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Has anyone read House of God? Hilarious and disturbing...

Discussion in 'Pre-Medical Allopathic [ MD ]' started by pepes1lv1a, 05.19.14.

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  1. pepes1lv1a

    pepes1lv1a Bird Law 2+ Year Member

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    Saw it on a "recommended reading for med students" list. Thought it was hilarious, but also deeply disturbing--I've been working as an ER tech for the past year, and I found myself paradoxically delighted by his spot-on description of the gomer(e)s while also mortified at his brand of ruthless realism.

    Can anyone weigh in on reading this as a pre-med versus as an intern? Does anyone have any perspectives on how things have changed for internship/residency years between the 70s (when the book was written) and now? Any comforting words on what the hell we're getting ourselves into?

    I have a decent (and fairly dark) sense of humor, and while I thought this book was a hilariously fun read, it also left me feeling deeply uneasy about what the clinical years/residency might do to my psyche. I thought it'd be interesting to hear other pre-med perspectives.
     
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  3. DoctorLacrosse

    DoctorLacrosse 2+ Year Member

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    I've heard great things, really gotta get a copy of this book.
     
  4. IgEdoc

    IgEdoc 2+ Year Member

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    Read it after residency and I could have added to it with some stories during those years. It was crazy.
     
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  5. Essene

    Essene People don't bury nickels 2+ Year Member

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    Ugh- I loathe reading.
     
  6. phunky

    phunky 2+ Year Member

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    It's my favorite book. I saw Samuel Shem give a lecture a while back. His take was that things have definitely gotten better, particularly with work hour restrictions, but everyone will still go through thing described in the book.
     
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  7. Psai

    Psai ヽ(´ー`)ノ Account on Hold 2+ Year Member

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    You may be on the wrong forums
     
  8. NickNaylor

    NickNaylor Daisy the Dog Lifetime Donor 7+ Year Member

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    The most interesting but somewhat disturbing thing about all of these medical expose type books is that they become more and more relatable the further you get into training. I remember reading books like House of God and Gawande's books and thinking the anecdotes had to be either patently false or, at a minimum, exaggerated. Having now been on the wards even just as a third year, though, I can assure you that they are not. You will likely have your own crazy stories to add to the mix after your own experiences. I know I do.


    Sent from my iPhone using Tapatalk
     
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  9. WhippleWhileWeWork

    WhippleWhileWeWork 2+ Year Member

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    They can always hurt you more.
     
    Last edited: 05.20.14
  10. dadaddadaBATMAN

    dadaddadaBATMAN 2+ Year Member

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    Only a medical student, but from what I hear the emotional side is accurate. Several family members in the ED claim that the book is closest to reality in that department, so you're probably experiencing a lot of it now.

    Buff and turf, hope they don't bounce.

    @IgEdoc said this better and more briefly.
     
  11. LostinLift

    LostinLift 2+ Year Member

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    I recently re-read How Doctor's Think and Do No Harm. Both are definitely worth reading - Do No Harm is a great insight into the life of a neurosurgeon during medical school, residency, and afterwards.

    But House of God is my fav.
     
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  12. mmmcdowe

    mmmcdowe Duke of minimal vowels Gold Donor SDN Moderator 7+ Year Member

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    I've always wanted to read the sequel, Mount Misery.
     
  13. WhippleWhileWeWork

    WhippleWhileWeWork 2+ Year Member

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    "Assume the Physician" is a pretty decent updated version of HOG. Though not nearly as masterful of a telling.
     
  14. Theafoni

    Theafoni True Blue 2+ Year Member

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    Excellent play on words ha
     
  15. Essene

    Essene People don't bury nickels 2+ Year Member

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    It's okay when I "have" to.
     
  16. WhippleWhileWeWork

    WhippleWhileWeWork 2+ Year Member

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    Like when you're on an internet forum?
     
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  17. Essene

    Essene People don't bury nickels 2+ Year Member

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    That's fine. I meant reading-for-fun.
     
  18. LizzyM

    LizzyM the evil queen of numbers SDN Advisor 10+ Year Member

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    Don't go there.... dreadful. It is very weird... a sequel in terms of characters but although it is "next year" the actual time period is about 15 years after HOG so as to make a commentary on the effect of managed care on psychiatric services. I loved House of God but Mount Misery was just misery.
     
