The House of God
Encyclopedia
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 interns during the course of medical internship in the early 1970s.
"). He is poorly prepared for the grueling hours and the sudden responsibilities without good guidance from senior attending physician
s. 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 (nicknamed "The Yellow Man" for his fulminant necrotic hepatitis
, who goes coma
tose 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.
.
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
; "Man's Best Hospital" represents MGH (Massachusetts General Hospital
.)
Some 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.
s 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, with Bess Armstrong
, Ossie Davis
, Sandra Bernhard
, and Michael Richards
in supporting roles.
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.http://scrubs.mopnt.com/faqs/. "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.'" One episode focuses on Dr. Dorian saving a patient by "doing nothing," which is a major theme of the novel.
Samuel Shem
Samuel Shem is the pen-name of the American psychiatrist Stephen Joseph Bergman . His main works are The House of God and Mount Misery, both fictional but close-to-real first-hand descriptions of the training of doctors in the United States.Bergman was a Rhodes Scholar at Balliol College, Oxford in...
(a pseudonym
Pseudonym
A pseudonym is a name that a person assumes for a particular purpose and that differs from his or her original orthonym...
of the psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Stephen Bergman), published in 1978. It portrays the psychological harm done to medical interns during the course of medical internship in the early 1970s.
Storyline
Dr. Roy Basch is an intelligent, naive intern working in a hospital called the House of God after completing his medical studies at the BMS ("Best Medical SchoolMedical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
"). He is poorly prepared for the grueling hours and the sudden responsibilities without good guidance from senior attending physician
Attending physician
In the United States, an attending physician is a physician who has completed residency and practices medicine in a clinic or hospital, in the specialty learned during residency. An attending physician can supervise fellows, residents, and medical students...
s. 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 (nicknamed "The Yellow Man" for his fulminant necrotic hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, who goes coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
tose and eventually dies because Potts had not put him on steroids early on), commits suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
. Basch becomes more callous, and he secretly euthanizes
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
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
Mime
The word mime is used to refer to a mime artist who uses a theatrical medium or performance art involving the acting out of a story through body motions without use of speech.Mime may also refer to:* Mime, an alternative word for lip sync...
performance by Marcel Marceau
Marcel Marceau
Marcel Marceau was an internationally acclaimed French actor and mime most famous for his persona as Bip the Clown.-Early years:...
, where he has an experience of catharsis
Catharsis
Catharsis or katharsis is a Greek word meaning "cleansing" or "purging". It is derived from the verb καθαίρειν, kathairein, "to purify, purge," and it is related to the adjective καθαρός, katharos, "pure or clean."-Dramatic uses:...
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
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
, 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
- GOMERGOMERA GOMER is a medical slang term for a patient in a hospital who is demented or bordering on death, hence taking up room unnecessarily in the hospital...
S DON’T DIE. - GOMERS GO TO GROUND.
- AT A CARDIAC ARRESTCardiac arrestCardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
, 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 #14G NEEDLE AND A GOOD STRONG ARM.
- AGE + BUNBlood urea nitrogenThe blood urea nitrogen test is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a by- product from metabolism of proteins by the liver and is removed from the blood by the kidneys.-Physiology:The liver produces urea in the urea...
= LASIXFurosemideFurosemide or frusemide is a loop diuretic used in the treatment of congestive heart failure and edema. It is most commonly marketed by Sanofi-Aventis under the brand name 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 BMS (Best Medical Student, a student at the Best Medical School) 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 takes place during the Watergate scandal, and follows such events as the resignation of Spiro T. Agnew and the stepping-down of Richard NixonRichard Nixon
Richard Milhous Nixon was the 37th President of the United States, serving from 1969 to 1974. The only president to resign the office, Nixon had previously served as a US representative and senator from California and as the 36th Vice President of the United States from 1953 to 1961 under...
.
The book is very likely autobiographical
Autobiography
An autobiography is a book about the life of a person, written by that person.-Origin of the term:...
