“68-year-old-female-with-hypertension-diabetes-hyperlipidemia-admitted for CHF-doing well overnight-no new complaints-no chest pain-palpitations-shortness of breath-diuresing well on (some number and dose of some drug whose name sounded vaguely familiar from the books).”
The barrage of words that greeted me as I was unceremoniously dropped off with my first medical team during my third-year internal medicine rotation twisted my stomach into a knot. Standing awkwardly with the team on rounds, the harsh fluorescent lighting overhead, I came to realization that I was much like Dorothy in the Wizard of Oz … I wasn’t in Kansas anymore. I had entered the completely different world of the hospital. More importantly I had stepped foot for the first time into the medical culture — an alien universe where words became practice and practice became dogma. And it was in those first few seconds when I cam to the sudden realization that the fight ahead was no longer one of knowledge, but rather of fitting into this foreign place. And I can say that for the first time in my career, I became scared of the world I had worked so hard to enter.
The fear continued until I learned from the age-old adage “fake it till you make it” — and that’s what I did. It wasn’t particularly difficult. You smile frequently, act interested, be enthusiastic, don’t be a jerk, ask a few questions and answer a few questions right every once in a while. The hardest part of third-year wasn’t the long days, unpleasant patients or draining fatigue. Nor was it the shelf exams or the near constant feeling of utter uselessness to your team. For me, the hardest part was having to assimilate into the medical culture. People viewed you differently for having a white coat and an unspoken rule was that you had to view yourself differently as well — infallible, strong and unbreakable.
And so the year went by and I entered fourth-year, where I had enough time to do things I gave up: guitar, writing, and reading (for fun, not as an obligation). Knowing that one of the quintessential books on the reading list of medical residents was “The House of God,” I decided to purchase a copy and crack it open with the hopes that it would somehow give me a new and unexpected view on the medical field. Briefly, the story is centered around the intern year of the newly indoctrinated Dr. Roy Basch at the famed “House of God.” Of course, you can google the plot so I won’t ruin the entire story save to highlight a few instances that really spoke to me about the pervasive roots of the medical culture.
During the course of his intern year, the reader sees the internal changes within Roy Basch as he becomes increasingly cynical about his life and occupation. While much of this cynicism is treated as comedic and has a satirical charm, I found myself saying “That is so true!” too many times for it to be a coincidence. And, yes, there were instances where I literally laughed out loud. Yet, alongside these moments of humor there is a deeper and darker story — one that was uncanny and presented the reader with a harsh truth about our profession.
The fact is, the hospital life changes you. I saw it happening to me during my third-year and the book paints a vivid picture of how the culture of medicine is one that is so embedded into the system that all you can do is surrender yourself to it or reach a breaking point. It turns from a story of pursing a dream into one of sheer survival, where living to collapse into your bed at the end of the day was viewed as a victory. The vision you had at the beginning of your education undoubtedly shifts and sometimes you end up asking yourself “Why did I ever sign up for this?” And though times have changed, the demands and expectations of the medical culture are still at large even in today’s residency programs.
Though written nearly forty years ago, “The House of God” still brings to light the tremendous burden we have placed upon ourselves as doctors. In fact, it was the raw, crude and unyielding realism that made it almost taboo to the older physicians of the era, basically publicly debasing the model of the doctor into something less. The book underscores the struggles of life and death that are not only placed in our hands for the patients we care for, but for ourselves as well. The biggest instance of this (Spoiler alert! Skip to the next paragraph in you want to avoid this.) is when one of Roy’s fellow interns commits suicide by throwing himself off of the hospital roof. In the ultimate display of surrender, the intern literally gives his life at the footsteps of the place that has taken everything from him. Cynical? Perhaps, but I have little doubt that a number of medical students and residents struggle with their own mental health issues.
Then the question inevitably becomes “Why did you go into medicine if you can’t handle it?” Truth time. All of us would not be where we are if we could not handle it. Roy and his fellow interns are all the best and brightest of their stock, yet they suffer within The House. Why? Because they’re human. And this is the legacy from “The House of God” that we should recognize and appreciate. If it was one thing that was truly revolutionary about The House of God,” it was that the model of what a doctor should be was replaced by what a doctor truly is. The characters were deeply flawed and human physicians, and we can take a great lesson away from them. We as doctors are not exempt from our own humanity, no matter how hard we may turn away to try to avoid it in an attempt to be the all-knowing, all-powerful doctor that cannot be fazed. There will undoubtedly be struggles through the noble journey that we have chosen to embark upon. But it’s okay to feel this way when we reach out for help. In fact, being able to face these issues head-on demonstrates an unparalleled kind of strength for which our patients would be all the more appreciative when we are able to practice as a truly human physician.