"The House of God" -by Samuel Shem

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EdLongshanks

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I came across a reference to this book on one of the medical blogs. The PCP was talking about how only doctors can understand the stories that doctors tell each other and never anyone else. He said these stories were in this book. I immediately downloaded it on my Kindle and starting reading.

It's a little breathtaking. It has several themes. The is that doctors never cure anyone. I'm not sure what his suggested attitude toward patients is. He calls the old people with dementia "GOMER"s for "Get Out of My Emergency Room." and his suggested treatment is to "BUFF" the chart and "TURF" them somewhere else and hope that they do not "Bounce" back.

Everything that I have read from medical professionals about this book is admiring. So, is this why hearing the fresh-faced pre-med student talking about "helping people" is so annoying. Do doctors believe that they never help anyone? The only reason to go into medicine is to make money?

I'm missing something here.

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I haven't read this book, and I'm not (yet) a doctor. But I did serve as a Peace Corps volunteer in sub-Saharan Africa for 2.5 years, and met a lot of aid workers, missionaries, doctors, and miscellaneous other westerners who were there trying to help. Sometimes when you'd get a bunch of them together, they'd do a lot of griping. It could be a room full of dedicated, good-hearted people who were busting their asses on a daily basis to get things done and make an impact, but maybe they all wanted to talk about the maddening stone-walling from petty local government officials, the actively counter-productive things they've seen villagers do, and how it seemed hopeless that they'd ever have any impact at all.

Maybe this is common for hard professions that people get into for idealistic reasons. A certain amount of disillusionment is inevitable, and sometimes people need to hash that out. If it's done in a sarcastic or biting way, it may not be pretty, or even very understandable to outsiders.
 
It's a little breathtaking. It has several themes. The is that doctors never cure anyone. I'm not sure what his suggested attitude toward patients is. He calls the old people with dementia "GOMER"s for "Get Out of My Emergency Room." and his suggested treatment is to "BUFF" the chart and "TURF" them somewhere else and hope that they do not "Bounce" back.

I'm missing something here.

I think you have to look at the book from its context and specifically its point of view: of a shell-shocked intern. I think that if you mosey over to general internship and residency forums, you'll see a lot of the same themes, just like you'll see a lot of the same emotion attached to different situations in the military or aid work. It's a coping mechanism for dealing with sh*tty situations. You dehumanize to maintain your humanity. And I think that's a place that most physicians understand due to the shared experience of internship. Hence the popularity of the book. My $0.02. Just curious, you didn't find the book funny? I thought it was one of the funniest things I've read.
 
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Ed, what I read as the central theme is Roy's realization that medicine is limited in what it can accomplish. He realizes that he can't save the GOMERs or ever make them well, and that the over-application of medical science (e.g. the hyperactive resident Jo) can do far more harm than good. Sure, the Fat Man goes on and on about the big fortuna he wants to make, but in the end they learn that they can't be superman and it's worth a lot more to comfort patients and support them emotionally.

You may wish to check out Return to the House of God, which is a series of responses and essays written by medical professionals about the book.
I thought it was one of the funniest things I've read.
Same here, despite all the rampant misogny and cynicism, I think it's brilliantly funny.
 
I came across a reference to this book on one of the medical blogs. The PCP was talking about how only doctors can understand the stories that doctors tell each other and never anyone else. He said these stories were in this book. I immediately downloaded it on my Kindle and starting reading.

It's a little breathtaking. It has several themes. The is that doctors never cure anyone. I'm not sure what his suggested attitude toward patients is. He calls the old people with dementia "GOMER"s for "Get Out of My Emergency Room." and his suggested treatment is to "BUFF" the chart and "TURF" them somewhere else and hope that they do not "Bounce" back.

Everything that I have read from medical professionals about this book is admiring. So, is this why hearing the fresh-faced pre-med student talking about "helping people" is so annoying. Do doctors believe that they never help anyone? The only reason to go into medicine is to make money?

I'm missing something here.
Some of it is more real than people like to talk about in polite company. One of the people featured in that book is an attending at my residency program.
 
I think you have to look at the book from its context and specifically its point of view: of a shell-shocked intern. I think that if you mosey over to general internship and residency forums, you'll see a lot of the same themes, just like you'll see a lot of the same emotion attached to different situations in the military or aid work. It's a coping mechanism for dealing with sh*tty situations. You dehumanize to maintain your humanity. And I think that's a place that most physicians understand due to the shared experience of internship. Hence the popularity of the book. My $0.02. Just curious, you didn't find the book funny? I thought it was one of the funniest things I've read.

I find a very lot of it very funny and I like it. I was trying to understand the point and missing it.

There are also several horrid stories that I believe. Sneaking in to kill the terminal man who is begging to die - I believe it. And I believe that hospitals do unnecessary procedures in order to make money. I'm not surprised at the shell-shock of the new intern. I'm dreading it myself.

Yes, I know that medicine has limits and the new doctor has to come to terms with this.

What I am not understanding is the emotional distance that the protagonist maintains from his patients. I know that "the patient has the disease". I've had a similar motto that I adopted from a book by Dorothy Gilman. "Don't bleed for the patient."

But why can't the doctor be glad that he is saving lives - and when he fails, why can't he cry with the family just a little while without coming apart himself.

Like I said, the book is saying something that I can feel brush past me and I'm not getting. Maybe I'm just a Jo, and there is no hope for me.
 
Like somebody else said before, it's a coping mechanism. A way to detach yourself emotionally. Otherwise, majority of us would spiral into severe depression and never come out of it alive.

Why?

Majority of us aren't emotionally strong to be "glad when we save lives" and "cry with the family when we can't" and then go back to work.

Dr. Cox summarizes it best:

http://www.youtube.com/watch?v=z670uPomQkM
 
Like somebody else said before, it's a coping mechanism. A way to detach yourself emotionally. Otherwise, majority of us would spiral into severe depression and never come out of it alive.

Why?

Majority of us aren't emotionally strong to be "glad when we save lives" and "cry with the family when we can't" and then go back to work.

Dr. Cox summarizes it best:

http://www.youtube.com/watch?v=z670uPomQkM

I guess I'll get it when I'm there. Maybe reading about it will at least let me know that what I go through is common to humans.
 
Like somebody else said before, it's a coping mechanism. A way to detach yourself emotionally. Otherwise, majority of us would spiral into severe depression and never come out of it alive.