, as the BMS is a thinly veiled Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
(commonly called HMS), and The House of God representing the Beth Israel Hospital, now a part of Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center in Boston, Massachusetts is a major flagship teaching hospital of Harvard Medical School. It was formed out of the 1996 merger of Beth Israel Hospital and New England Deaconess Hospital...
, one of the HMS-affiliated hospitals in Boston, Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
; "Man's Best Hospital" represents MGH (Massachusetts General Hospital
Massachusetts General Hospital
Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
.)
Some 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" or "no apparent distress"(used to recordMedical recordThe terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction....
the absence of abnormal signsMedical signA medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....
on examinationPhysical examinationPhysical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
). - ZebraZebra (medical)Zebra is a medical slang term for a surprising diagnosis. Although rare diseases are, in general, surprising when they are encountered, other diseases can be surprising in a particular person and time, and so "zebra" is the broader concept....
(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, think horses, not zebras").
Cultural references
In-jokeIn-joke
An in-joke, also known as an inside joke or in joke, is a joke whose humour is clear only to people who are in a particular social group, occupation, or other community of common understanding...
s 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
Pulseless electrical activity
Pulseless electrical activity or PEA refers a cardiac arrest situation in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse, but is not...
.
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
Charles Haid
Charles Maurice Haid III is an American actor and director, with notable work in both movies and television. He is known for his portrayal of Officer Andy Renko in Hill Street Blues....
as The Fat Man, Tim Matheson
Tim Matheson
Tim Matheson is an American actor, director and producer. He is perhaps best known for his portrayal of the smooth-talking Eric 'Otter' Stratton in the 1978 comedy National Lampoon's Animal House and has had a variety of other well-known roles, including providing the voice of the lead character...
as Roy, with Bess Armstrong
Bess Armstrong
Elizabeth Key "Bess" Armstrong is an American film and television actress.-Life and career:Armstrong was born in Baltimore, Maryland, the daughter of Louise Allen , who taught at Bryn Mawr, and Alexander Armstrong, an English teacher at the Gilman School...
, Ossie Davis
Ossie Davis
Ossie Davis was an American film actor, director, poet, playwright, writer, and social activist.-Early years:...
, Sandra Bernhard
Sandra Bernhard
Sandra Bernhard is an American comedian, singer, actress and author. She first gained attention in the late 1970s with her stand-up comedy in which she often bitterly critiques celebrity culture and political figures. Bernhard is number 97 on Comedy Central's list of the 100 greatest standups of...
, and Michael Richards
Michael Richards
Michael Anthony Richards is an American actor, comedian, writer and television producer, best known for his portrayal of the eccentric Cosmo Kramer on the television sitcom Seinfeld....
in supporting roles.
The TV medical sitcom-drama Scrubs
Scrubs (TV series)
Scrubs is an American medical comedy-drama television series created in 2001 by Bill Lawrence and produced by ABC Studios. The show follows the lives of several employees of the fictional Sacred Heart, a teaching hospital. It features fast-paced screenplay, slapstick, and surreal vignettes...
features numerous references to The House of God, which was reading material for some of the show's writers.http://scrubs.mopnt.com/faqs/. "Turfing", "Bouncing" and "Gomers" occasionally feature in the show's dialogue. In the episode My Balancing Act, Dr. Cox
Dr. Cox
Percival "Perry" Ulysses Cox, M.D. , is a fictional character played by John C. McGinley on the American television comedy-drama Scrubs....
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.
John Dorian
John Michael "J.D." Dorian, M.D. is a fictional character on the American comedy-drama Scrubs, played by Zach Braff. He is the narrator and main character of the series. He provides voice-over to the series which fills the roles of his internal thoughts and an overall narration in the show, often...
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.'" One episode focuses on Dr. Dorian saving a patient by "doing nothing," which is a major theme of the novel.
External links
- http://medi-smart.com/hog.htm The Fat Man's Laws of the House of God
- Film review at the NYU Literature, Arts, and Medicine Database site
- 30th anniversary review by Kit Boyes in the NZMSJ