The House of GodBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39084.673889.59 (Published 11 January 2007) Cite this as: BMJ 2007;334:99
- Richard Smith, chief executive, UnitedHealth Europe
Sex and death are all that matter, argues Philip Roth, perhaps the greatest living writer in English. The early years that doctors spend in hospital thus provide rich material, as the doctors are surrounded by death and obsessed by sex. The House of God by Samuel Shem is the most successful and literary of books describing the initiation of doctors and has sold over two million copies since it was published in 1978. Its bleakness, black humour, and brutishness paved the way for television programmes like Cardiac Arrest, Green Wing, and Bodies.
The book tells the story of the intern year of Dr Roy Basch in a hospital called the House of God, which is based on Beth Israel Hospital in Boston. Basch's experiences are those of Shem (a pseudonym for psychiatrist Stephen Bergman), who was a Rhodes scholar and trained at Harvard. The year is filled with exhaustion, error, despair, suicide, inhuman senior doctors, and lots of soulless sex, all leavened by humour—in other words, a typical “houseman's year,” as my generation calls it.
Everybody is now familiar with such material, but it wasn't so in 1978. The public was fascinated, hence the sales. Older doctors hated the book, but young ones loved it. Looking back after 25 years, Shem tells of a letter he received that said: “I'm alone on call in a VA in Tulsa, Oklahoma, and if it weren't for your book I'd kill myself.” Writing the book was for Shem a way to survive and heal, and he captures how the young doctors come together and make the transition to doctors: “Each life was being twisted, branded. We were sharing something big and murderous and grand. We were becoming doctors.”
One factor that lifts the book to the status of a classic is the energy, beauty, and insightfulness of the writing, but another is the “Laws of the House of God,” which entered medical parlance not only in the US but in the UK. Law one is “GOMERS don't die.” GOMER stands for “Get Out Of My Emergency Room” and is “a human being who has lost—often through age—what goes into being a human being.” Rule nine is “the only good admission is a dead admission.” The book is strongly ageist and sexist (just like medicine?), and the descriptions of taking sexual pleasure from examining a patient are more shocking in 2007 than they must have seemed in 1978.
The factor, however, that finally makes the book a classic is its deep understanding of good medicine—including, for example, how avoiding an intervention is often better than intervening. This understanding is captured best in the mysterious “Fat Man,” a resident who makes patients “feel like they're still part of life, part of some grand nutty scheme instead of alone with their diseases . . . still part of the human race.”
By Samuel Shem
First published 1978