Wednesday, May 1, 2019

House of God

I used to work with a doc who would continuously refer to the Rules of the House of God.  This was a novel, written in the 70's.  You should go read it, if it's still in print, it's doubtful it would be published in this day and age.  For non-jaded health care people, it's dark and full of scurrilous behavior. This doc always used to say that it should be required reading for anyone who works in an ER.

 The House of God outlines a set of rules that are still occasionally referenced by people old enough to remember it. Here they are:

1. Gomers* don't die.
2. Gomers go to ground.
3. At a cardiac arrest, the first procedure is to take your own pulse.
4. The patient is the one with the disease.
5. Placement comes first.
6. There is no body cavity that cannot be reached with a #14 needle and a good strong arm.
7. Age + BUN = lasix dose.
8. They can always hurt you more.
9. The only good admission is a dead admission.
10. If you don't take a temperature, you can't find a fever.
11. Show me a medical student who only triples my work and I will kiss his feet.
12. If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion
13. The delivery of medical care is to do as much nothing as possible

*an acronym for "Get out of my emergency room" - refers unkindly to old or chronically ill patients who used to sit on a resident's service for weeks awaiting placement in another facilityy in the good old days.  Like, the 1970's.

So I was thoroughly shocked to hear one of my current ER docs,  (probably in his mid 40's, sort of a know-it-all and borderline douche) refer to one my zone mates patients as being unable to go home, and needing a nursing home placement (see rule number 5).

"Yeah", he said airily, "that is one of the rules of The House of God.  Are you familiar with that?, probably not. You're too young.  It should be required reading".

Since he was speaking to my colleague who is in her mid-20's, she did not know.  I interjected.

Me:  "Oh, I used to work for a guy who was a med school classmate of the author, Samuel Shem, in medical school back in the 1970's.   He said it should be required reading too".  I proceeded to rattle off almost all of the rules, having been compelled to memorize them years ago.

The kids promptly started looking for the book, available on Amazon.

Dr. Know-it-all, taken aback, who thinks he is a trivia God: "Wow, you remembered almost all of them".

(Wanders away).