Can you imagine what it’s like to be a junior doctor? The gruelling shifts, the lack of sleep, the terror that, as you take the plunge from lecture hall to hospital ward, you’re responsible for the lives — and deaths — of others? Austin Duffy would like to help you try.
The oncologist’s third novel, The Night Interns, draws on his own exposure to the process more than 20 years ago which, he says, is “just imprinted in my head so vividly compared to other more recent stages of my career, where I’ve gone through a lot more dramatic stuff and had all sorts of intense experiences. But there’s obviously something about that initial year”.
Part of that “something”, as he describes it, is that while newly qualified medics have theoretical knowledge, they are suddenly confronted with the reality of trying to put it into practice, pitched into the unfamiliar surroundings and hierarchies of the hospital environment: “You cover these vast hospitals at night, and you’re wandering around with people who you’re in college with; you know them, they know you, and you’ve got each other to help you along, but it’s not like they’re in any better situation. It’s that moment where you’ve got a real foot in both camps: you’re not quite a fully-fledged doctor, even though you are on paper, and you’re not quite a total civilian, either. And on the medical side, you’re at the very bottom of the totem pole.”
In The Night Interns, which revolves around a trio of junior doctors, Duffy tries to capture the vulnerability and the isolation that he remembers — despite the fact, he says, that he had a pretty good internship. The result is a tense, claustrophobic narrative, filled with strip-lit corridors, bleeping pagers, absent consultants and catastrophically ill patients, its sharply observed details set against a backdrop of the protagonists’ unstable emotions. In short, Duffy followed one imperative as he wrote the book: “I wanted the reader to be on call.”
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Duffy’s imagination was fired by the description of young men caught up in a system over which they have no control
A clue to the intensity he wanted to achieve comes via a novel that, incongruous as it may seem, inspired him: the French writer Hubert Mingarelli’s A Meal in Winter, which follows three German soldiers working at a concentration camp who come across a Jewish escapee in the surrounding forest. Duffy’s imagination was fired by the description of young men caught up in a system over which they have no control although, he is at pains to point out, he’s drawing no comparisons between the two situations: “One’s a murderous regime, the other’s trying to help people and trying to make people better, but there was something about that dynamic that made me think, Oh my God, this reminds me of being an intern.”
Duffy’s days of being at the bottom of the totem pole are long behind him. Nowadays, he works as a consultant at the Mater and is an associate professor at UCD; he specialises in immunotherapy and spends much of his time setting up clinical trials to enable patients quicker and better access to new and experimental drugs, a process that he ruefully notes is slower than it should be in Ireland. “I’m not a real scientist,” he tells me, “not at all. I can speak the lingo, and sort of fake it” — but last year he was honoured by the National University of Ireland for his exceptional research into the treatment of liver cancer.
His day job, then, doesn’t sound like it would leave either much clock-time or headspace for writing fiction — not to mention the fact that he also has a young family, is a keen runner and plays the saxophone. But Duffy disagrees: indeed, he sees his career as a huge advantage, and not just because it pays the mortgage. At work, he does something that he loves, and that stimulates him, and he even finds the time pressure a spur to keep at it, writing before he leaves his house in Howth every morning, then on the Dart, with maybe a quick diversion to a coffee shop if he’s running ahead of schedule. If he has to take one of his children to football practice in the evening, he sits in the car with his laptop. “I’m very focused: when I sit to write, I’m not really looking out the window”, he says, which must be a terrific understatement. Does he feel impatient, I wonder, when he sees writers talking about their perfect writing set-up or the difficulty of carving time out for work? “Listen, everyone’s got their own way,” he replies, with immense tact.
He began to write when he was working in New York, living in hospital accommodation, basically “a box” with no internet or TV. With few personal commitments, he saw an advert for a weekly class at the writers’ studio, having long nursed the ambition and “dibbed and dabbed” throughout his 20s, including some forays into “the usual awful, sentimental crap stuff”.
I was very sceptical about creative writing classes,” he recalls. “But I figured I needed something external to just sort of get me going. And it worked perfectly, you know, it really did, it got me reading all these different writers that I would never have read. I met some people, and it was serious and good. And from that moment, I’ve basically written every day.”
Beyond the necessity of compartmentalising his timetable, I ask him, does he see links between his work as a doctor and his writing life?
He met his wife, artist Naomi Taitz, in New York and the couple subsequently moved to Washington before returning to Ireland in 2017, a year after the publication of his first novel, This Living and Immortal Thing, which centred on an ex-pat Irish research oncologist searching for a breakthrough. His second, Ten Days, followed last year and was shortlisted for the Kerry Group Irish Novel of the Year and the McKitterick Prize.
Beyond the necessity of compartmentalising his timetable, I ask him, does he see links between his work as a doctor and his writing life? Is it, in fact, an ingrained cultural misunderstanding that we separate the arts and the sciences so forcefully? “I don’t think there’s a sharp dividing line at all,” he replies. “Obviously, there are different techniques involved. But you’re kind of trying to get at the same thing in both. In science and medicine, you’re trying to get to a sort of an objective truth: does drug x work, or does it not? You’re doing an experiment basically, you’re trying to find out why is x causing y? You’re getting at that through experimentation and a different methodology than you would use, obviously, in art, but in art, you’re also looking for some form of truth.”
I ask him a cheeky question. The Night Interns features some truly horrible medical professionals at the top of the tree. How has he guarded against becoming one himself — if indeed he has? He bursts out laughing. “I wouldn’t survive for very long! I think those people, like the villain in the piece, you don’t see many of them around anymore. I think that is a genuine cultural change of the last 20 or 30 years. I’m sure there’s still things that go on. But I do think consultants, in general, are nicer. I’m obviously going to say that, right?”
Duffy points to the rates of personnel leaving the healthcare system for countries such as Australia
The Night Interns is not a novel of the pandemic, but it arrives at an interesting time, when the public has been made even more aware than previously of the strain on medical professionals: the images of nurses and doctors in heavy-duty protective gear for hours on end, working tirelessly to get to grips with an unfolding public health emergency, will take a long time to fade from the memory.
One of the questions the novel raises about the internship system is whether putting junior staff through such punishing initiations really correlates to whether they will become good doctors; Duffy points to the rates of personnel leaving the healthcare system for countries such as Australia, and although he’s cautious about comparing one country against another, he also thinks it can be instructive. “Burnout is a major concern,” he says and was even before Covid hit.
“Our strength is our people, and not just doctors or nurses, but all of the interactions that you get within the Irish health system.”
Encountering the trainee doctors and nurses on his return from America, he says, their calibre really hit him: “They’re just fabulous.” And The Night Interns will leave its readers in no doubt that they need protecting and preserving.
The Night Interns, by Austin Duffy, is published by Granta Books
