is providing a cure or a death sentence the way that we treat patients will always be tantamount to our success as future medical practitioners.