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The House of God, by Samuel Shem

February 20, 2013

There was a minor buzz over this on Twitter a few weeks ago, with mention being made to additions to the House of God laws. Intrigued, I checked it out and am glad I did.

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The House of God follows doctor Roy Basch, through his year as an intern in the House of God, the greatest of all hospitals. The experience is gruelling and dehumanising. The long hours, difficult patients and indifferent senior administration progressively wear Basch and the other interns down over the year. In contrast to all of this is the Fat Man, a counter-cultural resident who reveals to Roy the Laws of the House of God, the secret to practising medicine in 1970s America.

This book has been described as the Catch-22 of medicine. This is entirely true. As I read, I was aware of the parallels to Heller’s opus as they unfolded. They are both hilarious irreverent with rich veins of black humour. Furthermore, when both books take a turn for the serious and the tragic, the emotional shift resonates even more deeply. Believe me. As funny as this book gets, it also gets real bleak.

Shem is also obssessed with sex, to a near-pathological level. Described in bawdy and anatomical detail, a good deal of the book is given to Basch’s sexual encounters with the nurses and Social Services (referred to by the Fat Man as the Sociable Cervix). A late epiphany by Basch apologises for the rampant sexcapades as a means of affirming his vitality and humanity in the face of the House’s dehumanising treatment. But, like everything else in the book, its fun (and funny) to read. Shem has a tendency to let his sentences run on in a stream-of-consciousness fashion but it remains a page-turner.

Reading this 30 years later, it’s interesting to see the effect its had on medical culture. I can trace its influence on shows like Scrubs and House, M.D., especially in the former. Dr Cox plays a very similar role to the Fat Man as an iconoclastic mentor and JD even refers to Law 11:

“A famous doctor once said, ‘Show me a med student that only triples my work, and I’ll kiss his feet.'”

It could be argued that Shem was writing about a different time and is as historical as Catch-22 but Michael Foxton in Bedside Stories at the turn of the new century echoes the same sentiments in a slightly more autobiographical fashion.

I would go so far as to recommend this as essential reading to all medical students, to remove the halo around Medicine, to pull back the veil. But, it would be a brave medical school indeed to promote this book. While this book highlights the importance of compassion and all that jazz, it is scathingly critical of the medical establishment and the medical orthodoxy. Maybe that’s why I liked it so much – I do love a good satire.

In short, this is a darkly irreverent take on modern medicine that I could easily recommend to every medical student I ever meet.

For completeness sake, here are the 13 Laws of the House of God, dispensded by the Fat Man and Basch throughout the novel:

  1. GOMERS DON’T DIE.
  2. GOMERS GO TO GROUND (referring to patient’s, usually the eldery, tendency to fall or fall out of bed)
  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 #14G 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.

And lastly…

13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

 

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