Why?

Majority of us aren't emotionally strong to be "glad when we save lives" and "cry with the family when we can't" and then go back to work.

Dr. Cox summarizes it best:

http://www.youtube.com/watch?v=z670uPomQkM

Well said by Dr.Cox. I also think it's a coping mechanism. A way to stay sane in a profession where situations may spiral out of control quite rapidly and the desire to "save a live" sometimes is not enough (ex: terminally ill patients). On the other hand I also sort of get what Ed is referring to. I have not read the book but I do volunteer in a hospital and sometimes the way I hear doctors crack jokes about patients makes me wonder if after so long they have forgotten the reason why they decided to become doctors in the first place, and it scares me to think after a while that's what doctors become since they are faced with all these incredibly hard situations and they must find a way to cope with them. Perhaps as a pre-med I still see the profession idealistically and maybe at one point I will be the person having to fight back the emotions and "get back to work".
 
Personally, for me the best way to stay sane and cope will be (I'm MS2) via family support and faith. Not sure how much of this "picking on patients" I will be doing. We shall see.
 
When I read that book as a premed, I hated it. I haven't read it since, although since I'm going to be an intern soon, maybe I should reread it just to see how I feel about it now. :d

People cope with strong emotions like this in different ways. There *are* some people who cope by making jokes, but I'm not one of them. I cope by compartmentalizing I guess--sometimes you have to set the feelings on the back burner for a while so that you can not fall completely apart while you're at work. But that doesn't mean you can't show any emotion whatsoever, and it doesn't mean you can't do anything for the family at all.

I did several rotations at a hardcore tertiary care hospital, and my first patient who died, died during the last week of my surgery rotation. I had just started medicine that week, and two more patients died, one of mine and one other that I was present for (a failed resuscitation on the floor). By far, the resuscitation was the most traumatic for me. I had no idea how much violence a resuscitation commits on the patient, and I didn't realize how low the odds of saving the patient were. But the thing that hit me hardest (and this was one of the points where I was most seriously considering dropping out of med school) was how the doctor treated the family with pretty much utter indifference. It was like his emotions were just completely turned off. Not only was it just another day at work, but taking time out for that resuscitation meant more paperwork, more time before getting everything done and going home. It hit me that if he was the person I have to become, then I don't want to be a physician at all.

Subsequently, I worked with other physicians who were more like me, to put it bluntly. And I saw that it *is* possible to do something more than just tell the family sorry and "go back to work." Even if it's something as simple as sitting down while you talk to them instead of having one hand on the doorknob; or asking the family if there's someone they want to call; or stopping by later to check on them in case they have any more questions. No, you can't undo the grief, and you shouldn't even try to. But it's the little kindnesses that make a difference to people, and being kind is something you can do, if you want to do it.
 
When I read that book as a premed, I hated it. I haven't read it since, although since I'm going to be an intern soon, maybe I should reread it just to see how I feel about it now. :d

People cope with strong emotions like this in different ways. There *are* some people who cope by making jokes, but I'm not one of them. I cope by compartmentalizing I guess--sometimes you have to set the feelings on the back burner for a while so that you can not fall completely apart while you're at work. But that doesn't mean you can't show any emotion whatsoever, and it doesn't mean you can't do anything for the family at all.

I did several rotations at a hardcore tertiary care hospital, and my first patient who died, died during the last week of my surgery rotation. I had just started medicine that week, and two more patients died, one of mine and one other that I was present for (a failed resuscitation on the floor). By far, the resuscitation was the most traumatic for me. I had no idea how much violence a resuscitation commits on the patient, and I didn't realize how low the odds of saving the patient were. But the thing that hit me hardest (and this was one of the points where I was most seriously considering dropping out of med school) was how the doctor treated the family with pretty much utter indifference. It was like his emotions were just completely turned off. Not only was it just another day at work, but taking time out for that resuscitation meant more paperwork, more time before getting everything done and going home. It hit me that if he was the person I have to become, then I don't want to be a physician at all.

Subsequently, I worked with other physicians who were more like me, to put it bluntly. And I saw that it *is* possible to do something more than just tell the family sorry and "go back to work." Even if it's something as simple as sitting down while you talk to them instead of having one hand on the doorknob; or asking the family if there's someone they want to call; or stopping by later to check on them in case they have any more questions. No, you can't undo the grief, and you shouldn't even try to. But it's the little kindnesses that make a difference to people, and being kind is something you can do, if you want to do it.

Thanks Q. That was a great post.
 
I read "The House of God" when it first came out, (okay I'm old), and thought it was hilarious then. Maybe it was because at that time I was a social worker, and the situations were similar in that you just can't always (or even sometimes) fix people.

I still reread it now that I am in the health care professions, and I recommended it to some non-medical people. They were horrified. Oops. My bad. Somehow, nobody seems to get that Roy, at the end, rediscovers his humanity. But still, we have to remember, "it's the patient who has the disease".

And of course, Age + BUN = Lasix dose.

Oldiebutgoodie
 
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I read "The House of God" when it first came out, (okay I'm old), and thought it was hilarious then. Maybe it was because at that time I was a social worker, and the situations were similar in that you just can't always (or even sometimes) fix people.

I still reread it now that I am in the health care professions, and I recommended it to some non-medical people. They were horrified. Oops. My bad. Somehow, nobody seems to get that Roy, at the end, rediscovers his humanity. But still, we have to remember, "it's the patient who has the disease".

And of course, Age + BUN = Lasix dose.

Oldiebutgoodie

I finished the book and I think I understand a bit more, now. I also, since reading the "afterward", understand why I did not like part of it. The author considers himself a literature writer, first, and a doctor, second. So, I have now read "high literature" despite my successful attempts to avoid it through the years. It's like being clubbed over the head with a feather. The author wants to make a point without being explicit enough to be accused of having an opinion.

I think many people never finish the book, and so don't understand that it is the story of him losing, and then regaining, his humanity. But it's suffused with that '60's "think globally, act locally" bowel movement contents. Only when the interns join together and fight collectively against the man are they redeemed.

I get the stories. The new doctor is surrounded by demands that he "do something" for people for whom nothing should be done. Even when he finds something that will help, the patient or the system itself undoes his work. He sees incompetent doctors who kill patients, but have such social ability that they get by with it. He has to find some way to cope and remain human.

