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download House Of God (Black Swan) by Samuel Shem from site's Fiction Books Store. Everyday low prices on a huge range of new releases and classic fiction. The House of God is a satirical novel by Samuel Shem published in The novel follows a The Fat Man provides his interns with wisdom such as his own " Laws of the House of God" (which amount to 13 by the end of the book). One of. Called “The House of God,” the book was drawn from real life, and 30 years after its initial publication, it is still part of the medical conversation.
Samuel Shem Nov 28, What I've learned from speaking out against the brutality of medical training, in advocacy of quality connection -- and four additional "laws" for good doctors Kent State University Press For better or worse, except in real danger, I don't seem to run on fear. Guilt, yes; fear, no. It's a good thing, because my book The House of God enraged many among the older generation of doctors. I was maligned and disliked. The book was censored by medical school deans, who often kept me from speaking at their schools. None of it really bothered me, though.
And then one day I got a letter forwarded from my publisher, which included the line:. I realized that I could be helpful to doctors who were going through the brutality of training. And so I began what has turned out to be a year odyssey of speaking out, around the world, about resisting the inhumanity of medical training. The title of my talk is almost always the same: The theme of my speaking out is simple: And any good connection is mutual.
I base a lot of my talks on what I've learned from The House of God. About how I've come to see it, and all my novels, as a "fiction of resistance," a way of resisting the injustices of a system. It wasn't until years into my journey that I realized the importance of the fact that I and my fellow interns were products of the s.
We grew up in that unique lost period of American history -- beginning with FDR and ending with Reagan -- when we learned that if we saw an injustice, and got together and took action, we could bring about change. During my college years, we helped put the Civil Rights laws on the books and ended the Vietnam War.
When we entered our internships we were a generation idealistic young docs. We soon were caught in the clash between the received wisdom of the medical system, and the call of the human heart. Our patients, and we, were being treated inhumanely. As Chuck the intern put it:.
And so we took action. The novel can be read as a model of nonviolent resistance. Big hospitals, like all large hierarchies, are "power-over" systems. The pressure comes down on the ones at the bottom, and they become isolated. Not only do they get isolated from each other, but each gets isolated from his or her authentic experience of the system itself. You start to think " I'm crazy," instead of " This is crazy.
The crucial question is how to find mutuality -- or "power-with" -- in a "power-over" system. Historically, the only threat to the dominant group -- whether of race, gender, class, sexual preference, ethnicity -- is the quality of the connection among the subordinate group. In The House of God there were 13 "Laws. Law Connection comes first.
This applies not only in medicine, but in any of your significant relationships. If you are connected, you can talk about anything, and deal with anything; if you're not connected, you can't talk about anything, or deal with anything. Isolation is deadly, connection heals.
One of the worries in how the new generation of doctors practice medicine is their use of computers. If you have a laptop or smart phone between you and your patient, you are much less likely to create a good, mutual connection.
You will miss the subtle signs of the history, of the person. With a screen between you, there is no chance for mutuality, and the connection has qualities of distance, coolness, rank, authority, and even disinterest.
The "smart" digital appendages can make you, in human-connection terms, a "dumb" doctor. Learn empathy.
Put yourself in the other person's shoes, feelingly. When you find someone who shows empathy, follow, watch, and learn. Speak up.
If you see a wrong in the medical system, speak out and up. It is not only important to call attention the wrongs in the system, it is essential for your survival as a human being. Learn your trade, in the world. Your patient is never only the patient, but the family, friends, community, history, the climate, where the water comes from and where the garbage goes. Your patient is the world.
Some have said that The House of God is cynical. And yet in rereading, it has a constant message that I was dimly conscious of in writing: In the words of the hero of the novel, the Fat Man, "I make them feel that they're still part of life, part of some grand nutty scheme, instead of alone with their diseases. With me, they still feel part of the human race.
And so in I came away from The House of God aware of at least one thing: I read this in college, then again my first year of medical school, then again my last year of medical school, then again during my internship, and I'm reading it once more now as a senior resident.
Along with the television show Scrubs, it's the most accurate portrayal of American medicine that I'm familiar with. I gave it to my father and he called me saying that he wanted to go medical school. I gave it to my mother and she called me crying, asking if my job really is as bad as Shem makes it I read this in college, then again my first year of medical school, then again my last year of medical school, then again during my internship, and I'm reading it once more now as a senior resident.
I gave it to my mother and she called me crying, asking if my job really is as bad as Shem makes it out to be. I think when it first came out it must have been truly shocking.
