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house-hold god

The House of God

The House of God is a satirical novel by Samuel Shem (a pseudonym of the psychiatrist Stephen Bergman), published in 1978. It portrays the psychological harm done to medical residents during the course of medical residency in the early 1970's.

Storyline

Dr. Roy Basch is an intelligent, naive junior resident (i.e., intern or "tern") working 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 good guidance from senior attending physicians. He commences the year on a rotation supervised by an enigmatic, iconoclastic and wise senior resident who goes by the name The Fat Man. The Fat Man teaches him that the only way to keep the patients in good health and to survive psychologically is to break the official rules. The Fat Man provides his interns with wisdom such as his own "Laws of the House of God" (which amount to 13 by the end of the book). One of his teachings is that in the House of God, most of the diagnostic procedures, treatments, and medications that are received by the patients known as "gomers" (see Glossary, below) actually harm these patients instead of helping them. Basch becomes convinced of the accuracy of the Fat Man's advice and begins to follow it. Because he follows the Fat Man's advice and does nothing to the gomers, they remain in good health. Therefore, ironically his team is recognized as one of the best in the hospital, and he is recognized as an excellent intern by everyone, even though he is breaking the rules.

Later, Basch must leave the Fat Man's team for a rotation with another team. He is supervised by a more conventional resident named Jo, who, unlike the Fat Man, follows the rules, but ironically, unknowingly hurts the gomers by doing so. Basch survives the rotation with Jo by claiming to perform numerous tests and treatments on the gomers while in reality he actually does nothing. These patients again do well, and Basch's reputation as an excellent intern is maintained.

The book also details the great amount of hard, distasteful work the interns must perform, the sometimes poor working conditions, their lack of sleep, their lack of time to spend with friends and family, and the emotional demands of the work.

During the course of the novel, working in the hospital takes a psychological toll on Basch. His personality and outlook change, and he has outbursts of temper. He has adulterous trysts with various nurses (portrayed in great detail) and Social Service workers (nicknamed the "Sociable Cervix"). and his relationship with his faithful girlfriend Berry suffers. A colleague, Wayne Potts, who had been constantly badgered by the upper hierarchy and haunted by a patient, named Lazlow and nicknamed "The Yellow Man" for his fulminant necrotic hepatitis, who goes comatose and eventually dies because Potts had not put him on steroids early on, commits suicide. Basch becomes more callous, and he secretly euthanizes a patient, a man called Saul the leukemic tailor, who had gone into remission once but was back in the hospital in incredible pain and begging for death. Basch becomes more and more emotionally unstable, until finally his friends force him to attend a mime performance by Marcel Marceau, where he has an experience of catharsis and recovers his emotional stability.

By the end of the book, it turns out that the psychiatry resident, Cohen, has managed to inspire almost the whole year's group of interns and two well-spoken policemen, Gilheeney and Quick, to pursue a career in psychiatry, and that the terrible year has convinced most of the interns to receive psychiatric help. The book ends with Basch and Berry vacationing in France before he begins his psychiatry residency, which is how the book begins as well, because the whole book is a flashback. But even while vacationing, bad memories of the House of God haunt Basch. He is convinced that he could not have gotten through the year without Berry, and he asks her to marry him.

Laws of the House of God

  1. GOMERS DON’T DIE.
  2. GOMERS GO TO GROUND.
  3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
  4. THE PATIENT IS THE ONE WITH THE DISEASE.
  5. PLACEMENT COMES FIRST.
  6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
  7. AGE + BUN = LASIX DOSE.
  8. THEY CAN ALWAYS HURT YOU MORE.
  9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
  10. IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
  11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
  12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
  13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

Context and impact

The book takes place during the Watergate scandal, and follows such events as the resignation of Spiro T. Agnew and the stepping-down of Richard Nixon.

The book is very likely autobiographical, as the BMS is a thinly veiled Harvard Medical School (commonly called HMS), and The House of God representing the 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), and towards the end of the book events take on a semi-hallucinogenic tone, both of which can be taken as a depiction of the effects of chronic stress and sleep deprivation. In any case, upon its appearance, many American doctors felt that "The House of God" resonated with their own experiences during their internship training. However, according to the author, many older physicians were offended by the work.

Glossary

Several of the terms common to the jargon of junior hospital staff were widely popularized by the book:

  • To turf (verb: to find any excuse to refer a patient to a different department or team)
  • 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. Compare "NAD" = "no abnormality detected" (used to record the absence of abnormal signs on examination).
  • 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 hoofbeats, think horses, not zebras").

Cultural references

In-jokes abound in the work. One of the principal characters is Eat My Dust Eddie, a doctor so-called because of the saying embroidered on his jacket. His name is often abbreviated as EMD, which is also the acronym of the feared terminal cardiac event electromechanical dissociation, otherwise known as pulseless electrical activity.

In 1984, a film was made out of the book but never released in theaters or on VHS/DVD. The film was shown on HBO a few times, mostly as filler in non-peak hours. It starred Charles Haid as The Fat Man, Tim Matheson as Roy, and featured Ozzie Davis as a doctor-turned-patient. Michael Richard was also in the film, playing Dr. Pincus.

The TV medical sitcom-drama Scrubs features numerous references to The House of God, which was reading material for some of the show's writers. "Turfing", "Bouncing" and "Gomers" occasionally feature in the show's dialogue, in the episode My Balancing Act, Dr. Cox quotes the Zebra rule ("Newbie, do you happen to know what a zebra is? It's a diagnosis of a ridiculously obscure disease when it's much more likely that the patient has a common illness presenting with uncommon symptoms. In other words, if you hear hoof-beats, you just go ahead and think horsies -- not zebras.") and in the episode My Student J.D. quotes the medical student rule ("A famous doctor once said, "Show me a med student that only triples my work, and I'll kiss his feet".").

Bibliography

  • Samuel Shem. The House of God. 1979. ISBN 0-440-13368-8.
  • Samuel Shem. Mount Misery. 1999. ISBN 0-552-99813-3. Sequel of The House of God, (covering the hero's psychiatric residency).

External links

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