The author's coping mechanism, in the end, is social activism - beginning with his book. It's not a bad choice, and even though I agree with none of his politics, his activism in medicine has been a good thing.

At my age, I should already have learned how to cope, so I don't think I will have a problem. But I'm glad to have read the book. I tried reading some of the funny parts to my wife, but she didn't get them - it was all "that's horrible" to her.
 
Some of it is more real than people like to talk about in polite company...

I agree with this and with the Doctor Cox quote. Folks come out of med school idealists. After a few months of being overworked, not getting adequate sleep, and realizing that you could have a much better time without all these annoying patients asking you for things they don't really need at all hours of the night (like some home devised combo of ambien, benadryl and dilaudid which is the "only thing" that ever lets them sleep), or worse, decide to start circling the drain on you, you adopt an us versus them mentality, and distance yourself. A lot of it is gallows humor, a lot is simply a defense mechanism. But if you don't come out of internship a lot more jaded than when you went in, you probably are repressing something. At most hospitals, it's considered unprofessional to refer to patients as GOMER (get out of my ER) or SHPOS (sub human piece of @@#@), but that doesn't mean that you aren't thinking it every time some darn, pesky patient doesn't conduct themselves in a grateful, respectful, non-drug seeking, manner. Some patients are great, and sometimes you can fix what ails them. These, you will see, will be the minority during your training. Most of the time, they are chronic players with bad habits. So the disdain begins.
 
I agree with this and with the Doctor Cox quote. Folks come out of med school idealists. After a few months of being overworked, not getting adequate sleep, and realizing that you could have a much better time without all these annoying patients asking you for things they don't really need at all hours of the night (like some home devised combo of ambien, benadryl and dilaudid which is the "only thing" that ever lets them sleep), or worse, decide to start circling the drain on you, you adopt an us versus them mentality, and distance yourself. A lot of it is gallows humor, a lot is simply a defense mechanism. But if you don't come out of internship a lot more jaded than when you went in, you probably are repressing something. At most hospitals, it's considered unprofessional to refer to patients as GOMER (get out of my ER) or SHPOS (sub human piece of @@#@), but that doesn't mean that you aren't thinking it every time some darn, pesky patient doesn't conduct themselves in a grateful, respectful, non-drug seeking, manner. Some patients are great, and sometimes you can fix what ails them. These, you will see, will be the minority during your training. Most of the time, they are chronic players with bad habits. So the disdain begins.

That is plain and that is what I was having a hard time understanding the book to be saying. I am extremely impatient with high art. I just gave money to the author for him to tell me what he knows and thinks and instead of doing so, he tries to Socratically nudge me into agreeing with him.

All of the high art that I have ever come into contact with is a bunch of manipulative condescension, and I don't like it.

The author had information that I need to know, but he wanted to show me his literature skills and try to hypnotize me into agreeing with him before he would tell me. I am annoyed. Not at his main point, but at his "circling the drain" arrogance.
 
The spark of this conversation is the fiction. The information of it would be an entirely different conversation. And no less political. There are forums on sdn circulating the polemics of "health care is a right." Healthcare is a commodity. Ad nauseum.

Going in. I have serious doubts about all of it. As an overworked intern I'll be jaded, I'm sure. But the jadedness will be a directed at the whole of it. And not the patient. I had a colleague who was completely inappropriate with his gallows humor. And it wasn't funny in front of patients. Amongs ourselves. To keep us sane. Perfect;y funny. But a concerted callousness and disrrespect for what people are going through is just not funny.

I think Dr. Cox monologue tells the story with it's human complexity. As does the Shem character. Rather or not's it's high art or whatever. It's an interesting story. One that can't be ignored. I'm still amazed at the amount of narrative revolving around medicine that is completely irrelevant to it's ironies and real duplicities. It's hard to find it in nonfiction too come to think of it. Given the vested interests in sustaining it's illusions.

But high or low art. I think that's why the book has been around this long. It's probing something uncomfortable and real. Perhaps more so if he hadn't regained his humanity afterwords.

I tried and failed to make it through the second book about psych residency. Like Ed. Once I got the hang of the story at work it became a little dull to read. And also like Ed I respect the author's activism in medicine. Anyone who speaks out to make residency training and it's culture more humane is alright with me.
 
Just wait until you've seen this repeatedly, and then see how you feel.

Agreed. As an intern you will spend many a night in the ICU trying to keep multiple patients in a "circling the drain" holding pattern (aka alive) until the next shift relieves you. Basically a lot like spinning multiple plates on sticks -- you are running around all night checking on people who are trying to die on you, adjusting their treatment, etc. After a few months of this you will get the sense of the futility of it all. There will be numerous patients who cannot be save, who nobody expects you to save, but you will continue to be diligent at keeping everyone going, not because you delusively think you can make a difference, but more because you want to avoid all the phone calls and paperwork involved if a patient dies on your watch.

As for not enjoying the "art" in the Shem book, you (EdLS) have to realize that this is a very well regarded writing style. It is to medicine what Liars Poker was to finance. It tells the story of what goes on in that industry, based largely on true stories, but gives you a great sense of the culture and gallows humor involved. I don't really know how you get a better insight into what life is like for an intern in the 70s (and some of which still rings quite true today). You may not like to learn from this kind of art, but it was on the best-seller list for quite a long time, still sells well today, spawned a movie (although it wasn't very good), etc. I don't really think you got conned, I think maybe your notions of a good book don't jibe with most American readers.
 
After a few months of this you will get the sense of the futility of it all. There will be numerous patients who cannot be save, who nobody expects you to save, but you will continue to be diligent at keeping everyone going, not because you delusively think you can make a difference, but more because you want to avoid all the phone calls and paperwork involved if a patient dies on your watch.
This is exactly how my fiance feels about suicidal people. He operates public transit for a living and has to deal with suicides on a regular basis. It's not that he doesn't care if people die, but he understands that if someone really wants to kill themselves they will eventually succeed. He just doesn't want to be used as the tool of their destruction.

