Novelist Toby Litt reveals the medical profession's eye-popping trade secrets

Ever get the feeling you missed your vocation? That there's a ghost-version of you floating around somewhere, doing the job you should have done? And that the ghost-you is happier and more fulfilled than you yourself are? I'm certain that, if I am meant to be anything at all, then a writer is it. But, in moments of doubt, I think about what else I might be. Something less isolating. Something more practical. And what I usually end up wondering is, "Shouldn't I have been a doctor?"

Genetically, this is what might have been expected. My grandfather on my father's side was a GP, and on my mother's side, an optician. My Aunt Shirley was a district nurse. My Uncle John was a consultant psychiatrist. My cousins include John, a doctor who trains doctors, and Sandy, a psychologist specialising in post-traumatic stress disorder. If the Litt family has a unifying characteristic, it is that we are healers.

Here is how, up until a few years ago, I used to think about doctors: that they did one of the few undeniably good jobs in the world. They reduced suffering. And not just by telling people a story to help their commute pass more painlessly. Doctors went inside people's bodies, chemically, physically, mentally, and made changes there - changes, they hoped, for the better. They were medicins sans frontiers. Sometimes, doctors even saved lives; allowing people to continue enjoying themselves, and make a very positive contribution to society, for years and years. At the very least, they dosed people up on drug cocktails that took them out of themselves, until such time as they could vacate themselves completely.

Well, those were my idealised feelings towards doctors. I knew, in theory, there were always compromises. I also knew doctors didn't tend to see themselves in anything like as beneficent a light. I'd watched enough episodes of ER to learn that the patient whose life you were saving might, themselves, go out afterwards and create new suffering - greater suffering than you could ever alleviate. I knew that, in the day-to-day business of looking after people, hard choices had to be made. One patient's needs must be allowed to override those of another, perhaps fatally. I also knew that doctors lived in near-constant fear of mistakes they could make, and that, if this fear became big enough, you could no longer be a doctor.

'What are you going to be when you grow up?' When I was a kid, I went through various answers to this inevitable question. I started off with dinosaur-hunter, because I was certain I could succeed where all others had failed. (Time-travel, I seem to remember, was involved.) Then, pretty soon, I moved on to saying "vet". (My great-grandfather was chief veterinary officer of Shropshire.) But that was the closest I ever came, back then, to considering a future of white coats and looking concerned. The next fantasy occupation was architect (Pink Floyd had been training to be architects), and after that it was a matter of zeroing in on writer - via musician, painter, journalist.

While at university, I was friends with a couple of medical students. Nothing about their workload, or their general nihilistic attitude towards humankind, gave me pause. I had made the right choice. If I wanted to find out about anything else but English literature, I could do it through English literature. The subject was big enough to cover all bases.

However, a medical obsession has been there throughout my writing, and it has been steadily growing. One of the stories in my first book, Adventures in Capitalism, was about a severely brain-damaged baby in a neo-natal unit. Called Polly, she has no chance of leading a "full and active life". The nurse looking after Polly goes out and gets a cheap horoscope done for her, just so the baby - to whom she has become very attached - has some kind of future, even fictitious. Researching this story took me to the Neo-Natal Unit of Homerton Hospital, east London. I was distressed by what I saw, yet also fascinated. It wasn't somewhere I felt at home, I wouldn't go that far, but I could easily see the attractions of working in a place where everything - at least potentially - mattered.

My next fictional excursion into the clinical world was more extended. If readers say they like anything in my second novel, Corpsing, it's usually the extended descriptions of bullets passing through human bodies. This was where the novel started: with the image or, more accurately, the feeling of being shot. For quite a while, this came to me every night just before sleep. Sometimes it would end with that sudden muscle spasm (properly called hypnic myoclonia) many people often have just before they lose consciousness.

Once I'd decided to venture beneath the surface of the skin, following that bullet, I knew I'd have to get my anatomical facts right. I began to browse the medical sections of bookshops, particularly Blackwell's on Charing Cross Road. And it was here that I first came across one of the great books of our time, the Color Atlas of Human Anatomy, published by Mosby-Wolfe.

Like everyone else, I'd studied biology textbooks, and their cosy line-drawings of livers and kidneys - which, of course, bear about as much relation to the real, juicy, living organs as the London tube map does to the streets above. In the Color Atlas, for the first time, I was able to see something of what this hidden world looks like. The photographs in this book were made, close-up, from real dissections.

Since Gunther von Hagens' Body Worlds shows (omega) started touring, people have a much better idea of what goes on inside themselves. The fact is, no line-drawing will ever give you an idea of the complexity or wonder of the things themselves.

I have a theory that most people don't actually believe they have internal organs - not until a doctor diagnoses them with cirrhosis or lung cancer.

