Spoiler alert (esp. 3rd paragraph) Also, this book has some very *explicit* parts.This novel follows an intern, Roy G. Basch, for his internship year at a prestigious hospital nicknamed the “House of God.” Roy must deal with sickness of the elderly, the death of the young, the competition of his peers, the lack of an outside life, and the tension with his superiors. Roy discovers providing medical care is nothing like what he was taught in medical school. Each of these stresses makes Roy withdraw more and become more cynical. He eventually decides that medicine is not for him and takes a year off before going into psychiatry.tOne of the most interesting parts of the book is the juxtaposition of the two most prominent residents, Fats and Jo. Jo is an over-achiever who truly believes that she can cure all her patients. She never gives up, trying every intervention possible. She will come in even on her nights off to check on her patients. Fats, on the hand, makes fun of ‘”gomers” or old people who are so sick that they will never get better. Gomers are often unresponsive, so it is easy for the medical staff to not think of them as humans. Fats teaches the interns the rules of the “House of God.” He is trying to teach them how to not be hurt by working at the hospital. Fats states that the best thing to do is nothing. Often actually providing medical care actually makes the patient worse. To the interns surprise, Fats is right. As a patient, one would think that Jo would be the “better” resident, both in terms of provision of care and bedside manner. However, Fats is the one the patients love, and he has better outcomes. Yet the hierarchy of the hospital thinks he is too unorthodox and discounts him. Fats’s approach reminds me of Norman Cousin’s homeostatic theories. Sometimes it is better to let the body heal itself. It is an indication that we really do not fully understand how our bodies operate, so we cannot always properly intervene. tThe disrespect with which the interns treat the patients, especially the gomers could be unsettling. I wonder how true this feeling about patients is. Both The Doctor and Wit depict the medical staff as not caring about the patient and not bothering to learn names. Those doctors are only interested in the disease. However, in House of God, it goes a step further to actual derision. The book is trying to make the point that some defense mechanism is necessary to be able to survive the true sadness of the situation. This point is really driven home by the suicide of Potts, the one intern who did not give in to the cynicism and contempt of the others. He let everyone and everything knaw away at him. The book recognizes how morally reprehensible it is to make fun of the sick, as shown by Berry’s (Roy’s girlfriend) disgust at Roy’s jokes. What Roy had to learn (from Fats) is that these jokes are only acceptable in the company of other interns and residents on the unit. Fats understands the boundaries of protecting yourself and being callous. Roy, on the other hand, universally applies what he deems acceptable behavior. Eventually, Roy does learn how to become a less cynical doctor.This book is appealing for a lay-person because it describes so much of the day-to-day workings of the hospital for interns. For example, Roy rotates through several different units and schedules, and the reader learns the benefits and detriments to each type of unit. It could be surprising what Roy ended up enjoying, like the ER and the MICU over the usual wards. The usual wards were full of patients who were not going to get better, whereas there was more change and excitement in the other areas. It would be hard to describe all the details that were interesting to me as a lay-person, but I enjoyed that the book was able to give me the perspective of a hospital intern.
I don't usually review books I rate at 3 stars or lower, but this is an exception: I detest this book so much that I feel compelled to write something about it.Make no mistake: I am a resident physician (and read this book during my internship year), so none of the horrible things that happen in the book faze me. I am also the last person to dislike a book because it is not "feel-good", or because it offers more questions than solutions (those are often the best books). However, I take issue with this book because, to me, it doesn't deliver what it promises. "The Classic Novel of Life and Death in an American Hospital:" for me, the only word true in that subtitle is "Novel."The main character, a thin guise for the author himself, goes through internship. He is overworked, he is bitter, and he has sexy escapades with nurses and social workers while his fiance psychoanalyzes him. Okay, been there done that (minus the sexy escapades and fiance part). Let's see: then he rants against the evil of the medical training system and the futility of the medical care he delivers. Fine, now that the obvious stuff is out of the way, let's cut to the chase. Oh wait, now it's over.But where are the other things? Where's the guilt, not just over how you think you mishandled a patient's care, but also over how you've not lived up to what others and what yourself expected of you and how you've neglected all friends and family? What about the oppressive sense of responsibility which we are initially overwhelmed with, frequently take for granted, sometimes make light of, often resents, and occasionally try to dodge? What about inevitable dehumanization that is not so much created by a villanous, uncaring system but is really a part of the job description? What about your transferences and countertransferences towards patients, your natural defense systems and how they sabotage your clinical judgement, making you even more guilty and defensive, your feeling of inadequacy that is only outweighed by your desire to be somehow normal again and part of the rest of humanity? These are things my colleagues and I deal with on a daily basis. This so-called "classic" doesn't address any of them except in the most perfunctory manner possible.What it does do is rage against the residency system of his time. There have been immense changes since then; some may say the pendulum has even swung too much the other way. I cannot find much beyond that. The book is of historical interest in that regard, but given the depth of the emotional toil that is internship, I expected a lot, lot more out of the "classic novel".It also doesn't help that the central character acts like a sociopath, and I don't think you can blame that solely on the system.