His standard practice whenever he successfully thwarts a suicide is the following: Calmly park the vehicle. Step out, and hand a transfer slip to the would-be ground hamburger. Provide directions on where to catch the #28 bus which will convey said person to Golden Gate Bridge, where they can choose to do their business without making him have to fill out paperwork. If he's feeling particularly charitable he might also throw in directions to SF General. :meanie:
 
By far, the resuscitation was the most traumatic for me. I had no idea how much violence a resuscitation commits on the patient, and I didn't realize how low the odds of saving the patient were.
Yeah, the two open-chest CPRs I've witnessed were both that way. Both unsuccessful, and they seemed like gratuitous violence against the deceased's body. I may feel differently if I actually see some successful ones, but, geez.
But the thing that hit me hardest (and this was one of the points where I was most seriously considering dropping out of med school) was how the doctor treated the family with pretty much utter indifference. It was like his emotions were just completely turned off.
I find this very sad. If he wasn't capable of performing the death notification with some modicum of sensitivity, he should have asked someone else to do it. 🙁
 
...As for not enjoying the "art" in the Shem book, you (EdLS) have to realize that this is a very well regarded writing style. It is to medicine what Liars Poker was to finance. It tells the story of what goes on in that industry, based largely on true stories, but gives you a great sense of the culture and gallows humor involved. I don't really know how you get a better insight into what life is like for an intern in the 70s (and some of which still rings quite true today). You may not like to learn from this kind of art, but it was on the best-seller list for quite a long time, still sells well today, spawned a movie (although it wasn't very good), etc. I don't really think you got conned, I think maybe your notions of a good book don't jibe with most American readers.

I'm sure that my notions of good books are particularly mine and not necessarily related to a majority, minority, plurality, or even subset of any group. A couple of author's who I passionately agree with on this subject are Patrick McManus and Orson Scott Card. They will tell you that they know how to write encoded fiction - they teach literature at the university level - but they disdain doing so. Every time that I sense an author is committing "literature" instead of telling a story, I get annoyed.

When I started this thread, I was only halfway through the book and confused by it. I knew that I should be getting something valuable from the book, because so many doctors hail it as one of the few sources of accurate information, but I was missing something important, and started this thread for you all to help me. You have done so.

But while I was finishing the book, I realized why I was confused. It wasn't because I was dense, it was because the author was encoding his meaning.

When I first started teaching my adult Bible classes at church, I tried to teach inductively. That is, I tried to lead my class to my conclusions by presenting my arguments without first telling them what my point was. I often succeeded only in confusing them. After a few months, I realized that I was also being dishonest with them. "Today we will try to discover what Christ's purpose was during his Perean ministry." No "we" wouldn't. There wasn't any "discovery" involved. I already knew the answer.

Now I teach deductively. Tomorrow I shall start my class this way. "The purpose of Christ during his Perean ministry was to build upon his disciples new-found understanding of his divinity. You can see this in the following scriptures..."

I know that "The House of God" is a valuable medical classic that has done a lot of good for all of us. But excuse me for a moment while I recover from having literature committed upon me. I now need to wash the literary fluids out of my mental cavities.
 
I quit about 100 pages in. I just didn't feel like I was continuing to get much out of it. "residency sucks, aspects of medicine suck too, becoming jaded/dark humor are ways to cope with it. You can also bang nurses. The end."
 
I quit about 100 pages in. I just didn't feel like I was continuing to get much out of it. "residency sucks, aspects of medicine suck too, becoming jaded/dark humor are ways to cope with it. You can also bang nurses. The end."

That's just about the best summary I've ever read.

I got through the book, but I was disappointed as well. I strongly suggest you read Mount Misery, it's Shem's "redemption" of his character from House of God. Shem spoke at an AMSA convention a while back and really left an impression on me. He's one of the "good guys," and he still "believes in healing medicine."

Interns, Residents, and friends on the other side, what do you think of Shem's novels?
 
I quit about 100 pages in. I just didn't feel like I was continuing to get much out of it. "residency sucks, aspects of medicine suck too, becoming jaded/dark humor are ways to cope with it. You can also bang nurses. The end."

Oh, that's good. I wish I could say that much in so few words.
 
That's just about the best summary I've ever read.

I got through the book, but I was disappointed as well. I strongly suggest you read Mount Misery, it's Shem's "redemption" of his character from House of God. Shem spoke at an AMSA convention a while back and really left an impression on me. He's one of the "good guys," and he still "believes in healing medicine."

Interns, Residents, and friends on the other side, what do you think of Shem's novels?

FWIW, Mount Misery did not get the critical praise that the prior book did. I (and most readers) wouldn't put it on the same level. Just FYI "Samuel Shem" is a pen name -- there is no such person with that name.

You guys seem to have issue with the fact that the guy didn't sum up his point in one paragraph, rather than craft a book that millions enjoyed. I think you need to stick with authors you are comfortable with, because you apparently don't "get" this style of writing, which has been revered by many generations of American readers. That you don't care for it is fine -- you are free to read whatever you like. But don't delude yourself into thinking that the author is "committing literature" or "encoding fiction" on you like that is some crime. This isn't a text book. It's a story, encompassing a period of the author's life in the depths of internship. If you really think a book that merely says, "internship sucks, you become jaded, the end" is better than a strongly written novel with a healthy dose of reality mixed in, then I'm sorry but you simply aren't a very sophisticated reader.

It's troubling that you feel that the author was trying to "impose literature on you" as if he's sneaking something in, or "encoding fiction" as one of you called it. Don't think of literature as a bad thing. It's what all writers should be striving for, and generally are striving for. If you are not writing literature, you are writing garbage. The goal of all writers is to be the next Hemingway, Dickens, Fitzgerald, not to merely get a point across. You simply are looking for a take-home message rather than enjoying a novel. Which is unfortunate -- the take-home message is only a tiny tiny fraction of any novel, and generally not the critical part. Most people read for the enjoyment of it, not to get the message. Good writing is 95% entertainment, 5% message. If you flip the percentages you get a textbook, not something you read for enjoyment, and not something that ever will grace the bestseller list. Don't read a novel trying to figure out the message, read a novel because it's a good read (as this one is). You will enjoy reading a whole lot more if you take this approach.

Your analysis is sort of like tuning in Jerry Springer at the end for his wrap up message, rather than watch the trainwreck that is his show. Or looking up the box scores of a sporting event rather than watching the game, because you just want the conclusion, not the entertainment -- if you go through life doing that, you miss the best part. Don't look at literature as a negative -- it's the goal. If you don't like "literature", you probably shouldn't be commenting on what's a good book, because honestly "literature" is the gold standard in writing. If you feel the author has achieved "literature" you are praising his work as having reached the pinnacle of his art form. Basically if you call the work literature it is a kin to calling it literary genius. So it's kind of humorous that you throw around that word like it's an insult and that he's trying to sneak something by you.

