The Irish hospital: A harsh world of ugly paradoxes

Philip Larkin would make a good patron saint of hospitals, if Austin Duffy’s absorbing new novel The Night Interns is anything to go by. In an unnamed Dublin hospital man is certainly handing down misery to man in a dysfunctional, hierarchical system that seems to benefit few.

Narrated by a junior doctor, one of the maligned titular interns, the book unfolds as a quiet but insistent questioning of the moral code within the hospital, where pain and suffering are as commonplace among the staff as in the wards.

For the three surgical interns at the heart of this book, the dreaded night shift is by turns frenetic, monotonous, stressful, endless. Through Duffy’s skilled depiction, the hospital emerges as a harsh world of ugly paradoxes. The interns follow orders from superiors who don’t tolerate questions or pleas for help. They’re expected to learn on the job but also to know enough to carry out the job successfully. They live on takeaways and inconceivable amounts of coffee while advising patients about healthy diets. They are woefully sleep-deprived while doing work that requires the utmost attention. They are left alone in the trenches, then held to account by superiors when they inevitably mess up.

The most nefarious of these boss figures is the narrator’s senior house officer, Sharif, who switches from irate ranting to breezy nonchalance with alarming speed. He is all ego, concerned only with his own image and career progression. As for the patients? “You can try fifty times as far as I’m concerned. Turn their arm into a pin cushion for all I care.” On another occasion, Sharif bats away the death of a patient overnight, thrilled he isn’t culpable. Such behaviour is particularly nauseating when contrasted with his sycophantic approach to the consultant doctor, the curmudgeonly Prof Lynch.

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A similar hierarchy exists for the nurses, who defer to the consultants yet treat the interns like skivvies. Even among the interns, there is an obvious pecking order: courageous, capable Lynda; our middle-of-the-road narrator; then timid, ineffectual Stuart.

Duffy’s laconic prose style and inclination for long paragraphs evokes a living nightmare. He lulls us into the chaos, the sense of dislocation and isolation the narrator feels, bobbing about like a single lifebuoy in a sea of acutely or chronically ill people. It is a hugely immersive reader experience, with repetition used effectively to highlight the interminable workload: difficulties with intravenous lines; catheters; bodies in distress; Cheyne-Stokes breathing; and multiple suicides among the staff. The detached tone amid the frenzy is akin to reportage. A Dublin hospital at night, a war zone.

This book will cement Austin Duffy’s reputation as an astute chronicler of the medical world and the difficult lives of its practitioners

There is desperate irony in the way the interns are told to watch out for each other: “What exactly we were looking out for was never clear. Signs of stress? Trepidation? Inadequacy and the utter fear of God? We had all of these already.” Instead the narrator approaches the shift “like a prisoner who’d been found guilty and sentenced for an unspecified crime that hadn’t even been committed yet”, before turning to drink on his nights off.

Though the narrative arc of the book could at times be tighter, with a certain fleeting quality to scenes, the details of the job are always visceral: “An awful stench, the smell of moist infected flesh.” Anyone with a fear of needles, meanwhile, should stay away. The Night Interns is like a more sedate version of Adam Kay’s This Is Going to Hurt, which is not to say the book is dour in tone, rather that Duffy uses humour less frequently and in a less obvious way. His jokes are morose and deadpan: his offer to Lynda to split a leftover syringe of medication; bartering with an addict to put in his own line; or this exchange with a nurse after pronouncing a death: “She’s dead, I said. — No s**t Sherlock. Now go and document it, will you?”

A practising oncologist, Duffy is the author of two previous novels, Ten Days, and This Living and Immortal Thing, which was shortlisted for the Kerry Group Irish novel of the year. This book will cement his reputation as an astute chronicler of the medical world and the difficult lives of its practitioners. In a story where not much happens — aside from the business of life and death — there is a surprising flourish to the final sections, which are full of small moments of revelation.

The curtain is pulled back, godlike personas dismantled, a realisation “that surgeons were just plumbers at the end of the day, technicians who didn’t understand what they were dealing with most of the time”. The Night Interns is a disconcerting and exacting record of what goes on behind the scenes at a busy Irish hospital. Engrossing, if you can stomach it.