The House of God
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The House of God is a book by Samuel Shem (a pseudonym of the psychiatrist Stephen Bergman), published in 1978. As it provides a very cynical view of medical training and hospital life, it made a substantial impact on public opinion, and has arguably been an instrument in reforming medical training in the 1980s.
Storyline
Dr Roy Basch is a new intern in a hospital called the House of God, after completing his medical studies at the BMS ("Best Medical School"). He is poorly prepared for the grueling hours and the sudden responsibilities without much guidance from senior doctors. He survives the year (unlike a colleague, who commits suicide) due to various factors: his girlfriend Berry, various adulterous relationships with nurses (portrayed in great detail), and an enigmatic resident who goes by the name The Fat Man. The latter provides his patrons with wisdom such as the "Laws of the House of God" (which amount to 13 by the end of the book). The book finishes when it turns out that the psychiatry resident, Cohen, has managed to inspire almost the whole year's group of interns to pursue a career in psychiatry.Laws of the House of God
- GOMERS DON’T DIE.
- GOMERS GO TO GROUND.
- AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
- THE PATIENT IS THE ONE WITH THE DISEASE.
- PLACEMENT COMES FIRST.
- THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
- AGE + BUN = LASIX DOSE.
- THEY CAN ALWAYS HURT YOU MORE.
- THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
- IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
- SHOW ME A MEDICAL STUDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
- IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
- THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
Context and impact
The book is very likely autobiographical, with the BMS being Harvard Medical School (commonly called HMS), and The House of God is quite likely Beth Israel Hospital now a part of Beth Israel Deaconess Medical Center, one of the HMS-affiliated hospitals in Boston, Massachusetts.It is very likely that some details have been exaggerated (such as an orgy in the resuscitation room), but upon its appearance, many American doctors felt that the story resonated with their own experiences during their internship training.
Several of the concepts developed in the book have found their way into the jargon of junior hospital staff:
- To Bounce (verb: a turf that has returned to its first department)
- Gomer (noun: Get Out of My Emergency Room - a patient who is frequently admitted with complicated but uninspiring and incurable conditions)
- LOL in NAD (noun: Little Old Lady in No Apparent Distress - an elderly patient who following a minor fall or illness, would be better served by staying at home with good social support, rather than being admitted into a hospital with all the iatrogenic risks of modern medicine. A joke on 'NAD' abbreviation of 'No Abnormality Detected' used to record the absence of abnormal signs on examination).
- To Turf (verb: to find an excuse to refer a patient to a different department or team)
- Zebra (noun: a very unlikely diagnosis where a more common disease would be more likely to cause a patient's symptoms - from the common admonition that "if you hear hoof beats, it's more likely to be a horse than a zebra")
Criticism
Criticisms leveled immediately against the work are the depersonification of patients, ageism, sexism and the account of euthanasia. The bleak mood was hardly considered representative of the noble art of medicine.Miscellaneous
In 1979, a film was made out of the book.In-jokes abound in the work. One of the principal characters is Eat My Dust Eddy, a doctor so-called because of the saying embroidered on his jacket. His name is often abbreviated as EMD, which is also an acronym of the feared medical emergency electromechanical dissociation.
Bibliography
- Samuel Shem. The House of God. 1979. ISBN 0440133688.
- Samuel Shem. Mount Misery. 1999. ISBN 0552998133. Sequel of The House of God, (covering the hero's psychiatric residency).
External links
- [The Fat Man's Laws of the House of God]
- [The 1979 film]
- [30th anniversary review by Kit Boyes in the NZMSJ]
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