I don't know who told you to read House of God for the message, or as if it's a textbook on internship. I think your approach to that book probably tainted your ability to enjoy it. It is a novel, with a lot of reality mixed in. It isn't about the message, it's about a year in the author's and others lives. It's a good read, nothing more. Don't read it for the encoded message. Read it because you like to read and this is a fascinating story, well written, revered by many, about a topic that you probably should find interesting. If you read it for any other purpose, you miss the boat (as some posters in this thread clearly have). FWIW, you may enjoy it more after internship -- it's a better read once you can relate to the experiences. But don't kid yourself into thinking this is a "bad book" because some of you guys approached it oddly.
Best of luck.
 
As with all art (and I do consider literature to be art), value and beauty are in the eye of the beholder. And that's pretty much the issue from my perspective. Speaking as someone who loves to read literature, I'd argue that passing off "House of God" as an example of literature is about the worst character assassination of real literature that I can possibly come up with. Your analogy between the novel and Jerry Springer was pretty apt, actually. Sure, it's entertaining if that's your type of humor, and sure, it's "real life" as some experience it. But it's not exactly the universal human experience, and IMO, it's more pathetic than entertaining.

Oh, and don't be so troubled by other people's "mistaken" interpretation of art, L2D. Every time I go to someone's house or walk into any public building, I'm reminded again that there's no accounting for other people's tastes. 😛
 
As with all art (and I do consider literature to be art), value and beauty are in the eye of the beholder. And that's pretty much the issue from my perspective. Speaking as someone who loves to read literature, I'd argue that passing off "House of God" as an example of literature is about the worst character assassination of real literature that I can possibly come up with. Your analogy between the novel and Jerry Springer was pretty apt, actually. Sure, it's entertaining if that's your type of humor, and sure, it's "real life" as some experience it. But it's not exactly the universal human experience, and IMO, it's more pathetic than entertaining.

Oh, and don't be so troubled by other people's "mistaken" interpretation of art, L2D. Every time I go to someone's house or walk into any public building, I'm reminded again that there's no accounting for other people's tastes. 😛

I think it's of the same genre as Upton Sinclair's "The Jungle" (about the meat packing industry), which most agree is literature, but it certainly doesn't rise to that level of quality. Other books of this genre are Liars Poker (about the finance industry), Double Billing (about law firm associate life) and 1L (about the first year of law school). I'd say it's a good but not a great book.

But in fairness I wasn't arguing that it was literature so much as I had trouble with some of the posters criticizing it because the author was "committing a literature" on them. I took issue with folks reading a NOVEL simply for the takehome, "this is what you need to know about internship" message. That's silliness. This is a good read, and that's all it's meant to be. If you are reading books for the teaching points, stick with textbooks. That's all I was saying.
 
I figured it was kind of clear in that I quit, but I guess I should have added that I also wasn't particularly enjoying it. Just didn't vibe, and, like you said, it might better after intern year. But The Sound and the Fury sure isn't for everyone either, so maybe not too.
 
I quit about 100 pages in. I just didn't feel like I was continuing to get much out of it. "residency sucks, aspects of medicine suck too, becoming jaded/dark humor are ways to cope with it. You can also bang nurses. The end."
That was about how I felt. I thought it was a crappy book that wasn't very entertaining.
 
So does this book ever become good or is it really all about a whiny little prick that somehow grew up believing that the Disney channel's portrayal of a doctor is real? Seriously, how can someone be this annoying? If I were the fat man, I would have BUFF him with a kick to the balls and TURF him onto fantasy writing.
 
I don't know what to make of internet conversations in general. And. Even though I completely understand not being excited about the book. I find it strange that people have such decidedly negative, repulsive reactions. I mean. My wife is an artist. And you have to communicate your art to the world. Otherwise it's just your thoughts. But people would say bizarre, rude, things to her sometimes at an outdoor show etc.

I don't get it. Right so. What does the TriagePremed novel look like. What does the EdLongshanks book sound like.

If I'm not into something. Say. House music. I just leave whenever someone DJ's it. I don't think. All those people having fun are imbiciles.

Like L2D said. It's an Upton Sinclair type book. If I want some delightful jazz infused right brain weirdness I'll pick up a Haruki Murakami story.

If I want to know what being an intern was like in the 70's. My favortie deacde bar none. I'll rad ethis book. And think about if anything's changed or not. Maybe get a laugh.

How does it become so comfortable maintain absolute certainty in derrogative judgement. That'd something I'd like to get from this conversation.
 
i shall check out the book later in the week 🙂
 
FWIW, Mount Misery did not get the critical praise that the prior book did. I (and most readers) wouldn't put it on the same level. Just FYI "Samuel Shem" is a pen name -- there is no such person with that name.

Law2Doc... George Orwell is a pen name, and yet we still talk about Orwellian literature. Dr. Suess, Mark Twain, Lewis Caroll, Voltaire, and many others are pseudonyms as well. When relating to their literature, we use their pen names.

From the 2009 AMSA National Convention Schedule:

http://webcache.googleusercontent.c...spx+samuel+shem+AMSA&cd=2&hl=en&ct=clnk&gl=cr

Samuel Shem (pen-name of Stephen Bergman, M.D., Ph.D.)

Sunday, March 15, 11:30 a.m.
Shem is a psychiatrist, novelist, playwright, essayist and activist. He is the legendary author of House of God and The Spirit of the Place (winner of the national "Best Novel of 2008" award from USA Book News).


I'm probably overreacting, but people on SDN are too often condescending. You could have mentioned that Samuel Shem is a pen name without assuming it was new information to me.

-C.J.
 
So all of a sudden I have to be a book writer to judge if I enjoy it? And I have never made any statement saying that people that like this book are *****s, like you imply. I'm sorry if it hurt you that I think a character in a book is annoying.

I don't know what to make of internet conversations in general. And. Even though I completely understand not being excited about the book. I find it strange that people have such decidedly negative, repulsive reactions. I mean. My wife is an artist. And you have to communicate your art to the world. Otherwise it's just your thoughts. But people would say bizarre, rude, things to her sometimes at an outdoor show etc.

