<strong>MUSA</strong> 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that will be difficult to reconcile with the reality of resident life thirty years later: The text is littered with outdated medical references, and is punctuated throughout with a tone of arcane paternalism that would be unacceptable by today’s standards.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 <strong>Alberta</strong> Health Sciences Journal • April 2012 • Volume 7 • Issue 1
Thank you The UAHSJ wishes to thank the Faculty of Medicine and Dentistry for their generous support of this project.
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