If you have not read or at least heard of the book House of God, then you are not a physician. Most residents that I have known over the past 3 decades have read and laughed through this classic. The NY Times has this article about the book – A Book Doctors Can’t Close . The article is good, but I believe the popularity comes from a more fundamental need.
Having dinner last night with a group of 4th year students, I began to wax philosophic about the maturation process of 3rd year medical students. During the 3rd year of medical school you care for the broad spectrum of our society – all races and ethnic groups, all socioeconomic strata, those who work hard to optimize their health, those who seemingly work hard to destroy their health. During the 3rd year, students face mortality, addiction, homelessness, and many mental disorders. Students interact with those who they probably never before have encountered.
The emotional adjustment requires one to address issues that most 20 somethings avoid. How do we deal with addicts? How do we deal with the homeless? How do we deal with death?
Many students use humor as a defense mechanism. Medical student (and resident humor) has a darkness that those not in medicine generally find callous. This humor may seem inappropriate, but I believe we use the humor to develop an acceptance of the harshness that we see.
The House of God puts much of that humor on paper. We who read the book recognize the patients and the residents in the book. The book also focuses on the challenges of residency training, but I believe the attraction is the explication of patients.
Becoming a physician is a complex process. My students agreed that they have difficulty explaining their view of humanity to their relatives and friends who are outside medicine.
While some of the issues in the House of God are time specific, the general tenor of the book is timeless. The author did a great job of observing and describing the highs and lows of patients.
Many will find the book inappropriate. Those who do probably have not lived the experiences in the book.
As physicians we do care about all our patients, but sometimes we just shake our heads in disbelief. As I often say to students and residents – you cannot make up these stories. You cannot imagine the things patients do. You cannot understand the evils of alcohol until you see patients in DTs or patients with Korsakoff’s psychosis.
Sometimes our laughing seems inappropriate, but without it laughter we probably would just have to cry each day. We can be empathetic and still laugh beyond closed doors at the inanity of the human condition.
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I attended BI for residency. Some of the characters from the book are still practicing as attending physicians. We all know who they are!
Read it; realized it was a realistic description of medical practice in the absence of rational DNR policies.
I think of my book as the outpatient version of that one.
While on rounds, we often can’t actually laugh at the patients, families, other attendings and nurses who are (often unintentionally) funny.
House of God made it safe to laugh about other hospitals, and, in effect, your own too – and taught us that everyone else thought the way we did.
I tell my students and residents that if they start reading House of God, they have to finish it. Over the years, I’ve spoken with many colleagues who only read a few chapters, never realizing that the Fat Man actually loved his patients.
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