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July 10, 2019

Pre-Reflections on Re-Reading the House of God

The most apt Google Image result labeled for reuse
Some log-rolling: check out the fantastic video* JAMA made: ja.ma/HouseofGod.

I've read the House of God twice: First, as a senior in college, having done some shadowing and research work in EDs (and already accepted in med school) and again after my medicine sub-internship (on the advice of my brother-in-law/EM doc/premed mentor).

My first reaction on my first pre-med school read: OH WOW this is all so bizarre and dehumanizing what did I get myself into?!

My reaction after my med sub-I: yeah that's about right.

I haven't re-read it since then, and am currently planning to (on the library waitlist) so of course all of the grains of salt.

First, to some of the good points: the reasons it initially and still resonates speaks to it's "truth telling." Medicine is a fairly unique field for a number of reasons, including the dehumanizing nature of (particularly) hospital-based medical training, as well as the re-humanizing nature of the privilege I have in putting on pajamas and helping people who are usually some combination of sick and scared; I am rather well-paid to be let into their lives.

To some of the... less good points: there are a lot of sexist and probably racist aspects of/in the book; I haven't read the book in 12 years, and I am a pretty privileged cis-het white male, and I still remember a bit of that. The easy excuse is "well of course a book written 4 decades ago--known for its truth telling--is not very PC!" but perhaps, if nothing else, it reflects the sexism and racism that permeated medicine then and still do now. I'm not letting the book off the hook but I guess at the bare minimum that is where we were and where we are.**

I was speaking with some coworkers about it and one of them described The Fat Man in a way which I think applies well to the book as a whole: it is easy to see him only through his shallow cynicism, but it doesn't take much to see that he is trying to reach a deeper humanity in a very cynical world.

My favorite of the laws--Law #4--is similarly a microcosm of this. "The patient is the one with the disease" can mean a lot of things. It is a good reminder both for professional wellness--no matter how bad my shift, I was paid to be here, and I get to go home at the end. And, it's a nice reminder that we're here *for* the patients, to help them, as they are the one with the disease. (I wrote about some of this previously Who is the Poor Historian? in EP Monthly).

I'm looking forward to rereading largely because I'm curious how much my memory holds up and how much my perspective has changed.

Lastly, I will repeat my oft-repeated opinion that the hands-down most accurate portrayal of what it's like to work in a hospital is Scrubs.




*and outstanding hyperlink. For the record I did not work on this at all, but I do get to work with the amazing people who made this video on JNO Live.

**I don't mean to be too cynical but I would not be surprised if I need to edit and update this paragraph after people much smarter and better able to speak to these issues give me much needed feedback.