The House of God

This book was recommended by one of the physicians I used to work for. Written by a physician, fiction, but a real insight into the "way it used to be" in the medical world. Brought back good memories of nurses you could actually recognize in white uniforms and unfortunately some of this was very true at the time. If you were in the medical field anywhere close to the 1960s-1970s you need to read this.

I read this as a first year med student, when everything to come was a great mystery. The world of the training institution (think large, urban teaching hospital here) comes alive in this book, and while it seemed to me at the time that much of it must have been "buffed" by the author to make it more interesting, it turns it out is pretty right on. I hope it doesn't shatter the readers' confidence in their doctors; what comes accross as a lack of compassion amongst Interns & Residents is just a symptom of the duress of their training ordeal (and their lack of sleep). Happily, excellent skills are usually attained by the concentration of work done, and compassion, if flagging in a few, returns to most all not long after Residency ends.

There are all kinds of things I hate about this book. I hate remembering how long I would go without sleep and the psychic torture that an internship inflicts on you. I hated the depersonalization of patients. I hated the sexual escapades. Most of all, I hated having in print the real feelings of an intern who has been up for three days - praying on the way to the ER that that Nursing Home Gomer with 20 fatal diagnoses would have the decency to croak before you got there so you could get an extra five minutes of sleep or a stale doughnut before the cafeteria closed again.Shem portrays masterfully the jumble of emotions of a typical intern. There is a superficial level of glossy brown-nosing that got you into med school in the first place. Buzz words like compassion, continuity of care and empathy are used with the teaching physicians and in meetings. Then there is a deeper level of survival where you would kill your mother for 5 minutes of sleep or being able to crap without the code blue pager going off. This level is usually not discussed or written about in many of the typical intern coming-of-age books out there. Not because it isn't true, but because it's uncomfortable and offensive to non-physicians. Shem is the master of this level of medical thinking. No one else even comes close. Shem approaches but doesn't quite get to an even more primal level - that of duty. This level is what keeps an intern from punching his residency directors or the arrogant surgeon who asks him "What is the difference between a sh*thead and a brown-noser" and then tells you the answer is depth perception.(True story) It's what makes you do your best when you know the patient is hopeless or even abusive as you try your best to save them from themselves or some disease.The humor is black as night and the sex is soft-core porn, according to my nephew in medical school to whom I sent a copy of this book. House of God has two profound themes. The first is a detailed description of medicine and medical training. This theme is presented with black humor, and some (but not as much as you think) exaggeration. I have read nothing that does this better. The second theme of the book is universal, however. It is the theme of Man vs. World and the World wins, but the Man is too maimed to know it.The book still disturbs and haunts me because Shem puts in print graphically and eloquently some of the thoughts and occurences that we don't even admit to ourselves.

To the lay-readers who find the book's images and points of view both horrifying and repulsive, I would say only this: As a street paramedic I fully empathize with any experienced doctor, nurse, P.A., or other medical practitioner, who happens to be a little "crispy around the edges." Medicine at any level of practice is often a mental beat-down, frequently unrewarding, and always tough. The "gallows-humor" that HOG depicts so graphically is a defense-mechanism for a lot of health-care workers. Myself included. You either succumb to its temptation, or you burn out. And in that case, you're no good to anyone, least of all your patients. If you read the book from a perspective outside the medical profession, please keep an open mind and you will love the book as much as we who are "in the know" do. And if that doesn't work, you could always try walking a mile in our shoes...