The House of God

I finally read the classic medical book, The House of God by Samuel Shem.

This was a fun read, reminding me of interesting situations and thoughts that come to mind while being a medical student or resident in a large medical teaching facility.

While I did not relate to all the experiences, this book is a must read for all physicians sometime in their life. There are so many quotes, phrases, experiences that in some way relate back to this book, that part of the culture of medicine was honed in Samuel Shems' work.

This book develops characters and plot. It does so with classic uses of love, care, conflict, loss, and more. Even more than that though, it gives quality insight into what it means to be a doctor.

"I understand," he said, "it's the hardest thing we ever do, to be a doctor for the dying."

Talking about medicine, I told him with bitterness about my growing cynicism about what I could do, and he said, "No, we don't cure. I never bought that either. I went through all the same cynicism, all that training, and then this helplessness. And yet, in spite of all our doubt, we can give something. Not cure, no. What sustains us is when we find a way to be compassionate, to love. And the most loving thing we do is to be with a patient, like you are being with me."

Later, the main character struggles with the concept that oftentimes the best thing to do for a patient is nothing:

"Nope. I'm telling you that the cure is the disease. The main source of illness in thei World is the doctor's own illness: his compulsion to try to cure and his fraudulent belief that he can. It ain't easy to do nothing, now that society is telling everyone that the body is fundamentally flawed and about to self-destruct. People are afraid they're on the verge of death all the time..."

He then describes what patient really want after receiving gifts from his patients:

These gifts were for "helping" them. The only way I'd helped them was by not TURFING them elsewhere. That was it: with the delivery of medical care this swiftly revolving door, with every doc on the planet frantic to BUFF and TURF elsewhere, the people had gotten expert at finding a static center and hanging on. They could spot a Fat Man a mile away, These people didn't give a damn about their "diseases" or "cures"; what they wanted was what anyone wanted, the hand in their hand, the sense that their doctor could care.

Here are the famous 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 School Student) who only triples my work and I will kiss his feet.
12. If the radiology resident and the BMS both see a lesion on the chest x-ray, there can be no lesion there.
13. The delivery of medical care is to do as much nothing as possible.

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