Articles and Case Studies

We Pay a Visit to the House of God and You are All Invited!

09 May 2013

If you have ever BUFFED and TURFED a GOMER, it is highly likely you have read – or trained under someone who has read – Samuel Shem's seminal work of medical fiction, The House of God.

By Nerissa Ferrie, MDA National Medico-legal Advisor

Dr Jane Deacon and I had the great pleasure of meeting award winning author Dr Stephen Bergman and his wife Janet Surrey, at the Pre-Vocational Medical Education Forum held in Perth in November 2012.

The House of God

Despite the book being written in the mid-seventies, at a time of far less technology and far more shenanigans in the on-call room, the central theme of connectedness still holds true today and continues to guide Dr Bergman's writing and public speaking commitments.

Being a junior doctor is tough and this book simply says "it's okay – you are not alone."

When Dr Bergman wrote The House of God, over a period of three years during his training as a psychiatry registrar, little did he know that his cathartic tome would be read and loved by a third generation of medical practitioners worldwide.

Dr Bergman was just starting his psychiatry practice when the book was published in 1978, and due to concerns about the effect his "sexy and radical book" might have on his patients, the penname Samuel Shem came into being. With the publicity surrounding the release of the book, patients soon discovered their therapist was the author but Dr Bergman says their interest only lasted about 30 seconds before their own problems again became far more important than the celebrity of their therapist.

More than fiction

If you have read The House of God, it may come as a surprise that one of the most important characters in the book is entirely fictional. The Fat Man was, according to the author, the doctor the interns needed as opposed to the doctors they actually got.

Dr Bergman remains good friends with many of the doctors who joined him in his intern year and upon which his (mostly) beloved characters were based. His former colleagues were immensely proud to be part of the book, so much so that Dr Bergman says there are significantly more doctors in America who claim to have been "in the book" than those who actually were!

The book contains a lot of sex, and I asked Dr Bergman if this was a sign of the times, or a way to share the trauma of internship?

When I wrote the book it was a totally different time. I did my internship in 1973/1974. It was pre-AIDS so pretty much any disease you got could be cured, and it was a very sexual atmosphere. As described in the book, a lot of sex was happening.

Dr Bergman instinctively knew that without the light relief of sex and black humour, The House of God would be a pretty grim read.

After The House of God was published in 1978, Dr Bergman focused on the practice of medicine and avoided the publicity trail, despite the popularity of the book and the intense interest it generated. But something changed. A letter from an intern led Dr Bergman to realise that the book had become far more than a work of fiction.

The letter read I'm on call tonight in a veterans' hospital in Tulsa, Oklahoma and if it weren't for your book, I'd kill myself.
 

Bill W and Dr Bob

After Dr Bergman recognised the importance of his book, and how the notion of connectedness and staying human resonated with many, both he and Janet felt compelled to share the message with a broader audience.

Dr Bergman went on to write three further novels (Fine (1985), Mount Misery (1996) and The Spirit of the Place (2008)) but you can't help feel their joint work – the play "Bill W and Dr Bob" – is their proudest achievement.

"Bill W and Dr Bob" is a humorous and touching piece which tells the story of a famous (but broken) New York stockbroker, Bill Wilson, who forms an incredible relationship with Dr Bob, a surgeon who is battling demons of his own. This is the story of how Alcoholics Anonymous (AA) was formed.

The play has been performed off-Broadway, and MDA National was fortunate enough to sponsor the play when it was performed in Sydney in July 2011. Dr Bergman canvasses doctors during his speaking engagements, and he is always surprised by the number of doctors treating patients with alcohol dependence who have never attended an AA meeting. He believes the model of AA is a major treatment modality that every doctor should be familiar with.

I asked Dr Bergman's wife and co-author, Janet Surrey, how the AA model differs from conventional medical care.

Alcohol is a disease with physical, psychological and spiritual elements, and it has to be treated in all three ways. AA started the holistic movement in America in 1935. Conventional medical are often neglects the multidimensionality of the human experience, focusing mostly on the physical. The essence of good medical care is the same as the essence of any care, even of care itself – it's what Bill and Bob discovered- the danger of isolation, and the healing power of good connection.

Dr Bergman was asked to provide a message to doctors who may be feeling isolated, or trying to remain stoic while walking the line of functionality.

My best advice? You are not alone in your suffering. This is not your fault. It goes with the territory of being a doctor. This is a tough job. Everything you think – that you are special and you are alone in this – is common. You don't realise how much help is out there for you.

Members can also seek support from MDA National's Doctors for Doctors Personal Support Program (1800 011 255). This is a peer support program to assist Members during a course of a complaint, investigation or other process.

The Laws of The House of God

I      Gomers don't die.
II     Gomers go to ground
III     At a cardiac arrest, the first procedure is to take your own pulse.
IV    The patient is the one with the disease.
V     Placement comes first.
VI    There is no body cavity that cannot be reached with a #14 needle and a good strong arm.
VII   Age + BUN = Lasix dose.
VIII  They can always hurt you more.
IX    The only good admission is a dead admission.
X     If you don't take a temperature, you can't find a fever.
XI    Show me a BMS (a student at the best Medical School) who only triples my work and I will kiss his feet.
XII   If the radiology resident and the BMS both see a lesion on the chest x-ray, there can be no lesion there.
XIII  The delivery of medical care is to do as much nothing as possible.

Age and experience can produce great wisdom, and this is reflected in four new Laws of The House of God published by Samuel Shem in a recent article:

XIV   Connection comes first. This applies not only to medicine, but in any of your significant relationships. If you are connected, you can talk about anything, and deal with anything; if you are not connected, you can't talk about anything, or deal with anything. Isolation is deadly, connection heals.
XV    Learn empathy. Put yourself in the other person's shoes, feelingly. When you find someone who shows empathy, follow, watch and learn.
XVI   Speak up. If you see a wrong in the medical system, speak out and up. It is not only important to call attention to wrongs in the system, it is essential for your survival as a human being.
XVII  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.

Further reading

If you would like to read more of Dr Bergman's work, we recommend The Spirit of the Place – the story of a young doctor joining his old mentor in family practice in his hometown. One reviewer referred to it as "the perfect bookend to The House of God". 

You can also visit the following websites:

 

Photo: Dr jane Deacon, Dr Stephen Bergman and Ms Nerissa Ferrie

 

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