Though today, with so much of medicine being patient-directed and not physician-directed , I think you could look as this as a quaint little black mark on American history -- like the old cartoon cigarette commercials, or the movie "Freaks". Yeah but the thing is The essence of medical care continues to be placement. Gomers still, without fail, go to ground. Any medical student who doesn't triple my time is worth his or her weight in gold.
There's a rumor that the Fat Man was fired from his position due to his indiscretions which were detailed in this book, which is a shame. I continue to learn from him even at this stage in my career. View 1 comment.
Dec 11, Cecelia rated it really liked it Shelves: I felt I should read this book, described as the "Catch of medicine" before graduating from med school. It was scary how accurate most of it is, right down to the 'Laws' of the House of God quoted throughout. But well written and a good read, although I don't know how funny it will be to those outside the medical profession probably still so to spouses.
View all 5 comments. I've avoided reading this for years. To be fair, I didn't even know about it until half way through med school and then I never had much desire to come home and 'read about the day job'.
But, now I'm a GP and have been out of the hospital for approaching 2 years now I thought I'd give it a whirl. It's about what I was expecting. Almost everyone who has reviewed it on here appears to be a doctor and the number of 'just like real life' comments astound me. I trained in the UK and work in NZ so I don't have any first hand knowledge of what it's like to work in the States but damn.
I hope this is extremely dated compared to modern practice but it seems people still feel this is accurate. Medicine really is a different kettle of fish in America in that case. There are flashes of familiarity and a few incidents and feelings have a ring of truth with a few things I suspect only doctors could really fully appreciate.
But the sheer unpleasantness, disgust and lack of humanity is disturbing. In all honesty, my first house year was probably one of the best of my life. Fun, busy, new, a great group of close knit friends; dancing, sex and drinking definitely played a role, plus there were long nights, weekend shifts and some stressful on calls. But there was none of the negativity portrayed here. Yeah, you deal with crap at times literally and figuratively but I just cannot relate to the majority of the feelings in the book.
I really enjoyed my elderly care and old age psychiatric rotations and love working with older patients one of the joys of life as a GP. There were no major train-wrecks in our first year though I have seen the toll on other doctors over the years.
I think it's an ever lasting theme amongst the medical profession. I've heard that countless times, I've said it myself and I've heard older doctors tell me their mentors said exactly the same to them.
By this standard, modern medicine should be a breeze. We still worked long hours and calls, still had to work hard with limited support and make tough decisions. I don't think many of us went in with our eyes so shut though. We were all fairly aware what life as a junior doctor would be.
The reviews comparing this to Catch 22 seem a little lazy. Perhaps as a historical hopefully depiction of the horrors of the American Health Care System it has some merits, but otherwise it just leaves a nasty taste in the mouth.
Now I've read it I can put it aside but I'm not sure I'd recommend it and I would truly be concerned about med students reading this for tips. Oct 03, Elizabeth Holter rated it really liked it. I did my internship and residency at the other hospital, "MBH," in Shem's classic novel about medical training, at the same time that he was busy observing his fellow house officers and higher ups at the House of God.
So my take on this book is colored by immersion in the culture he parodies, and by the fact that one of his main characters bears strong resemblance to a medical school classmate who interned in Boston at Shem's hospital. Fresh out of five years of medical training, I Disclaimer: Fresh out of five years of medical training, I read this book back when it came out and found it laugh-out-loud funny because, like all caricatures, it is based in truth. It has just appeared in audio, and the view from a few decades down the road is a little bit different, but still entertaining though I have to admit that the raunchy sex got a little boring.
The exaggerations seem a little more exaggerated, and the truths more grounded in the realities of experience. There was a Fat Man in my training program - actually several of them- and I suspect everyone who has become a doctor knows a few.
The Fat Man's rules all contain germs of truth. Shem was an astute observer of the human condition at a young age. Most of us were just trying to learn and survive, but he was taking notes.
Mar 25, Natalie rated it liked it. This was my second attempt at reading this book. My first, when I was still a medical student, ended a few chapters in, when I had to stop reading because I found the book far too cynical and depressing. Now, apparently, I'm jaded enough to enjoy it, though I know the reality isn't quite as awful as this book would have you believe. Plenty of it, of course, hits right on target. The exhaustion of night shifts: The sense of losing touch with the outside world, of being unable to connect with anybody who hasn't lived your experience: It certainly can be hard to expalin that experience to someone who hasn't lived it.
The isolation and uncertainty that comes after one error, and the lack of support or counselling by senior staff - now that can be all too common, and the story of the unfortunate Potts is a frightening example of just where that can lead. I think one of my favourite reflection-of-reality moments was the way Roy seemed to feel, over and over again, that each new rotation was better than the last - excited with the change he'd think he had finally found a way to be human in medicine, before the inevitable disillusionment.
