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The House of God

October 24, 2008

The House of God is a novel written about an intern’s experiences during his residency in the early 1970’s. It is an uncensored (yet quite exaggerated at times) look at residency, namely at the psychological trauma faced by residents every day at the hospital. But it also deals with other lesser known truths about medicine that persist to this day: that most patients don’t belong in the hospital; that attendings often unnecessarily keep patients in the hospital to make money; that you feel helpless that for many patients you really don’t do much; and that you see the same patients–frequent flyers–in and out of the hospital for the same problems.

The book is a must-read for anyone involved in medicine, and even for those who are not, as it vividly portrays the above.  They made us read a lot of books in medical school, but no book was as influential, entertaining, and educational as this one.

The book is based on the thirteen “Laws of the House of God”, thirteen maxims taught to the intern-protagonist by his senior resident (the only sane and human person left in the entire hospital). These rules help him to survive the ordeal of internship.

Four months into my own internship, I’ve decided to add a few addendums to the original laws based on my experiences thus far. As the year continues, perhaps I’ll have more, but if anyone wants to add their own laws, please feel free.

Laws of the House of God (from the novel)

  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 BMS (Best Medical Student, a student at the Best Medical School) 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 THERE.
  13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

Addendums to the Laws of the House of God

 

  1. All women ages 10-65 are pregnant until proven otherwise.
  2. Everyone needs IV fluids.
  3. If the patient can chew gum, he is not in respiratory distress.
  4. The 5 minutes you don’t spend on seeing the patient can be used towards writing a more impressive SOAP note.
  5. The hospital has a CT machine; don’t be afraid to use it.
  6. If the patient asks for a specific dose of Vicodin, he doesn’t really need pain meds
  7. When a chronic pain patient says he wants benadryl + dilaudid + phenergan IV push as opposed to slow mix, don’t knock it till you try it.
  8. (number of allergies x number of problems in past medical history)/(age) = the Riaz constant for how many times you will get called in the middle of the night to deal with the patient.
  9. Even if you have no plan for an albatross* patient, order a CBC and BMP for the morning anyway to make it look like you do.
  10. Dermatology consult: If it’s dry, wet it. If it’s wet, dry it. If not, use steroids and antifungal creams. If still no improvement, biopsy.
  11. If you must get an orthopedics consult, you must first get an MRI.
  12. Repeated EGDs and colonoscopies will eventually help you find the bleed.
  13. ID consult: vancomycin + aztreonam + metronidazole. Add acyclovir and fluconazole depending on the day of the week. If that doesn’t work, write a case report.
  14. If a malingering patient keeps asking for pain meds, replace potassium through a peripheral IV line, order an NG tube, foley catheter, and rectal exam. Consider ordering restraints and bowel prep for colonscopy.

*an albatross patient refers to a patient that like the bird, just hangs around forever

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From → Medicine

6 Comments
  1. krfan permalink

    Glad you’re back. You have been missed, that’s for sure.

    Lol at this post, yet how true.

  2. maulanaMUSCLES permalink

    what a shameless plug to get chicks.

    Why don’t you just walk into the ISNA lobby wearing your white coat kr?

  3. Boo this blog sucks…

    And I’ve read this book…and it sucks too…

    I should write a blog about which sucks more…your blog or the book…

    Boo again!

  4. bloodmetal&flesh permalink

    maulanaMUSCLES

    Im sure KR has already tried that or atleast thought of it. A white coat guy at ISNA : 1) would only attract aunties, or 2) would mean there’s a DermSpecialist running around desperate to introduce to the Institute of Instant Beauty.

  5. bloodmetal&flesh permalink

    9.a. Feeding the Albatross* at the first visit reveals all symptoms immediately and re-defines “long-term care”.

  6. AzamHussain permalink

    6 and 10 on your addendum rules are gold. Good to see you back in the blogosphere.

    MaulanaMuscles: The guy is a resident, we’ll have to expect way more medical posts than before. If he gets married as a byproduct, well it’s all God’s will.

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