Abstract
Edited by Martin Kohn and Carol Donley. Ohio: The Kent State University Press, 2008, 241 pages, $16.
Samuel Shem's satirical novel, The House of God, has been considered unofficial required reading for physicians in training since it was published in 1978. The novel chronicles the experience of Dr. Roy Basch, recent medical school graduate, as an intern in internal medicine at an academic tertiary care center in Boston in the late seventies. Shem describes the writing of this novel as “a catharsis to share with my buddies what had been the worst year of my life.” Over the last 3 decades, it has acquired more global significance, raising important questions about present day medical training in the United States. To commemorate the thirtieth anniversary of its publication, Martin Kohn and Carol Donley have put together a collection of essays by today's foremost physician and nurse writers exploring the influence of The House of God on medical education, literature, and residency reform.
The book is divided into six themes, including historical, philosophical, literary criticism, women's studies, re-reading, and biographical. The first section reviews historical perspectives of residency education, taking us from pre-House of God academic medical centers in Boston to residency training in France. Another essay by Kenneth Ludmerer highlights the ongoing challenges that graduate medical education has faced in the 30 years since The House of God was published.
The second section, titled Justice, Virtue and the Laws of The House of God, includes an essay written by the editors on the subject of justice and humor, whereas another examines the depiction of virtue in the novel. One particularly entertaining and enlightening piece in this section by Howard Brody refers to the infamous “Fat Man's Laws.” These are a set of bylaws penned by one of Shem's more memorable senior residents, the Fat Man, and contain phrases such as “Gomer's don't die,” and “Placement comes firsts.” Brody extracts the pearls of medical wisdom hidden in the infamous laws and notes their continued applicability 30 years later. The third section presents four works of literary criticism, including John Updike's introduction to the 1995 edition of the novel.
Women's Perspectives and Criticism is particularly interesting given the evolution of women's presence and role in medicine since The House of God was first written. Authors note that in Shem's novel nurses are portrayed as ineffectual and submissive, whereas the only female resident is “both a lousy person and a lousy doctor.” Clearly, since 1978 there have been significant improvements in the disparities women face in medicine; however, contributor Amy Haddad notes that there is much work to be done in terms of collegial physician-nurse relationships. The fifth section presents four essays on insight gained while re-reading the book, such as the need for reflective skills (writing being one example), in the emotion-charged world of medicine. Finally, the book finishes with works by Shem's wife, Janet Surrey, as well as Stephen Bergman, that is, Samuel Shem himself, who discusses lessons he has learned throughout his career on how to resist the inhumanities in medicine.
Return to the House of God brings together an impressive, if eclectic, list of authors, resulting in a poignant series of essays that uses Samuel Shem's The House of God as a springboard for important discussions of the evolution of medicine and medical training over the last 30 years. The collection is well-organized, with a broad range of professional and personal perspectives. In combination with a re-reading of the original novel, as a well as the benefit of professional hindsight, it offers an interesting and enlightening commentary on modern medicine.