What do You think about The House Of God (2003)?
I was an intern in 1978 which is the copyright of this book. I never read it until now and I'm not sure why. The stage was overwhelmingly familiar to me and makes me wonder now how much that year has affected my life, who I would be had I not done it. I do not know how this book would read to someone who has not been a health care provider, but I can say that it presents the full spectrum of emotions of a young life under intensely stressful situations. It includes a fair amount of comedy relief and, fyi, is very sexually explicit and not politically correct.
—Colleen Parker
Over the years, I've been told many times by many different people that I should read The House of God. These recommendations usually come with some variation on an explanation that the book is a thought provoking insight into the delivery of healthcare and/or medical education. I envisioned delving into an Atul Gawande-esque, cerebral discussion of the virtues and limitations of modern medicine. Instead, I found myself stifling gut wrenching laughter as I - initially - enjoyed this "fictionalized" memoir of a first year resident in the 1970s. This, while in the middle seat on a transatlantic flight, must have left the people next to me thinking they were stuck next to a madwoman for eight hours.I thoroughly enjoyed the beginning of the novel, cherishing (and identifying with) the interns' horrors at their introduction to hospital wards and the stereotypes of their patients and the care they receive. The descriptions of the emotions that an overburdened, under supported intern can feel are things I can imagine or have experienced in some way. These depictions were raw and utterly honest. For that, I would recommend this book to any medical student or resident.This exploration of the trials and challenges of medical training becomes consuming - to the protagonist and to the reader. I take most of the later part of the book with "a grain of salt" - recognizing this novel as the catharsis of a disillusioned resident who - notably - abandons his career path, takes time off of residency training, and ultimately returns to specialize in psychiatry.For the gratuitous and extreme male chauvinism illustrated in The House of God, I find the book nearly unreadable. The protagonist's treatment of women is repugnant and offensive. His interactions with female colleagues and hospital staff constitute sexual harassment by any definition. Furthermore, the depiction of the protagonist's relationship with his girlfriend reads like an adulterers' fantasy of a self-sacrificing, subordinate female partner, which I find difficult to read. Ok, ok ... the book was written in the '70s and should be examined within its historical context, you say. In response, I'll point you to the author's afterword, written 25 years after the book was published. Nearly hidden in the author's self-congratulatory remarks are a few reflections on changes in medicine since the book's debut. He mentions that, "Another great advance is the status of women - now at least fifty percent of medical school students (in 1973 they were ten percent). As carriers of caring in our culture, women bring these qualities to the care of patients and relationships with peers," then quickly skips to applaud adoption of meditation and acupuncture as other great advances in the field. Hardly enough for me to come close to seeing past the frat-boy-like detailing of the protagonist's sexual exploits and abuse of nurses, social workers, and the solitary female resident so unflatteringly depicted in the novel.
—Rosemary
When I was a nursing student, I was sitting at the nurses station and writing a rough draft of my patients notes for my supervising RN to read through before I put them in the file. One of the medical interns sat down next to me and asked me if I'd read The House of God. I thought he might have been trying to convince me to join some obscure religion. I hadn't, I warily told him so, and he threw his hands up in the air and said "You have to, you need to read it, it's real life put down on paper, and it will stop you going mad. Or make you feel better about going mad when you do get there. It certainly made me feel better about going mad. They tell us we should read it, but they never tell you nurses and that's a crime. So I'm telling you now. Have a good shift!". Then he bounced up out of his chair and disappeared to wherever doctors go when they're not making the place look messy and stealing the charts just before you need them.It took me a while to track down this book, but now I have I can absolutely say that this intern was one hundred percent right. This book IS real life down on paper. Everything in it (with regards to patients, emotional turmoil, medical care, and bowel runs) is totally relate-able. It may be dated (all these references to the Nixon era make only the vaguest sense to anybody in my generation who is not American) but it is still relevant, and after my first year out, it was cathartic to read this book and see that it isn't just me. Other people before me have felt the same helplessness and cynicism and experienced the same highs and lows, regardless of when they started or whether they're medical or nursing or anything else. And the Laws of the House of God? Are hilariously, wonderfully, absolutely true.
—McGooglykins