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  19. lysine9740

    lysine9740 2+ Year Member

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    Is it more of a religious book? I'm not big on religion, so would I still enjoy it?
     
  20. LizzyM

    LizzyM the evil queen of numbers SDN Advisor 10+ Year Member

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    LOL... not the least bit religious. "House of God" is a satirical riff on the name of the hospital, IIRC, like Beth Israel, Mount Sinai, etc.
     
  21. mimelim

    mimelim Vascular Surgery 5+ Year Member

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    Laws of House of God - Mimelim's commentary

    1. Gomers don't die - Only the good people die. The cockroaches live forever. Obvious selection bias, but the worst things seem to always happen to the good people.

    2. Gomers go to ground - Attention to small details saves people. After doing a central line, gotta drop the bed back down to the lowest level and put the railings up. E = mgh. Sure as hell can't change my patient's mass or the size of the Earth, but patients fall no matter what you do and hospital causes subdurals or broken femurs suck++.

    3. At a cardiac arrest, the first procedure is to take your own pulse. - Has a different meaning in Vascular Surgery, but panicking doesn't help anyone. I've seen codes 'taken away' from residents because they were clearly unable to provide the best care because of their inability to compartmentalize and focus.

    4. The patient is the one with the disease. - You see so much pathology around you. Yes, it could all happen to you, but you can't worry about it because you will go insane. Move on, take care of your patient and worry about it another day.

    5. Placement comes first. - ER docs don't even bother trying to admit to me. If they have more than one medical problem, they go to a medical service and with a Vascular Surgery patient population, that means they always go to a medical service. I have 50+ patients on my list, patients will suffer if I need to titrate their DM or HTN meds. Yes, I can do it and yes, I can do it well, but a medicine team has more time and will actually do it. As soon as someone arrives, you have to think dispo. Paperwork in modern medicine sucks LTAC, SNF, rehab, and home health all take time and coordination. I have two PMR docs on the front page of my phone. If one doesn't respond to my text message about a patient, the other gets the consult. Last week we actually consulted them before we did the AKA. Worked out great.

    6. There is no body cavity that cannot be reached with a #14 needle and a good strong arm. - Although I enjoy getting my trauma numbers thanks to the interventional cardiologists that think they know how to do procedures, for the sake of the patients... LEARN TO USE THE GOD DAMN ULTRASOUND (and a micropuncture kit).

    7. Age + BUN = Lasix dose - Never really thought about this one.

    8. They can always hurt you more. - They always hurt you more.

    9. The only good admission is a dead admission. - I'm the happiest and most optimistic person I know. This was relatively repulsive to me initially. Then I did trauma call for 10 straight weeks as a junior resident at the busiest trauma hospital in the US. On those nights with 15+ level 1/2 traumas, the page that says, "Level 1 GSW to head, G-3 S-0 BP-0 R-0, CPR in progress" was a breath of fresh air because it would require minimal work and minimal paperwork. Also presenting at morning report wasn't stressful. "Patient arrived dead and remained dead. The next patient...."

    10. If you don't take a temperature, you can't find a fever. - Your job is take care of patients. Not to cure them of all their ailments, the vast majority of which are not medical.

    11. Show me a student from the "best medical school" who only triples my work and I will kiss his feet. - Invest in students. If you don't have the attitude, "I need to make these students better than I was at their level", you aren't working hard enough or are at the wrong hospital. Doctors (residents) are good students, but we do not select for good managers and administrators. Yes, the advent of EMRs decrease the scut that can be turfed to students, but there are things, both physical and cognitive that medical students can help a lot with.

    12. If the radiology resident and the "best medical student" both see a lesion on the chest X-ray, there can be no lesion there. - "Trust, but verify." - my chief my first week of residency. If you depend on radiological studies in your practice, you should be able to read them for what you use them for. There is no excuse for not being able to do basic interpretation of films.

    13. The delivery of medical care is to do as much nothing as possible. - Yes, modern medicine is amazing. Yes, we can improve the health and lives of many patients. But, we are limited, by resources and our own abilities. Nothing HAS to be done. It is always possible for a patient to say, "No, just stop and let me be". It is always a possibility that the "right" thing to do is to tell a patient, "We can do XYZ, but for you, it would be better to do nothing." You might get paid less, but it is still the right thing to do.
     