I don't get it. Right so. What does the TriagePremed novel look like. What does the EdLongshanks book sound like.

If I'm not into something. Say. House music. I just leave whenever someone DJ's it. I don't think. All those people having fun are imbiciles.

Like L2D said. It's an Upton Sinclair type book. If I want some delightful jazz infused right brain weirdness I'll pick up a Haruki Murakami story.

If I want to know what being an intern was like in the 70's. My favortie deacde bar none. I'll rad ethis book. And think about if anything's changed or not. Maybe get a laugh.

How does it become so comfortable maintain absolute certainty in derrogative judgement. That'd something I'd like to get from this conversation.
 
So does this book ever become good or is it really all about a whiny little prick that somehow grew up believing that the Disney channel's portrayal of a doctor is real? Seriously, how can someone be this annoying? If I were the fat man, I would have BUFF him with a kick to the balls and TURF him onto fantasy writing.

This was the 1970s. There was no Disney Channel. Or Grey's Anatomy. Or House. or Scrubs. There was Ben Casey. The portrayal of doctors on TV was pretty limited. And folks didn't "shadow" doctors before applying to med school like they did now. They went in blind. Most of what you know about residency from SDN and the internet was not public knowledge at this time. And so folks were pretty much blindsided by the life that is internship. It was a culture foreign to most, before this book. And that made this book a very big deal, because here was a window into this life, in novel form. I promise you that you will find the "whiny little pricks" you will meet during your intern year now ten times worse than the protagonist of this book, because they now have the ability to find out a lot of this stuff ahead of time, and have nobody to blame but themselves. But before this book, there was nothing very useful out there. You went to med school thinking one thing about medical training, and came out thinking another.
 
I personally loved this book. I'm kind of surprised by these outrageously negative reviews people are giving it.
 
While I do agree with what you post about many people having no knowledge of what they are getting into at that time, I also have to think that I never thought medicine was like the idealist portrayal. How can you truly not know at some instinctual level that you'll run across some of the "nastiest" things to do with humanity if you're going into the job of curing disease? Maybe it is that I'm a product of my time and it's making my words very naive, but I'd think even during another time I would have at least suspected that I would encounter a lot of horrifying things.

This was the 1970s. There was no Disney Channel. Or Grey's Anatomy. Or House. or Scrubs. There was Ben Casey. The portrayal of doctors on TV was pretty limited. And folks didn't "shadow" doctors before applying to med school like they did now. They went in blind. Most of what you know about residency from SDN and the internet was not public knowledge at this time. And so folks were pretty much blindsided by the life that is internship. It was a culture foreign to most, before this book. And that made this book a very big deal, because here was a window into this life, in novel form. I promise you that you will find the "whiny little pricks" you will meet during your intern year now ten times worse than the protagonist of this book, because they now have the ability to find out a lot of this stuff ahead of time, and have nobody to blame but themselves. But before this book, there was nothing very useful out there. You went to med school thinking one thing about medical training, and came out thinking another.
 
This was the 1970s. There was no Disney Channel. Or Grey's Anatomy. Or House. or Scrubs. There was Ben Casey. The portrayal of doctors on TV was pretty limited. And folks didn't "shadow" doctors before applying to med school like they did now. They went in blind. Most of what you know about residency from SDN and the internet was not public knowledge at this time. And so folks were pretty much blindsided by the life that is internship. It was a culture foreign to most, before this book. And that made this book a very big deal, because here was a window into this life, in novel form. I promise you that you will find the "whiny little pricks" you will meet during your intern year now ten times worse than the protagonist of this book, because they now have the ability to find out a lot of this stuff ahead of time, and have nobody to blame but themselves. But before this book, there was nothing very useful out there. You went to med school thinking one thing about medical training, and came out thinking another.

I agree with your characterization and historiagraphy of the book's impact. But to that effect. Do you really think that now all of this information leads to accurate picture of anything medicine related?

I am actually curious about your thoughts on that. And if so why do you think that?

To my mind. There are many, though perhaps not as many, obstacles to an accurate picture of what one is getting into now as then. The whole premed track is dominated by the tenets of science and technological/industry-vested interests. Causing a massive distortion. Most of my colleagues don't even know how to take a blood pressure and we're about to be dumped into a healthcare system that is burdened with making us workable fools. And it didn't happen overnight. Four years of studying as if I were a scientists and then 2 more just to make certain I hit the ground as useless and ridiculous as possible has gone into the distortion of expectation as it meets with reality.

The competition for a middle class lifestyle. One of the few viable industries being the herding of babyboomers through the system. All sorts of media still indicating the ideal. And even the villianry of it is a distortion. The echo chamber between both these poles never hitting the gray morass of it. And then back to the competion and the effect of them taking a year of my wages in one week. They own me. Effectively silencing any irreverance. Any notion of rebeliousness. Any tinge of a thought that doesn't come pre-digested from above. It's completely stifling if your not adjusted to
Stepford-like acquiesence.

That's why the book still resonates with me. And we're due for another one. Panda's blog did a lot to fill this void. There's just not that much of that. Medicine seems to have a nose for killing it's prophets. For sport.


Triagepremed. Trust me I'm not hurt. I've just never had any taste for critiqueing severely anything I couldn't do myself. Exactly why I dropped out of literary study. Another lifetime ago.
 
This was the 1970s. There was no Disney Channel. Or Grey's Anatomy. Or House. or Scrubs. There was Ben Casey. The portrayal of doctors on TV was pretty limited. And folks didn't "shadow" doctors before applying to med school like they did now. They went in blind. Most of what you know about residency from SDN and the internet was not public knowledge at this time. And so folks were pretty much blindsided by the life that is internship. It was a culture foreign to most, before this book. And that made this book a very big deal, because here was a window into this life, in novel form.

This book was absolutely at the tip of the spear of the coming non-fiction medical narrative genre, which as you mentioned, didn't exist at the time. If you go by your local bookstore and pick up anything in the medical section that isn't an NCLEX study guide, it will owe a debt to The House of God. There isn't a single non-fiction or fiction depiction of internship and residency that would challenge the narrative that House of God paints: internship is a game of survival, pure and simple. Everyone is different, but coping mechanisms must be developed to survive. There are far more Fat Man's who thrive on the wards than Jo's.
 
