The House of God

by Samuel Shem

“Why, no one doesn’t need a contract. No one doesn’t, at all.”

“Oh, and one more thing: I’m writing a letter to the Chief of Medicine, Dr. Leggo, with copies to the Chief Resident and the BMS and House Board of Trustees. I been a patient here eight times and I never been treated so good. Usually my intern is some whiny kid from the Bronx who’s so scared of a Zock pegging out that he’s in the room every ten minutes doing tests, taking blood, and I get worse before I get better. By the time I’m out of here I’m so exhausted I’ve got to fly straight to the condo in Palm Springs for a rest. Bad for business. But you—you had enough savvy to let me heal. And I knew you were there in case anything went wrong. Basch, you were with me man to man. You handled my wife, my fat kids, and you handled me. So I’m going to tell your bosses, eh? Give a call Saturday. I’ll send my man around.”

“Gomers,” said Howie, “gomers are what’s going on.” “You mean old people? We took care of old people too.” “Gomers are different,” said Eddie. “They didn’t exist when you were a tern, ’cause then they used to die. Now they don’t.” “Ridiculous,” said the Leggo emphatically.

“You can’t save us,” I said, “you can’t stop the process. That’s why we’re going into psychiatry: we’re trying to save ourselves.” “From what?” “FROM BEING JERKS WHO’D LOOK UP TO SOMEONE LIKE YOU!” screamed the Runt. “What?” asked the Leggo shakily, “what are you saying?” I felt that he was trying to understand, and I knew he couldn’t but that he was crying inside because we’d pushed the button that had him hearing the tapes of all his failings, as father and son, and I said as kindly as possible, “What we’re saying is that the real problem this year hasn’t been the gomers, it’s been that we didn’t have anyone to look up to.”

“What we mean, man,” said Chuck forcefully, “is this: how can we care for patients if’n nobody cares for us?”

“This might have been the only thing that could have awakened you. Your whole life has been a growing from the outside, mastering the challenges that others have set for you. Now, finally, you might just be growing from inside yourself. It can be a whole new world, Roy, I know it. A whole new life.” Eyes wet with tears, she said, “I’m going to love you even more, Roy, because I’ve been waiting a long time for you to begin.”

LAWS OF THE HOUSE OF GOD 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. X 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.

GOMER: Get Out of My Emergency Room; “a human being who has lost—often through age—what goes into being a human being” (the Fat Man).

House of God: hospital affiliated with the BMS; founded in 1913 by the American People of Israel when their medically qualified Sons and Daughters could not get good internships because of discrimination; competitor of MBH (see MBH).

LOL in NAD: Little Old Lady in No Apparent Distress; not a GOMERE.

M BH: Man’s Best Hospital; a BMS-affiliated hospital founded by WASPs; competitor of the House of God.

MOR: Marriage On Rocks; frequent event during internship; cf. ROR.

Primum non nocere: first of all, do no harm.

ROR: Relationship On Rocks; frequent event during internship; cf. MOR.

MOR: marriage on the rocks

Tern: Intern, the first of a series of House Staff members, including Resident, Junior Assistant Resident, Senior Resident, Chief Resident, Fellow, Junior Fellow, Senior Fellow.

I and my core group of fellow interns were products of the 1960s. We believed that if we saw an injustice, we could organize, take action, and change things for the better. Our generation put the civil rights laws on the books and helped end the Vietnam War. We were pragmatic idealists. When we entered our internship, we were taught to treat our patients in ways that we didn’t think were humane. We ran smack into the conflict between the received wisdom of the medical system and the call of the human heart.

Mount Misery,

Oh dear God in heaven... There's a sequel?!

I faced the choice between Vietnam and Harvard Med. Clearly our bloodbath in Vietnam was obscene. I also realized that if I depended on my writing for my livelihood, I would not be able to write what I wanted—I’d probably wind up in television or film. Writing was too vital to me to do that. I chose Harvard Med. Somehow I would find a way to write.

People got up and said, “If we go out on strike, we’ll never learn the kidney!” Others said, “The hell with the kidney, let’s go!” We went. I never learned the kidney. In the novel it’s a fuzzily described organ, located somewhere between the back of the neck and the back of the knee.

Another great advance is the status of women—who now account for at least 50 percent of medical school classes (in 1973, they were 10 percent). As carriers of caring in our culture, women bring these qualities to the care of patients and relationships with peers.

Book was definitely male oriented

Why in the world should health care be for profit? We doctors, after all, are the workers. Without us, there’s no health care. Has anyone ever heard, in a crowded theater, the call go out: “Is there an insurance executive in the house?” We doctors and other health professionals have to speak up and stand up for what we believe, and bring about healthy change. The only workable solution is a universal coverage federal system. Relieved of the burden of the insurance industry’s obese profit, avalanche of paperwork, and crazy incentives for minimal care delivered in minimal contact with our patients, we doctors could rediscover what we went into medicine for: to “be with” our patients and relieve pain and suffering. We could focus on what is glaringly absent from the national health care debate: staying human in medicine.

The Spirit of the Place is how to stay human when you get out, as a doctor who is a person in a community, a doctor out in the world.

Another book

This is the basic human story. We are all on the same journey. Every one of us will suffer—there’s no way around it. The crucial question is not how to avoid suffering, it’s how we move through it.