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  22. wannabeMD19

    wannabeMD19 2+ Year Member

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    Very good book. Eye-opening for those pre-meds who are blissfully unaware of the ugly/unhappy/disturbing side of medicine.
     
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  23. reedsposer22

    reedsposer22 2+ Year Member

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    yes I have. look at my signature! Love that quote!
     
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  24. pepes1lv1a

    pepes1lv1a Bird Law 2+ Year Member

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    Seems the consensus is that it's fairly accurate, and I should probably be a little apprehensive. Mimelim, very interesting to hear your take coming from the vascular surgery perspective. Emergency has always been my number one interest but that's as an M-zero who has only ever worked in the ER, so I guess we'll see. Maybe psychiatry is my calling after all...
     
  25. Mt Kilimanjaro

    Mt Kilimanjaro

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    The first time I read this I wondered how accurate the depiction of AA in the 70s is (the racistly caricatured black guy just returned post cards to get into college, med school, and residency).
     
  26. Espadaleader

    Espadaleader 5+ Year Member

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    That was hilarious! Of course it wasn't like that thou. I think the author did that on purpose. Chuck downplayed his successes, which a character like Chuck would do. He was very modest. Oberlin, Chicago, BethI, he never bragged about how good he was. If someone asks me thats what I am gonna say
     
  27. pepes1lv1a

    pepes1lv1a Bird Law 2+ Year Member

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    Probably about the same as the sexistly-charicatured sex-kitten nurses. At least in my ER, they're definitely not all bombshell nymphos tripping over the residents.


    The total absence of male nurses in HOG did seem strange to me. Male midlevels and nurses are so common in my ER, and I guess I never realized what a generational paradigm shift that was
     
  28. TXKnight

    TXKnight Better Known as TXK 5+ Year Member

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    Didn't like it that much. I mean, it's ok, and at times entertaining. Some thing haven't changed, but it obviously feels a bit dated.
     
  29. WhippleWhileWeWork

    WhippleWhileWeWork 2+ Year Member

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    Well, you are wrong.
     
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  30. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Obviously it was over the top...it is a satire after all.

    I think (a) male nurses were probably even less common 40 years ago than they are now. And (b) the sexualization was a matter of the times. And again, the book was a satire. But it was exceptionally accurate in that some residents use objectification of women and hyper-sexualization as a coping mechanism.
     
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  31. DermViser

    DermViser 5+ Year Member

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    Not really. I guarantee you if you gave the usual superachiever premed "House of God" and had them read it, they would think 1) It's a complete overexaggeration if not outright fiction, 2) it won't happen to them - bc they'll just pic a great specialty that doesn't involve that, or 3) you're just trying to psych them out from getting into med school.
     
  32. Venko

    Venko True to self Lifetime Donor 7+ Year Member

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    I agree with the overall appreciation for the book.

    I have met a small percentage of folks who didn't like the book and they didn't finish it. I am of the opinion that the book is not completely understood if you don't finish it. I would recommend by starting it unless you are going to finish it.

    There is so much negativity in te middle that I have met people who don't walk away with the right message because they didn't go all the way through.
     
  33. sb247

    sb247 wait...you mean I got in? 2+ Year Member

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    It was 1982 when the common practice of barring men from public nursing schools was banned in court
     
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  34. TXKnight

    TXKnight Better Known as TXK 5+ Year Member

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    If you want to read a real book, oh I'm sorry (no offense intended), a really good book try "the emperor of all maladies". Now, it's a different genre, but it's an outstanding Non fiction for those of you who were let down by the house of God. I may bite my tongue and end up loving the book once I make it into residency......but anyway
     
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  35. pepes1lv1a

    pepes1lv1a Bird Law 2+ Year Member

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    Read that one a few months ago. It was a really good book, but you can't really compare the two--HOG is like the Candide of residency, and Emperor of all Maladies is a nonfiction tour de force of cancer therapy.

    If you liked Emperor of all Maladies, though, I gotta suggest The Spirit Catches You and You Fall Down. Just finished that one last night and even though it got a bit slow in the middle, it was by far the most gripping account of a tragic cultural clash I've ever read--and the fact that it's written by a journalist, and not a doctor, gives it a much more unbiased and raw perspective about the consideration cross-cultural practices deserve in Western medicine.