(Of course, the relationship of doctors to their own bodies is where things get really fascinating. How could an oncologist ever touch a cigarette? But we all know they do. There's an old joke: Why don't doctors smoke? Because their hands are shaking too much to light the cigarettes.)

Whilst writing Corpsing, I acquired a number of other medical textbooks which I have referred to ever since. Among the most fascinating of these was the Color Atlas of Embryology. If there is anything I find genuinely miraculous, it is the cell division of a newly created embryo. I know on a rational level that what is happening is controlled by intricate chemical interactions, but I don't really believe it.

In 2001, my mother had a stroke - a subarachnoid haemorrhage. Thankfully, she made an almost full recovery, but soon afterwards - and, I'm sure, not unconnectedly - I had the idea for a novel called Hospital. I knew it had to be a big book, to deal with such a big subject. I also knew that it had to be weird. Weird not for the sake of being weird, but because that's what hospitals are - weird and terrifying.

Here's one example. After being admitted to Bedford Hospital, having lost some of her sight due to the stroke, my mother had to wait several agonising days for a CAT scan. No slot was free, we were told. A few months later, there was a headline in the papers. It turned out that Bedford Hospital had made a policy of hiring their CAT-scanners out to local vets, in order that dogs and, yes, cats could be x-rayed. The trust made more money from them than from human scans.

Perhaps part of my reaction to the stroke was a belated wish to do something. At one point, during my mother's treatment, I had a junior doctor put her brain scans up on a lightbox, so that I could see what had happened. I saw one thing straight away: the doctor had put the scans up back-to-front. He wasn't paying much attention. My mother was an entirely run-of-the-mill case. He was impatient to be elsewhere.

Over the next few years, in preparation for writing Hospital, I started to assemble a library of medical-related books. Most of them were non-fictional. And they came at the subject from every point-of-view.

There was the medical coming-of-age story. For example The Intern Blues, which is modestly subtitled The Timeless Classic about the Making of a Doctor. It might more rightly be described as The Systematic Brutalisation of a Medical Student. It's all here, all the stuff you expect, from sleep deprivation to fatal errors of judgement, from gallows humour to love across a dissecting table. (It also came equipped with a glossary, as did several others of these books.) "I try to do my best with each one, I try to think of each one individually and I do, I know I do, but, I don't know, in some ways it all becomes a blurred mass of humanity flowing through the doors of the emergency room."

Then there was the point of view of the patient, which few have done better than Ben Watt, one half of the pop group Everything But The Girl. His book, simply entitled Patient, resulted from his hospitalisation for a very rare disease which left him completely debilitated. "The new drug, an antifungal bombshell called Fluconazole, was dropped at midday. My body retreated further into itself, pulled back into trenches deep and familiar, leaving me half soundproofed from the hospital boom. I fell into a deep sleep. I dreamt I was draining away, water from an outdoor pool, leaves caught in the net above."

Virginia Woolf's essay "On Being Ill" was the best thing I read from the patient's side. It was also acute on the literature of illness, or the lack of it: "Novels, one would have thought, would have been devoted to influenza; epic poems to typhoid; odes to pneumonia; lyrics to tooth-ache. But no; with a few exceptions... literature does its best to maintain that its concern is with the mind; that the body is a sheet of plain glass through which the soul looks straight and clear..." This isn't the case. "All day, all night the body intervenes; blunts or sharpens, colours or discolours..."

For a not-quite-so-serious approach to this side of things, there's John O'Connell's I Told You I Was Ill:(omega) Adventures in Hypochondria. This includes chapters such as "A Visit to Gimpface" - Gimpface being the nickname O'Connell and his wife give to their GP. It also contains the story of Sam, who picked up neurocysticerosis by street-eating in India. In other words, "a parasite - 'think of it as a worm' - had made a home for itself in his brain". Sam made an almost full recovery, but began to pester his consultant with incessant visits and questions. One day, the consultant cracked, and made this salutary speech:

"I spend my whole life hacking into people's brains. And you have to understand this: practically no-one I touch gets better. If they do, it's because I've lobotomised them. Neurology is the most depressing area of medicine. You're the one person in the last ten years who's been cured... Now, go away, and I hope I never see you again."

Then there was the point of view of the patient's relatives. Mark Sanderson's Wrong Rooms unflinchingly charts the treatment of Sanderson's boyfriend, Drew, through terminal cancer. "A pair of nurses undressed Drew painfully and wired him up to an electrocardiograph. I explained that he needed morphine and lots of it. They said a doctor would be along shortly."

And, of course, there was the view of the hardened clinical professional, for example Frank Huyler's The Blood of Strangers: True Stories from the Emergency Room. In one episode, he witnesses a family idealising and eulogising about their relative. "At some level they must have understood that their brother, father, and son was a drug addict and a murderer dying a slow death by his own hand, but that was not how they spoke of him... That night, tired as I was, their glib revision of him infuriated me. Their grief was real, but the words they used to describe it were not."

