The House of God

The House of God by Samuel Shem is a classic medical satire and a must-read for all medical students and residents. Written by a doctor who did his internship at Beth Israel Deaconess in Boston, it captures amazingly the brutal callousness and coping mechanisms of intern year. When I first read it prior to medical school, I was taken aback by the gallows humor, the coarse views about patients and patient care, and the ridiculous situations encountered. But after third year of medical school, I've realized that though the medical system has become much more humane since the 1970s (when the book is set), much of the underlying themes ring true. It has become a fiendishly bare yet funny expose of the medical training system.

The main themes of the book can be summarized by the Laws of the House of God as given by the Fat Man, a brilliant nonchalant resident who guides the interns through their harrowing year. Law #5 ("Placement comes first") describes how the intern's goal is to figure out how to make his service smaller and turf patients to other teams; Law #4 ("The patient is the one with the disease") describes how interns cope with the horrors of dying patients; Law #3 ("At a cardiac arrest, the first procedure is to take your own pulse") teaches interns how to approach emergencies; Law #10 ("If you don't take a temperature, you can't find a fever") warns against unnecessary tests and procedures ("Law #13: The delivery of good medical care is to do as much nothing as possible."); Law #7 ("Age+BUN = Lasix dose") captures some of the randomness of medical care.

The book captures beautifully the psychological impact this year has on the main character; with the long call nights, the dreaded patient population ("gomers" - the elderly with complicated but uninspiring medical conditions), and the oppressive hierarchy, the main characters turn to coping mechanisms like sex. They soon find their personal relationships falling apart. The book hits upon so many details of the hospital experience: minorities, the intensive care unit, needle stick accidents, autopsies, relationships with nurses and staff, clinic, medical mistakes, euthanasia, and the "lifestyle specialties" (rays, gas, path, derm, ophtho, psych).

I highly recommend this book to anyone in the medical field with a cautionary grain of salt; it portrays not the idealistic white coats that we would like our doctors to be but the filth they have to wade through in their training. Though extreme, moments ring true and that authenticity, often veiled in humor, rings a chord in me. The writing style isn't the best and the plot gets bogged down in the latter half, but it is still a worthwhile read.

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