What it look like on the inside?

Just like the outside except it has a flexible strip of leather in the center and a metal clip that attaches the Kindle on the right .  There is also a three inch deep pocket on the left.

Explain the metal clip...

The metal clip is attached to the cover with three brass brads.  Since the majority of the left side is taken up with two giant page buttons, the clip is only securing the Kindle at the top and bottom.  It does not interfere with the buttons.  Metal will not distort or become loose as the ears on other covers, the reason it falls out.

What's on the right side? Unlike some covers that use a mile of Velcro, there is a postage stamp sized Velcro square on the right.  This small square, in combination with the metal clip is more than adequate to keep the Kindle from falling out.

There is no hole in the back to reach the buttons because it's fairly easy to stick your finger behind the top right corner.

Many people have an issue sticking Velcro to their Kindle, unfortunately there is not much on the right side of the Kindle to attach.  Take the stock cover for example.  The elastic just don't cut it.  If you think you don't like a postage sized piece of Velcro, try the popular $75 dollar cover that has ten inches of Velcro!  Be sure to also purchase the "Jaws of Life" to remove a Kindle with this much Velcro.

Can I hold it on the left side?

If that's your preference, no problem.  That's the idea behind the soft leather strip down the middle.

Plenty of thumb real estate from those giant buttons!

What about the right side?

Not a problem as once again, there was a reason for a leather strip down the middle.  It's flexible!

What if I want to hold it upside down while I read in bed?

Go for it, hold it in any position.  My sole purpose for making this cover was because I wanted to have the same flexibility as reading a non-electronic book.