MUSA - Alberta Pharmacy Students' Association

MUSA
general themes that many facing a career in
a medical discipline are likely to encounter:
from management of chronically ill patients,
to acrimonious relationships (both personal
and professional) with fellow colleagues.
If you have not yet read the House of God,
your first thought may be whether this
fictionalized account from the 1970s has
any relevance to the plight of today’s
medical trainee. The short answer, which
becomes obvious even after the first few
chapters describing Roy’s arrival to the
House, is a resounding yes. There are of
course elements of the book that will be
difficult to reconcile with the reality of
resident life thirty years later: The text is
littered with outdated medical references,
and is punctuated throughout with a
tone of arcane paternalism that would be
unacceptable by today’s standards. These
anachronisms, however, beyond reminding
us that the book is situated in another era
altogether, are also important for another
reason. They allow today’s reader to
appreciate those egregious aspects of the
American healthcare system of the 1970’s
for their comic relief, and serve to reinforce
many of the book’s themes. Furthermore,
the fact that many of its themes still apply
today only reinforces Bergman’s talent and
perspicacity.
By introducing us to the morbid humour
and unsavory behaviour which Roy and
his colleagues would often invoke to make
sense of the difficult situations in which
they found themselves, Bergman reveals the
importance of having a stress outlet. We see
this evinced through different characters
in the book. The narcissistic Pinkus
comes to mind, with his utter emotional
detachment from his ICU patients, coupled
with his nearly monastic devotion to his
own running routine and sculpted calves.
The lack of an appropriate outlet is also
mirrored in Roy’s steadily mounting inner
turmoil as his internship year progresses.
Our protagonist’s ongoing awareness of the
macabre, often futile nature of his various
coping strategies gives the narrative further
36
depth and tension, and keeps the reader
wondering just how much more Roy can
take.
Bergman’s development of secondary
characters to further explore the
complexities of internship is nicely
accomplished. Notable among these is Barry,
his clinical psychologist girlfriend, whose
unwavering presence serves as a moral
counterweight to his frenetic mood swings
and constant disequilibrium. Indeed, Barry’s
views often come across as a reminder of
the humanity and basic conscientiousness
that Roy begins the year with, but gradually
loses, as he sinks further into the soulsucking
drudgery of ward-based medicine at
the House.
Roy’s in-house sanity is provided by the
enigmatic and brilliant senior resident,
known only as the ‘fat man’, whose
sacrosanct “Laws” of the House come to
form the basis of most of Roy’s clinical
decisions, often in flagrant disregard to
everything his previous medical education
has taught him. While some may seem
trite at first (e.g. law #4 “THE PATIENT IS
THE ONE WITH THE DISEASE”), others,
such as law #13, come to signify one of the
book’s pervasive themes: “THE DELIVERY
OF GOOD MEDICAL CARE IS TO DO AS
MUCH NOTHING AS POSSIBLE”. This
statement may seem fairly counterintuitive
at first, but gains considerable traction
when considered in the context of Roy’s
misadventures at the House.
The House is also a rich resource on
terminology for any new initiate to the
medical sphere, and worth the read from
that perspective alone. Here we find the
origins of terms that many of us may be
familiar with already, such as GOMER (‘get
out of my emergency room’); BUFF (the
careful art of making a chart look good,
which often treads the fine line between
perjury and embellishment); and TURF
(using any excuse possible to hand off
care of your patient to another service or
department). While such catchwords may
not be used very frequently today, the spirit
of these terms almost certainly persists, as
many with first-hand clinical experience will
recognize.
Dr. Bergman also addresses the notion of
hierarchy throughout the book, and how
embedded it is at all levels of training and
administration. While his criticisms are
often oblique and bordering on subversive
(often at the expense of one of Roy’s senior
colleagues or House staff), they are also
poignant and hilarious. A particularly
memorable image is that of the Leggo, Roy’s
uptight and oblivious superior staff member,
with his stethoscope in its default position
winding down into his trousers (which Roy/
Bergman playfully mocks throughout the
book). Interestingly, Bergman’s depiction
allows the reader some first-hand insight
into both the folly and utility of this
entrenched system, the relics of which are
still present today.
At the end of the day, The House of God
is a pleasant and engrossing read, and
there is much to be gained in reflecting on
Roy’s tumultuous foray into the world of
hospital-based medicine. The prescience of
this book and the ‘Laws of the House’ are
worth noting today as we find ourselves
in the midst of health care system that is
underfunded, short-staffed, and overused.
In critiquing the medical system in which
we train and work (albeit through the lens
of a 1970s intern), The House of God forces
the reader to consider just how sustainable
our current practices are. This message is
especially pertinent in the context of our
ageing population, since many of our current
practices in medicine were founded in Roy’s
era of relative resource abundance.
University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1