But don't delude yourself into thinking that the author is "committing literature" or "encoding fiction" on you like that is some crime.

You may not understand my view. I know that the upper-class people of the world consider high brow literature to be superior to low-brow. I just happen to think that this is a case where upper-class people are wrong. It's a matter of taste. I also won't try Brie or quiche, es cargo, caviar, or foie gras. I suspect that I would prefer KFC to the best that Chef Ramsey can produce. I was born low-brow and I will be low-brow till I die - and concerning matters of taste (as Theodore Veblen said) there can be no argument. I know about literature, I just don't like it.

For the poster who asked, the ideal EdLongshank's novel is by Orson Scott Card or Tolkien. Both of these authors were educated men who could have written encoded fiction if they wished - but did not. I despise novels that are written as literature first, and a story second. For a good example of this, see some of Louis L'Amour's attempts at literature like "The Haunted Mesa" As I said, It's a matter of taste.

Having stated my primary criticism of Shem's book, my secondary reaction is fairly positive. He has an interesting story to tell, he just let his education get in the way. Beth Israel and its association with Harvard had clearly led to some bad synergy in the early '70's and it needed exposing and correction. The book is a satirical way of doing this. Satire is sometimes hard to read - I had a hard time working my way through Gulliver's travels also - but it is sometimes needed.
 
I don't care who gets this or not, but many a resident or fellow I ve worked with knows the truth. Many ICU and critical care RNs know this circling the drain business quite well. It's the arrogance of playing the game that is hard to stomach.

Maybe read something like "Learning to play God." Nothing worse than killing yourself during a code on a kid that has been coded for hours on end, pupils like 10 & fixed, w/ the whole DIC coagulopathy going on, and the poor kid is thinned out , bleeding literally from EVERYWHERE, yet someone decides the kid MUST go on ECMO...what an unspeakable nightmare. The smells alone can be overwhelming...and I am not talking about feces...I am talking about coding pts oozing blood everywhere for long periods of time, and well basically their body is rotting from lack of even half decent perfusion, and the whole unit is smelling like there is a giant, GI bleeder that has taken over the unit or ED. It is really nice...plus all the truly false hope and sometimes, well, incompetence....and that gets glossed over b/c after all "We are a teaching hospital."

The more experiences like these, the more I think it opens your eyes. But remember. There are also those that do get the help, and the vital, as well as other kinds of support they need.

The playing god factor gets to be way too much. Add to that all the many other factors that lead to feeling fried, and really it is not too hard to get. Most get through it, but it does take it's toll. Mostly there's a lot many have to learn to make peace with. You deal with it when you are there, though some don't deal or make peace with it. It is not for everyone. It is that simple. OTOH, many get through it knowing that they will work in an area
where they will little to never have to work with it. Not everyone can deal w/ being an ED physician, or an anesthesiologist, or a critical care intensivist.
 
Not everyone can deal w/ being an ED physician, or an anesthesiologist, or a critical care intensivist.

That's one of the most interesting posts you've ever made, Jl. As a nurse you understand this better than anyone.

But, I don't get the "anestesiologist" part of that quote. What does an anesthesiologist have to do with patients effectively already dead?
 
I don't know what to make of internet conversations in general. And. Even though I completely understand not being excited about the book. I find it strange that people have such decidedly negative, repulsive reactions. I mean. My wife is an artist. And you have to communicate your art to the world. Otherwise it's just your thoughts. But people would say bizarre, rude, things to her sometimes at an outdoor show etc.

I don't get it. Right so. What does the TriagePremed novel look like. What does the EdLongshanks book sound like.

If I'm not into something. Say. House music. I just leave whenever someone DJ's it. I don't think. All those people having fun are imbiciles.

Like L2D said. It's an Upton Sinclair type book. If I want some delightful jazz infused right brain weirdness I'll pick up a Haruki Murakami story.

If I want to know what being an intern was like in the 70's. My favortie deacde bar none. I'll rad ethis book. And think about if anything's changed or not. Maybe get a laugh.

How does it become so comfortable maintain absolute certainty in derrogative judgement. That'd something I'd like to get from this conversation.
Have you ever read your posts....on weed?
 
You may not understand my view. I know that the upper-class people of the world consider high brow literature to be superior to low-brow. I just happen to think that this is a case where upper-class people are wrong. It's a matter of taste. I also won't try Brie or quiche, es cargo, caviar, or foie gras. I suspect that I would prefer KFC to the best that Chef Ramsey can produce. I was born low-brow and I will be low-brow till I die - and concerning matters of taste (as Theodore Veblen said) there can be no argument. I know about literature, I just don't like it.

For the poster who asked, the ideal EdLongshank's novel is by Orson Scott Card or Tolkien. Both of these authors were educated men who could have written encoded fiction if they wished - but did not. I despise novels that are written as literature first, and a story second. For a good example of this, see some of Louis L'Amour's attempts at literature like "The Haunted Mesa" As I said, It's a matter of taste.

Having stated my primary criticism of Shem's book, my secondary reaction is fairly positive. He has an interesting story to tell, he just let his education get in the way. Beth Israel and its association with Harvard had clearly led to some bad synergy in the early '70's and it needed exposing and correction. The book is a satirical way of doing this. Satire is sometimes hard to read - I had a hard time working my way through Gulliver's travels also - but it is sometimes needed.

You didn't mention C.S. Lewis or whether you care for his writing or not. His style is the epitome of the "encoded message", but I would think (an admitted assumption) that his subject matter would resonate well with you.

And how can you say you'll never even try Brie? Just because it's "high-brow"? Wha? Get over your silly notions about the pretentiousness of cheese and melt some Brie over some sliced Granny Smith apples. It's the bomb.
 
You didn't mention C.S. Lewis or whether you care for his writing or not. His style is the epitome of the "encoded message", but I would think (an admitted assumption) that his subject matter would resonate well with you.

And how can you say you'll never even try Brie? Just because it's "high-brow"? Wha? Get over your silly notions about the pretentiousness of cheese and melt some Brie over some sliced Granny Smith apples. It's the bomb.

CS Lewis doesn't encode his message. It's explicit. If you are talking about the Narnia books, then they are a series of books that answer the question, "What would Christ be like in another universe." He then proceeds to tell a good story.