On the other hand, a lot of what occurs in this book simply wouldn't happen in the real world, or at least it wouldn't in a hospital in Australia. I'm not too sure if the differences are because the story takes place in the s, or because it's the US, or a bit of both.
For example, ordering invasive investigations that clearly aren't indicated just so the hospital makes money Also, interns being left alone to run the hospital - that doesn't happen either, of shouldn't anyway. Interns answer to registrars and registrars answer to consultants, and ultimately if something goes wrong, it's the consultant who'll have to explain it.
Anyway, I think this book is still a worthwhile read for anybody starting out in medicine - if only as a chance to reflect and appreciate how and why the way we practice medicine has changed. It's also, of course, darkly hilarious, and remains the source of many a medical in-joke what's the first thing you should do at a cardiac arrest? Take your own pulse Dec 25, McGooglykins rated it it was amazing. 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, 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.
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. I came from Doctor Mike's video. View all 4 comments. Naman Gera He is so cool 4 hours, 7 min ago. Tucker Naman wrote: Oct 24, Elizabeth rated it really liked it Recommends it for: Spoiler alert esp.
This novel follows an intern, Roy G.
Roy discovers providing medical care is nothing like what he was taught in medical school. Each of these stresses makes Roy withdra Spoiler alert esp. 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. One 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. Gomers are often unresponsive, so it is easy for the medical staff to not think of them as humans.
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. 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. 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. The 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. 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. 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.
Sep 26, Emily rated it it was amazing Shelves: I read this during the first weeks of residency and couldn't have picked a better time to do so. What an excellent depiction of all that medical training is but shouldn't be.
Few thoughts: I thought long and hard about this--and even about why it wasn't shocking to me. Here's the rub: All I can say is that if the anecdotes make you so uncomfortable, commit yourself to improving health care and medical educa I read this during the first weeks of residency and couldn't have picked a better time to do so.
All I can say is that if the anecdotes make you so uncomfortable, commit yourself to improving health care and medical education. We've come along way since the s, but there's still a long way to go. But, I can't imagine that it would be fully understood by non-medical people. So if you're interested, we can always discuss afterwards.
They just felt disproportionately over-the-top. Perhaps this is a reflection of the audience it was initially written for: Everything else in the novel had modern-day applicability, but the on-call threesomes, etc.
Jan 05, India Clamp rated it really liked it. Samuel Shem is the pen name for the author of this book. After reading a few lines of the lascivious tales within, it becomes obvious why a pseudonym was used. Contents are plenary, raw and tragic. Get the job done, and since we're all in the ninety-ninth percentile of interns, at one of the best internships in the world, what you do turns out to be a terrific j Samuel Shem is the pen name for the author of this book.
Get the job done, and since we're all in the ninety-ninth percentile of interns, at one of the best internships in the world, what you do turns out to be a terrific job, a superlative job. Don't forget that four out of every ten interns in America can't speak English. And at Beth Abraham Hospital nurses akin to divine buxom cherubs named: Must read for any resident, intern or student of medicine! download, laugh and learn. Reir, llorar, vomitar y temer el momento de tener que ir a un hospital.
Jun 21, Sophie rated it really liked it Shelves: Feb 21, Vanessa Rogers rated it really liked it Shelves: I'm really happy that I held onto this one to read as I prepared for my residency interviews.
I found myself smiling often while I read it, either agreeing with the humour or grimacing from the honesty. Some parts of this I find exaggerated but the bulk of the trials of internship I actually do find believable. I can see why people out of the medical field often do not enjoy this book, but I definitely found much to relate to throughout.
Medicine is not as neat and tidy as the public w 4. Medicine is not as neat and tidy as the public would like to believe.
I like to think that my clerkship has not been anywhere near this level of destructiveness but there are some similarities. The hours. The preceptors who expect you to give your life over to the hospital. The constant instructions to find balance without giving us the means to do so.
The attitude of "I had to suffer and so will you too" attitude from our senior colleagues. There were also a lot of differences. The sex - does anyone's modern clerkship look like this? Money hungry doctors - there are some, but honestly this doesn't work terribly well in Canada.
Read this book if you're in the burnout zone of a medical career. And then also if you're not, and you're not scared from losing faith in medicine. Jan 12, Lorelei rated it it was amazing Recommended to Lorelei by: Oh my goodness, this was so good, and so painful! Funny and endearing enough to make up for all the horrible, and there is a lot of horrible.
This is very true to modern medicine as I have experienced it. People constantly tell me that 'it's different now.