But most educative of all, to me, were the novels that medical students themselves read, to give them some idea what they are in for. About the most famous of these is Samuel Shem's The House of God. The blurb describes it as doing "for the doctor's art what Catch-22 did for the art of war." I'm sure that's what it hopes to do. The main catch is that relating to "Gomers". Gomer, as a glossary at the back tells us, is an acronym for Get Out of My Emergency Room. Gomers are usually old, incurable, incontinent, and a general pain in the ass. Law number one of the The House of God is that "GOMERS DON'T DIE". The ones who do die, as you'll see in any episode of ER, are those fit 22-year-olds admitted for twisted ankles or slight breathlessness.

What our hero, Roy Basch, learns throughout his year's unsentimental education, is that all medicine can be reduced to two things: turfing and buffing - turfing being shifting patients on so they're no longer your problem, buffing being making something (a patient, their notes) look so good they no longer are anyone's problem. In other words, medicine isn't about saving anyone's ass but your own.

The same basic trajectory, from innocent idealism to cruel cynicism, is followed in any number of novels. Jed Mercurio's Bodies - subsequently adapted for TV - is a good example. Here the Hippocratic Oath to "do no harm" is racked up to "don't get caught actually in the act of killing someone".

However, I ended up agreeing with Virginia Woolf. Considering the vastness of the subject, there is little fictional writing about the medical world. The most numerous books, by far, are doctor and nurse romances. As Hospital would be incomplete without a similar plotline, I read a few of these. My favourite was Grace Read's Heart Murmurs, which I chose for the wonderful title, and which contains a character called the Reverend Dick Long.

Returning to the non-fictional, I found an anthropological approach in Simon Sinclair's Making Doctors: An Institutional Apprenticeship. This contained a delightful chapter called 'Strange Meeting: The Dissecting Room'. Here Sinclair captures, in one sentence, the essence of medical education: "One male student suggested making a cocktail out of blood-stained fluid collected in the pleural cavity, because it looked like tomato juice; he was ticked off by a female colleague for laughing and showing disrespect for the dead, but she smiled."

But she smiled. There was even a certain amount of black humour to be found in the textbooks I acquired. The most useful was the Oxford Handbook of Accident & Emergency Medicine. If you've ever wondered, this is what junior doctors have bulging in those big white pockets of theirs; this is the medical Bible they'll scurry away into a corner to consult. Under assessing alcohol problems, the doctor is advised to "Look for significant features in the history, including compulsion to drink, loss of control, development of tolerance, narrowing of repertoire, and stereotyped drinking habit." How many sad stories are contained in those words "narrowing of repertoire"? And here is something on the management of Munchausen's Syndrome (the compulsion to be admitted to hospital): "Once discovered, most patients will simply self-discharge from hospital, often noisily, but rarely violently." The pressures on doctors are clearly there, between the lines: "Avoid a 'showdown' with the patient. Simply state that deception is at an end, that no retribution is planned, and offer to help the patient with their problem."

How many shift-weary doctors must have dreamed of staging a showdown! Of finally, finally, exacting retribution from all the fakers and time-wasters, the attention-seekers and hypochondriacs.

Even just reading this stuff, you start to become inured to suffering. You start to be interested only in the most extreme cases, the "fascinomas". And you begin to realise that the Catch-22 parallel of The House of God is justified. It's a war out there. Or, rather, it's a war in here - within the hospital walls. And the war isn't Doctors vs Suffering, it's Doctors vs Patients.

On one thing, every single one of the books I read was agreed: Hospitals are a parallel universe. Jed Mercurio catches this well in Bodies: "Those of us who work in the interior constitute a society twice removed, once from the outside world and once again from the borderlands of the hospital."

What it comes down to, it seems to me now, is the great medical paradox: in order to care, you can't care.

In this, there's a similarity to English literature degrees. You might go in to university thinking, "I love books and want to express my love for them." But, pretty soon, you're having to dissect them in a very unamorous way. You may even find that the books you write about best are those you hate most.

The desire to alleviate suffering might motivate people to become doctors, but it is the desire to be a good doctor which keeps them going. Like all occupations, it becomes aestheticised - a thing in itself. How else could a radiologist look at all those brain scans? Of course we expect a degree of compassion from our carers; weeping over a computer screen, however, isn't going to help anyone.

At the end of all my research, and knowing them a little better - their cynicism, their contempt - I respect doctors even more than when I began. They have to face, head on, every day, the furthest extremes of human stupidity and self-destructiveness. They have to help people who not only can't help themselves but who actively want to harm anyone who dares try to help them. And they have to help them repeatedly, in the full knowledge that it is no use. Could I really do that? I don't think so. s

'Hospital' by Toby Litt is published by Hamish Hamilton at £14.99, to buy at the special price of £13.50 inc. p&p, telephone Independent Books Direct on 08700 798 897