    Along those lines, 2 more suggestions for nonfiction--first, Five Days at Memorial is a beautifully written, intensely researched and totally poignant account of the horrific conditions that led some doctors to almost unthinkable extremes in post-Katrina New Orleans.

    Second, The Immortal Life of Henrietta Lacks--another fantastically written account of one woman's strangely immortal tumor and the monumental impact it had upon the field of clinical research. Especially if you're interested in cancer, the human story behind the HeLa cells makes for a really interesting convergence of clinical practice, research, and patients' rights.
     
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  36. LizzyM

    LizzyM the evil queen of numbers SDN Advisor 10+ Year Member

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    Following along with @pepes1lv1a , I recently picked up The Lazarus Case: Life-and-Death Issues in Neonatal Intensive Care by John D. Lantos. I read it years ago and it still resonates. I am particularly enjoying his description of his observations of the NICU as an M4 -- very much the way so many of you feel when you are shadowing. If you want a complete picture of academic medicine, rural medicine, medico-legal issues and much more, get a copy. No laughs or satire but a good read.
     
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  37. Being

    Being

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    Would we be premeds if we had not?
     
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  38. phunky

    phunky 2+ Year Member

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    Just ordered. Thanks for the tip. I've been on a huge medical book kick recently.
     
  39. sameas

    sameas 5+ Year Member

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    The House of God made a deep impression on me when I read it in high school. I've read it 5 times since then and I consider it a tale of the human condition, rather a true-to-life account of PGY1. While the book had a lot of cynical humor in it, it was also hopeful and idealistic. I read Catch 22 some years later and would recommend that novel as better than HOG--it is more deeply bitter and cynical and more satisfying to read.
     
  40. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    Hospitals now frown on you using the acronyms and names for patients used in that book. They were more blatant when talking about gomers and circling the drain back then. Otherwise little has changed. Good book.
     
  41. FCMike11

    FCMike11 SDN Silver Donor Silver Donor 5+ Year Member

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    What a book. The man who wrote this could of had a serious career as an author (I guess he did technically with such a book).
     
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  42. LizzyM

    LizzyM the evil queen of numbers SDN Advisor 10+ Year Member

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  43. pepes1lv1a

    pepes1lv1a Bird Law 2+ Year Member

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    I'm not so sure...some of the ER humor bandied around between the doctors/nurses/techs is just as irreverent, if not a direct HOG reference.

    That is the one part of HOG that still vexes me. Who were the policemen supposed to be?! I mean, what purpose were they supposed to serve? Don't get me wrong, I thought they were awesome, just baffling.


    Also, @LizzyM, I told myself I was going to branch out from the medical-themed summer reading for a while, but I may have to make an exception. The thought of performing any sort of risky procedures in a NICU for the first time makes me all sorts of NOPE
     
  44. LizzyM

    LizzyM the evil queen of numbers SDN Advisor 10+ Year Member

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    Take a look at those reading lists as we did end up discussing non-medical stuff, too. As for the M4 in the NICU, he wasn't doing anything except "shadowing" and what he experienced reminded me of many of you undergrads.
     
  45. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    They were a literary device, and a good one at that
     
  46. orangeman25

    orangeman25 2+ Year Member

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    I just finished Better and Complications by Atul Gawande. Gonna check out House of God next. It's a little old though - anyone have issues with that while reading?
     
  47. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    Residency is " a little odd". It helps give you the appropriate vibe.
     
  48. dadaddadaBATMAN

    dadaddadaBATMAN 2+ Year Member

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    this question was addressed earlier in the thread I think. It was part of OP's q.

    "it's a little old."
     
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  49. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus 10+ Year Member

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    My bad. Trying to read on a small phone. It's neither particularly odd nor outdated. A lot more of that book is still accurate today than many in the profession would like to think.
     
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  50. TXKnight

    TXKnight Better Known as TXK 5+ Year Member

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    I appreciate your suggestions. I read a couple of years ago the immortal life of HL, it was great. I am an Anthropology graduate, I focused on cultural anthropology, thus The Spirit Catches You and You Fall Down is very appealing to me. I will move on to that one once I'm done with "medicine and culture".
     

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