The House of God

by Samuel Shem

GOMER, for Get Out of My Emergency Room.

Written by a psychiatrist, Stephen Bergman, under the pseudonym Samuel Shem,

the novel is based on his grueling, often dehumanizing experiences as an intern at Harvard Medical S...

Life’s like a penis: When it’s soft you can’t beat it; When it’s hard you get screwed. —The Fat Man, Medical Resident in the House of God

Gomer is an acronym: Get Out of My Emergency Room—it’s what you want to say when one’s sent in from the nursing home at three A.M.”

Next the Fat Man showed us how to get just the head of the bed up, for pulmonary edema; the foot of the bed up, for stasis ulcers of the foot; the middle of the bed up, for disorders of the middle. Finally, after he’d done everything with the gomer bed but twist it into a pretzel, using Rokitansky for the holes, he became solemn and said in an excited voice, “I’ve saved the most important control for last. This button controls the height. Mr. Rokitansky, are you ready?” PURRTY GUD.

From this height, if a gomer goes to ground it is an automatic intertrochanteric fracture of a hip, and a TURF TO ORTHOPEDICS. This height,”

“Key concept,” said the Fat Man, “to think that you’re doing a shitty job. If you resign yourself to doing a shitty job, you go ahead and get the job done, and since we’re all in the ninety-ninth percentile of interns, at one of the best ternships in the world, what you do turns out to be a terrific job, a superlative job. Don’t forget that four out of every ten interns in America can’t speak English.”

Blood Urea Nitrogen—was an indirect measure of heart failure,

“And with luck, soon a rich one. Bedtime for Fats. Remember, Roy, primum non nocere, and hasta la vista, muthafucka.”

How I Saved the World Without Dirtying My Whites book,

“See that crowd there?” I did. There was a crowd of people in the waiting room, a mélange looking like a bar mitzvah at the United Nations. “My outpatients. I do nothing medical for them, and they love me. You know how much booze, hot merchandise, and food there’s gonna be in that crowd as Hanukkah and Christmas presents for me? And all because I don’t do a goddamn medical thing.” “You’re telling me again that the cure is worse than the disease?” “Nope. I’m telling you that the cure is the disease. The main source of illness in this

world is the doctor’s own illness: his compulsion to try to cure and his fraudulent belief that he can.

And yet, having been primed by the Fat Man, I was surprised to find my Clinic being fun. Relieved to think that my compulsion to try to cure was the only real disease in my patients, I sat back and let them, as people, bring me into their lives. What a difference!

My basketball-playing arthritic black woman, when I ignored her aching knees and asked about her kids, opened up, chatted happily, and brought her kids in to meet me. When she left, for the first time she forgot to leave a Jehovah’s Witness pamphlet. Many of my other patients brought me gifts: my LOL in NAD with the taped-up eyelids brought me her niece, a knockout sabra with a tanned face and shoulders like a fullback and a smile as enticing as a Jaffa orange; my artificial breast brought a bottle of whiskey, and my Portuguese artificial foot brought me a bottle of wine. 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, these people had gotten expert at finding a ...

But how is the poor wretch to acquire the ideal qualifications that he needs in his profession? —Sigmund Freud Analysis Terminable and Interminable

NPC—No Patient Care—specialties number six and only six: Rays, Gas, Path, Derm, Ophthalmology, and Psychiatry.”

*Each specialty has advantage of NPC: No Patient Care, in the Fat Man’s sense of the term. **Berry, Clinical Psychologist and Psychotherapist.

I Gomers don’t die. II Gomers go to ground. III At a cardiac arrest, the first procedure is to take your own pulse. IV The patient is the one with the disease. V Placement comes first. VI There is no body cavity that cannot be reached with a #14 needle and a good strong arm. VII Age + BUN=Lasix dose. VIII They can always hurt you more. IX The only good admission is a dead admission.

If you don’t take a temperature, you can’t find a fever. XI Show me a BMS who only triples my work and I will kiss his feet. XII If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there. XIII The delivery of medical care is to do as much nothing as possible.

BUN: Blood Urea Nitrogen; indirect measure of heart failure.

CVP: central venous pressure, the pressure in the vein feeding directly into the heart; CVP line, a catheter placed in that vein to measure pressure.