What happens when a graduate of Harvard Medical School arrives at Columbia Presbyterian Hospital for his straight medicine internship and discovers he is woefully underprepared? They say you can tell a Harvard man, but you can’t tell him much. But Matt is a Harvard man and he doesn’t know much. He doesn’t know much about the practical aspects of drawing blood, putting down a nasogastric tube, or placing a central line. He is pretty close to useless in a cardiac arrest. And needs special guidance on how to decompress a tension pneumothorax. As a Columbia Medical School graduate I have had the suspicion that graduating from Harvard confers a handicap. This book proves that suspicion true. Matt McCarthy deserves credit for his honesty and perseverance and his clear telling about the real deal. And it is nice to see his character slowly develop into that of an excellent physician. We cheer him along the way as he discovers his ability to think beyond the science of medicine to the art of medicine. The patients discussed are interesting too including Dre with AIDS who doesn’t want to take her meds, the man who waits and waits and waits for a heart transplant, and the patient at Allen Hospital who had Hepatitis C who suddenly arrested and died for no apparent reason. Believe it or not, medicine has a high cultural component. What is standard of care at Harvard is sometimes quite different at Columbia. And I know from my internship at Cornell and the New York Hospital that Cornell medicine was sometimes quite different from what was considered standard care at Columbia. At Cornell, for instance, if a patient arrived with a pure motor hemiparesis, he would get a gigantic load of tests including four vessel arteriograms. At Columbia he might get a portable chest film, some care and attention to electrolytes, nutrition, and bowel and bladder control and just put to bed for a two week rest, followed by rehab. The outcome was usually, but not always, better by the Columbia method of “do no harm” and let the patient recover. So I recommend this book if you really want to see how Columbia house officers think and function at a world class medical center. Medicine is a complex discipline and the Columbia house staff more often than not gets it right.