The House of God

The House of God is a fictional book written in the 1970s by Samuel Shem about medical school graduates who are starting their intern year. I do a lot of reading for my job so whenever I have free time I usually don't spend it reading books. However this book is well-known in the medical community and since it obviously directly relates to what I am doing right now I decided to pick it up from Amazon and read it.

The book centers around main protagonist Dr Roy Basch and the psychological harm done to him during his intern year while working at The House of God. The House is an analogy for the hospital where Basch works, which is supposed to be the best hospital in the country. Roy isn't prepared for the long hours and psychological consequences of his job - namely constantly being around death. One of his senior residents, named the Fat Man, teaches Roy that in order to deal with the stress and provide good health care he must do almost the opposite of everything he has ever been taught. This mostly involves doing as little as possible. After Roy adopts this policy, his team quickly becomes the best intern team in the hospital.

The book goes into great detail talking about the psychological changes that come directly from Roy's job. Namely the poor working conditions, long hours, consequences of medical decisions, lack of time spent with friends and family, and emotional demands of the job. As a consequence, Roy's personality and outlook on life suffer greatly. His relationship with his girlfriend suffers too. He begins having relations with one of the girls in the social services office (which he nicknames the sociable cervix) and with one of the nurses. At one point in the book Roy secretly euthanizes a patient suffering from great cancer pain as he becomes more and more callous. One of Roy's co-interns makes a mistake early on when treating a hepatitis patient who later become comatose. The attending docs bother this intern about the mistake to the point that he later jumps out of a window, committing suicide.

By the end of the book, one of the psychiatry residents convinces almost all of the interns to go into psychology and that they should seek psychological help themselves. In the end Roy and his girlfriend are vacationing in France before Roy starts his residency in psychology and he asks her to marry him.

A lot has changed in medicine in the 40 years since this book was written. Residents still work a lot of hours but their schedules are now controlled and limited by federal laws. Medicine is much more of a multi-team, multi-disciplinary approach now with multiple quality control measures in place so it is difficult to pin mistakes on one person as every decision goes through several people to ensure safety. The book features a lot of sex between the various interns and nurses. In my experience that really doesn't happen all that much (not saying never). Of course at my hospital most of the nurses are twice as old as the interns so that might be part of the barrier. And while doctors do have one of the highest divorce and suicide rates among any profession, an intern jumping out of a window to commit suicide seems a little over the top. The whole book, frankly, was a bit over the top honestly. But it was an interesting read, and there were parts of it I could relate to. Mostly the Laws of the House of God, which I have listed below.


I. Gomers don't die

• Gomer is an acronym for Get Out of My ER. This rule is stating that when taking care of people on the floor, you don't have to worry about the elderly sick people. It is the young and middle aged people who you have to worry about something happening to and dying.

II. Gomers go to ground

• Be careful - the elderly fall easily.

III. At a cardiac arrest, the first procedure is to take your own pulse

• I agree with this statement 100%. I've already mentioned it in an earlier post.

IV. The patient is the one with the disease

• One day I was interviewing a patient and when I was finished I walked back to the attending with a frustrating look on my face. When he asked me what was wrong I explained that nothing the patient said made any sense and that I was frustrated with the fact that I couldn't figure out what they were talking about. He just looked at me and said "It's them, not you."

V. Placement comes first
VI. There is no body cavity that cannot be reached with a #14 gauge needle and a strong arm
VII. Age+BUN=Lasix dose

• Interesting enough this is usually pretty accurate, although we don't follow this guideline for dosing Lasix. BUN - blood urea nitrogen, a metabolic waste product. Lasix is a diuretic ("water pill").

VIII. They can always hurt you more
IX. The only good admission is a dead admission

• This rule plays on the theme in the book that most medical procedures actually harm patients more than help.

X. If you don't take a temperature you can't find a fever

• see explanation for rule IX.

XI. Show me a BMS (best medical student) who only triples my work and I will kiss your feet.
XII. If the radiology resident and BMS both see a lesion on a chest x-ray, there can be no lesion there
XIII. The delivery of good medical care is to do as much to nothing as possible.

• Again, see explanation for rule IX. For the most part I adopt this strategy when taking care of patients on nights. I don't go out of my way to find something to do. I respond when there is a request or problem only.