Shem's fictionalized memoir, recounting his year as an intern in a major Boston hospital, is by turns dark and depressing and cynical and ribald and wildly funny. Set against the final days of Richard Nixon's presidency, the disintegration of a formerly powerful man is reflected in the increasingly fractured and disintegrating medical intern training system of the day.
Urged to "do everything possible for every patient, every time", Shem's Roy Basch and his fellow internal medicine interns are faced with aging patients whose lives can be extended, but not improved, by the medical procedures the system (and their superiors) insist they perform. And while the elderly and often demented patients are not permitted the final rest they seek (to the extent that they are capable of seeking anything), Basch's younger patients have a horrifying tendency to expire, either from the underlying conditions that brought them to the hospital or from botched treatments that harmed instead of helped. Battling an increasingly heavy burden of despair, Basch tries everything from long-distance running to wild bouts of casual sex to utter withdrawal from emotional involvement, with varying levels of success.
He's not alone on his journey, as the novel is also filled with sharp and involving characters, including two of the most unlikely cops ever to appear on the printed page.
How he survives the year and begins the healing that will ultimately save him, makes an often fascinating, often troublesome, always compelling read.