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MST Recommended Reads For Med Students (and Everyone Else): The House of God

Welcome to this, the first of hopefully many installments of MST’s “book club,” where we recommend books for people in the medical field, or review books that have been recommended.

We start off with a classic, Samuel Shem’s tale of madness, sex, and heartbreak in the intern year, The House of God. I first read this as a medical student in my first year when a preceptor told us that we should all read it several times in our career—during our pre-clinical years, during our clinical years, during our intern year, as a resident, and probably once again after that point.

I read it, loved it, gave it away for the benefit of other med students, and revisited it just now, 6 years later, for this review.

It’s even funnier, more poignant, maddening, and heartrending now, after all the experience I’ve had since then (kinda like watching Office Space when you’ve worked in the corporate world for a while). I can’t recommend this book enough, and am here to answer all your questions about it.

Can you give us a pat, pithy description of the book?
Catch-22 for doctors

How about describing the experience in six words?
Scream and laugh till you cry

In one-half word?

What’s the premise?
It covers the medical intern year of one Roy G. Basch at the fictional House of God, loosely based on the author’s (Shem is a pseudonym for Stephen Joseph Bergman) experience at one of Harvard’s teaching hospitals. It follows him and his colleagues as they fight against exhaustion and apathy, rage against the system, and descend into increasingly destructive patterns.

But this is a hyperbolic satire, right? I mean, how true can it be?
It is biting satire, but it’s true enough that Bergman used a pseudonym, and that I will not be detailing the ways in which Basch’s experience matches mine.

That sounds kind depressing. Is this book depressing?
It’s no more enraging or depressing than working in this field, doing this work in this climate.

So…why should I read a book that makes me angry or sad?
Because these are the things you’ll feel and do. This is with what you will deal. Nowhere else have I heard someone so unflinchingly describe how what’s at stake in this work is our very humanity. Nowhere else has someone so thoroughly covered every defense and coping strategy we employ to deal with our anxieties about our own helplessness, our uncertainty, our ignorance, our failures, our futility against the unending march of death and decay. These are the things that make us pull away from our loved ones, to retreat into intellectualization, algorithms, phrases such as, “The patient failed treatment,” and avoiding the terminally ill and their families – anything to avoid painful contact with others or our lack of control.

Wow. That sounds important. But what about the satire? Will this make me laugh?
Out loud, even. I cackled to myself on the train aplenty while reading this. If you’re the type of person who likes to use medical terminology in everyday scenarios, even better. Here are some examples:
pg. 136 – “You know what they say: It’s better to have dyspareuned than never to have pareuned at all.”
pg. 187 – The nurse said there was a man I’d better see right away, his blood pressure being “patent pending over 150.” “Patent pending over 150? What the hell’s that?” “At the top of the scale where the mercury ends, the machine says ‘patent pending.’ the highest it goes.” A new House record.
pg. 296 – Unfortunately, Gogarty turned out to be a smokescreen, for as Jo and the nurses left his room what sight should greet their eyes but Old Lady Zock spread-eagled nose-down on the tiled Unit floor, stone dead. It turned out that, having heard the commotion in Gogarty’s room, Old Lady Zock, in a final philanthropic gesture, had wished to pitch in at the arrest, and following the most heart-rending of House LAWS: GOMERS GO TO GROUND, had done so, in the process dislodging the cardiac pacemaker which was prodding her generous heart, and had died.
[When Chuck – an intern who is working hard to protect his patients from the aggressiveness of his resident – saves a woman who’s struggling to breathe by looking in her mouth, finding a piece of broccoli lodged in her throat, and removing it, he has the following exchange with his resident:] “What are you doing for her?” asked Jo. “What am I doing for her? Why, I got her on a low-broccoli diet, gurl, what else?”

How’s the writing?
Wonderful. Here are some examples:
pg. 5 – I’ve been drunk while swimming in our river, at noon the temperature of water, air, and body all the same, so that I can’t tell where body ends and water begins and it’s a melding of the universe, with the river curling round our bodies, cool and warm rushes intermingling in lost patterns, filling all times and all depths.
pg. 176 – “Sure, Gramp,” I said, my mind filled with plus purple couches in a dark vestibule and the creaking metal-slatted elevator and then the childhood thrill of running down the long peculiar-smelling corridor toward Gram and Gramp’s door, which would be thrown open and filled with their embraces.

Can you compare the writing to any authors we know?
The most obvious comparison is to Heller’s Catch-22, though this is a bit more serious. Shem’s style is his own, but it did remind me in places of different books/authors I’ve loved. The plays on common phrases reminded me of the zany mischief of Adam’s The Hitchhiker’s Guide to the Galaxy. E.g.:
“I think it’s great. You should see the cases we’re going to get now.” Soon we saw the cases we were going to get then.
All the acronyms and capitalized terms, as well as the glossary in the back, reminded me of ingsoc in Burgess’ A Clockwork Orange. The talk of being hurt by the system and the system’s desire to be loved by those it tortures reminded me of Orwell’s 1984. The colorful characters reminded me of Toole’s A Confederacy of Dunces.

Sounds promising. Any other benefits to reading this book?
Shem, a psychiatrist, does a remarkable job of portraying every defense mechanism and coping strategy commonly employed by those who face the harsh realities of this work, and expertly depicts progressive psychopathology in providers, from symptoms of trauma to depression to psychosis.

Any last words?
Yes. Read this book early and often. Keep your friends close. Revel in the joys of this work, and allow yourself to feel your pain. And perhaps above all, find your own Berry and never let go.

Have you read The House of God? Have any books to recommend? Tell us below!