It's funny that you bring up Lewis. In his "Surprised by Joy", he discusses this very subject of having a taste for high art. He notices that he has a taste for it and most people do not - and he felt superior to those who do not - though he struggled against this particular vanity. So Lewis is on your side of the debate. Most of his fiction, on the other hand, is on mine. If you want to read his encoded fiction - try the space trilogy, if you can struggle through it.

In both Tolkien's and Lewis's worlds there is an underlying philosophy through which that world makes sense. But the reason that philosophy is there is not because they encoded it into the fiction, but rather because it's what they believed. Tolkien was a medieval Catholic and Lewis was a "mere Christian".

My problem with much of modern literature (beginning with Moby Dick, for instance) is that the author wants you to discover his purpose, instead of telling you his purpose and then illustrating it with a good story.

In the afterward of the 2010 publication of "The House of God" (on Kindle) Stephen Bergman describes his time spent as Rhodes Scholar "I didn't want to be a scientist, I wanted to be a writer." He went into medicine because it was either that or be drafted to Vietnam.

He also talks about his time in Dublin and the hospital where some of James Joyce's "Ulysses" is set. "Wandering Duplin - damp, chill, coal-smoke, and stale Guinness - and reading Joyce and Beckett and Synge and Yeats and, a a master of humor, Flann O'Brien, Writing. Doctoring. Hand in hand."

So, that's his idol. James Joyce. And, everyone can agree, "Ulysses" is the pinnacle of encoded fiction.

Look, I agree it is a good and useful book. I just resent being raped by high art against my will. I am certainly not seduced.
 
I think that whether or not you identify with the author on this might depend on your philosophy of why healthcare? For me, I identify because I feel like healthcare is an effort to do the best we can to take care of people & acknowledge their human dignity. If I make a difference, it is not due to my awesomeness, its due to a combination of the patient, the disease, the education level, the environment, chance, etc.

I volunteered at an urban free clinic for two years, and learned quickly that it is not about me at all. If you make it about yourself and wait on people to pat on the back for the difference that you made in someone's life, you are guaranteed to be disillusioned. Sometimes people spit in your face or try to steal the rubbing alcohol, sometimes they are back the next week for the exact same thing, and no matter what I did--they were still sleeping on the streets and penniless--the root of almost all their health concerns.

I believe that I am responsible for how I treat the patient--I believe in treating everyone with dignity, respect, and empowering them to make decisions regarding their own health. What did I do in these cases? Just press on and treat them like regular human beings--stay focused on what my role was--to improve their lives (through healthcare & listening) and not to be judgemental.

Honestly, we know that life descends into entropy--all I hope to do as a physician is fight back against that entropy for a little bit and hopefully improve lives in the process. Validation comes from yourself and those you love--if I hope for it from patients, I am dissapointed.

Another subject I found interesting was that of making fun of patients. I know it is inevitable everywhere--I was in the military, human resources area for 7 years--and complaining about customers is way too easy to do. But, it sets up an us vs. then dynamic that pervades the way you treat people. And honestly, I find it disrespectful to people. I never let my military folks disparage customers.

And Paul Farmer said it best "You can't sympathize with the staff or you end up not sympathizing with the patients."

Anyway--how interesting to read all the discussions here. Thanks for starting it EdLongshanks.
 
That's one of the most interesting posts you've ever made, Jl. As a nurse you understand this better than anyone.

But, I don't get the "anestesiologist" part of that quote. What does an anesthesiologist have to do with patients effectively already dead?

Anesthesiologists pretty much take over when patients code in the OR is my understanding
 
That's one of the most interesting posts you've ever made, Jl. As a nurse you understand this better than anyone.

But, I don't get the "anestesiologist" part of that quote. What does an anesthesiologist have to do with patients effectively already dead?

OK well anesthesiologists in effect have to deal with critical patients. Now some may deal more with pain mgt or basic, simply surgeries, but even w/ those, anything that can go wrong often enough wil go wrongl. Murphy's Law lives strong in all of medicine IMHO. Should be the first thing they teach second or third years.

Critical care intensivists tend to be those that have first trained in anesthesiology...not always but a lot. In fact, at a famous children's hospital that I worked in, that was the requirement for the critical care intensivist fellowship-->having undergone residency in anesthesilogy. In many areas of critical care and in a number of units, we intensive recovery nurses not only work with surgeons, IM people, and interventionists, but also we work a lot with anesthesiologists. I have been lucky to have had great experiences with many of them.

At any rate, often they are the ones running the codes in many critical care areas, including ORs, PACUs, ICUs, etc. Anesthesiology residency is cool, but it's very hard and stressful.
 
I think that whether or not you identify with the author on this might depend on your philosophy of why healthcare? For me, I identify because I feel like healthcare is an effort to do the best we can to take care of people & acknowledge their human dignity. If I make a difference, it is not due to my awesomeness, its due to a combination of the patient, the disease, the education level, the environment, chance, etc.

I volunteered at an urban free clinic for two years, and learned quickly that it is not about me at all. If you make it about yourself and wait on people to pat on the back for the difference that you made in someone's life, you are guaranteed to be disillusioned. Sometimes people spit in your face or try to steal the rubbing alcohol, sometimes they are back the next week for the exact same thing, and no matter what I did--they were still sleeping on the streets and penniless--the root of almost all their health concerns.

I believe that I am responsible for how I treat the patient--I believe in treating everyone with dignity, respect, and empowering them to make decisions regarding their own health. What did I do in these cases? Just press on and treat them like regular human beings--stay focused on what my role was--to improve their lives (through healthcare & listening) and not to be judgemental.

Honestly, we know that life descends into entropy--all I hope to do as a physician is fight back against that entropy for a little bit and hopefully improve lives in the process. Validation comes from yourself and those you love--if I hope for it from patients, I am dissapointed.

Another subject I found interesting was that of making fun of patients. I know it is inevitable everywhere--I was in the military, human resources area for 7 years--and complaining about customers is way too easy to do. But, it sets up an us vs. then dynamic that pervades the way you treat people. And honestly, I find it disrespectful to people. I never let my military folks disparage customers.

And Paul Farmer said it best "You can't sympathize with the staff or you end up not sympathizing with the patients."

Anyway--how interesting to read all the discussions here. Thanks for starting it EdLongshanks.


I have to agree with many of your points here rural.
 
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