MUSAgeneral themes that many facing a career ina medical discipline are likely to encounter:from management <strong>of</strong> chronically ill patients,to acrimonious relationships (both personaland pr<strong>of</strong>essional) with fellow colleagues.If you have not yet read the House <strong>of</strong> God,your first thought may be whether thisfictionalized account from the 1970s hasany relevance to the plight <strong>of</strong> today’smedical trainee. The short answer, whichbecomes obvious even after the first fewchapters describing Roy’s arrival to theHouse, is a resounding yes. There are <strong>of</strong>course elements <strong>of</strong> the book that will bedifficult to reconcile with the reality <strong>of</strong>resident life thirty years later: The text islittered with outdated medical references,and is punctuated throughout with atone <strong>of</strong> arcane paternalism that would beunacceptable by today’s standards. Theseanachronisms, however, beyond remindingus that the book is situated in another eraaltogether, are also important for anotherreason. They allow today’s reader toappreciate those egregious aspects <strong>of</strong> theAmerican healthcare system <strong>of</strong> the 1970’sfor their comic relief, and serve to reinforcemany <strong>of</strong> the book’s themes. Furthermore,the fact that many <strong>of</strong> its themes still applytoday only reinforces Bergman’s talent andperspicacity.By introducing us to the morbid humourand unsavory behaviour which Roy andhis colleagues would <strong>of</strong>ten invoke to makesense <strong>of</strong> the difficult situations in whichthey found themselves, Bergman reveals theimportance <strong>of</strong> having a stress outlet. We seethis evinced through different charactersin the book. The narcissistic Pinkuscomes to mind, with his utter emotionaldetachment from his ICU patients, coupledwith his nearly monastic devotion to hisown running routine and sculpted calves.The lack <strong>of</strong> an appropriate outlet is alsomirrored in Roy’s steadily mounting innerturmoil as his internship year progresses.Our protagonist’s ongoing awareness <strong>of</strong> themacabre, <strong>of</strong>ten futile nature <strong>of</strong> his variouscoping strategies gives the narrative furtherdepth and tension, and keeps the readerwondering just how much more Roy cantake.Bergman’s development <strong>of</strong> secondarycharacters to further explore thecomplexities <strong>of</strong> internship is nicelyaccomplished. Notable among these is Barry,his clinical psychologist girlfriend, whoseunwavering presence serves as a moralcounterweight to his frenetic mood swingsand constant disequilibrium. Indeed, Barry’sviews <strong>of</strong>ten come across as a reminder <strong>of</strong>the humanity and basic conscientiousnessthat Roy begins the year with, but graduallyloses, as he sinks further into the soulsuckingdrudgery <strong>of</strong> ward-based medicine atthe House.Roy’s in-house sanity is provided by theenigmatic and brilliant senior resident,known only as the ‘fat man’, whosesacrosanct “Laws” <strong>of</strong> the House come t<strong>of</strong>orm the basis <strong>of</strong> most <strong>of</strong> Roy’s clinicaldecisions, <strong>of</strong>ten in flagrant disregard toeverything his previous medical educationhas taught him. While some may seemtrite at first (e.g. law #4 “THE PATIENT ISTHE ONE WITH THE DISEASE”), others,such as law #13, come to signify one <strong>of</strong> thebook’s pervasive themes: “THE DELIVERYOF GOOD MEDICAL CARE IS TO DO ASMUCH NOTHING AS POSSIBLE”. Thisstatement may seem fairly counterintuitiveat first, but gains considerable tractionwhen considered in the context <strong>of</strong> Roy’smisadventures at the House.The House is also a rich resource onterminology for any new initiate to themedical sphere, and worth the read fromthat perspective alone. Here we find theorigins <strong>of</strong> terms that many <strong>of</strong> us may befamiliar with already, such as GOMER (‘getout <strong>of</strong> my emergency room’); BUFF (thecareful art <strong>of</strong> making a chart look good,which <strong>of</strong>ten treads the fine line betweenperjury and embellishment); and TURF(using any excuse possible to hand <strong>of</strong>fcare <strong>of</strong> your patient to another service ordepartment). While such catchwords maynot be used very frequently today, the spirit<strong>of</strong> these terms almost certainly persists, asmany with first-hand clinical experience willrecognize.Dr. Bergman also addresses the notion <strong>of</strong>hierarchy throughout the book, and howembedded it is at all levels <strong>of</strong> training andadministration. While his criticisms are<strong>of</strong>ten oblique and bordering on subversive(<strong>of</strong>ten at the expense <strong>of</strong> one <strong>of</strong> Roy’s seniorcolleagues or House staff), they are alsopoignant and hilarious. A particularlymemorable image is that <strong>of</strong> the Leggo, Roy’suptight and oblivious superior staff member,with his stethoscope in its default positionwinding down into his trousers (which Roy/Bergman playfully mocks throughout thebook). Interestingly, Bergman’s depictionallows the reader some first-hand insightinto both the folly and utility <strong>of</strong> thisentrenched system, the relics <strong>of</strong> which arestill present today.At the end <strong>of</strong> the day, The House <strong>of</strong> Godis a pleasant and engrossing read, andthere is much to be gained in reflecting onRoy’s tumultuous foray into the world <strong>of</strong>hospital-based medicine. The prescience <strong>of</strong>this book and the ‘Laws <strong>of</strong> the House’ areworth noting today as we find ourselvesin the midst <strong>of</strong> health care system that isunderfunded, short-staffed, and overused.In critiquing the medical system in whichwe train and work (albeit through the lens<strong>of</strong> a 1970s intern), The House <strong>of</strong> God forcesthe reader to consider just how sustainableour current practices are. This message isespecially pertinent in the context <strong>of</strong> ourageing population, since many <strong>of</strong> our currentpractices in medicine were founded in Roy’sera <strong>of</strong> relative resource abundance.36<strong>University</strong> <strong>of</strong> <strong>Alberta</strong> <strong>Health</strong> <strong>Sciences</strong> <strong>Journal</strong> • April 2012 • Volume 7 • <strong>Issue</strong> 1
Thank youThe UAHSJ wishes to thank theFaculty <strong>of</strong> Medicine and Dentistry fortheir generous support <strong>of</strong> this project.
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