Friday, 19 May 2017
Monday, 15 May 2017
Thursday, 27 April 2017
Thursday, 20 April 2017
Tuesday, 4 April 2017
|GOMERs go to ground|
but they never die.
Told in flashback, from the sunlit terraces of a holiday in France where the narrator still feels the spectre of his internship haunt his every waking moment, it is a riotously, bawdily furious work. Dr Roy Basch is a mature** intern at The House of God, the best Jewish hospital in the city. He and other interns are grist for the hospital mill, often taking the worst cases and saddled with the care of the hospital's GOMERs - that stands for Get Out Of My Emergency Room, a reference to the old and infirm who clutter up the admissions and wards but ironically, never get so ill that they die. Basch's first senior resident is the iconoclastic Fat Man, whose teachings inspire Basch and his colleagues to great heights of patient care, again ironically by doing as little as possible in terms of actual care. By the end of the book, the Fat Man's list of LAWS of the House Of God reaches thirteen:
- GOMERs don't die.
- GOMERs go to ground.
- At a cardiac arrest, the first procedure is to take your own pulse.
- The patient is the one with the disease.
- Placement comes first.
- There is no body cavity that cannot be reached with a #14G needle and a good strong arm.
- Age + BUN = Lasix dose.
- They can always hurt you more.
- The only good admission is a dead admission.
- If you don't take a temperature, you can't find a fever.
- 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.
- If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there.
- The delivery of good medical care is to do as much nothing as possible.
By 'buffing' charts (skillfully and artistically altering patients' medical charts) and 'turfing' patients (getting patients placed in other wards, such as gastroenterology, G&O or, more worryingly, the morgue), Basch becomes the hospital's MVI - most valuable intern - but in the process finds himself de-humanised and callous. In one scene he puts out of his misery one terminal patient in excruciating pain on whom the other, fastidiously thorough senior resident is determined to try every medical procedure in the book (thus proving law 13), and he and his team become ragged, mentally and physically exhausted and demoralised by the demands of the job. In a particularly upsetting chapter, one intern commits suicide after a rookie error leads to the lingering death of a patient, a death which lasts the majority of the book and of which he is reminded every day until the end. Meanwhile, the interns take every opportunity to indulge their sexual appetites in a vain attempt to fuck away their problems and to reaffirm their humanity, with the contrary results.
It's no wonder the medical community were aghast when this was published, and one can see why Shem sought to protect his identity. Nowadays, Shem is more sanguine about its impact, feeling that it brought to light the pressures under which medical interns were routinely forced to work, citing one clinician who credits Shem's book with saving him from suicide. He's travelled the world since then speaking to audiences on a simple topic: "the danger of isolation, the healing power of good connection. And any good connection is mutual." He's also added four more laws:
- Connection comes first.
- Learn empathy.
- Speak up.
- Learn your trade, in the world.
Coming from a place similar to that of Joseph Heller's Catch-22, it's clear to see the impact the book has had on medical shows, in particular, satires like Bill Lawrence's excellent Zach-Braff-vehicle, Scrubs***. It's in turns hilarious and savage, slapstick and poignant, and the punchline is that all the residents (and amusingly both the policemen routinely on duty at the Emergency room) choose not to stay for a second year's residency but instead opt for the more emotionally connective and humane choice of psychiatry, leaving the hospital with a shortfall in workforce. It might disturb, but it also educates and amuses, greatly.
*By MY account...
**'Mature' meaning of relatively advanced years compared to his peers - any wisdom acquired from these additional years is not in evidence.
***Wikipedia has all the Scrubs references you need to know.
Tuesday, 28 March 2017
|Terror, and relief; relief and terror,|
so intermingled that they feel like
the same thought.
Michael Marshall Smith (or Michael Marshall when he writes out-and-out horror/thriller titles) is a British writer who brings to mind the work of his contemporary sci-fi & etc. novelist Jeff Noon. His first book was Only Forward (on my To Re-Read list for sure) which with the talking appliances originally made me think of Rogue Trooper in 2000AD comics, and got me into slick, quick, character and plot-driven sci-fi back in the late 1990s.
Spares is set in a dystopian American future (one assumes) where the rich can grow spare bodies for harvesting in the event of tragedy and trauma to their own, where MegaMalls fly through the sky and where we find Jack Randall, a retired detective and former Bright Eyes soldier, in charge of one of the spares farms, who after an accidental overdose becomes acutely aware of the horror of his existence and vows to not only save the spares but eventually to avenge the death of his wife and child. That's a lot of back story to drip feed throughout a book that also races forward to a violent end via a parallel dimension known as The Gap (no relation to the clothing store I would hope). The Gap itself made me think of William Gibson's Neuromancer and his virtual environment, but in this it's more of an in-between place, somewhere the lost things of this dimension slipped into, and where in the narrative history of Spares Jack Randall had been sent to fight the inhabitants, wraiths, ghosts, trees and leaves, empty villages and deadly miasmata, and where he first becomes addicted to the drugs that nearly kill him later but kept him alive in-country. Anyway, it never intrudes, only adding to the deepening mystery and it remains unresolved throughout until the surprising denouement which ties it all together, skillfully if a little too happily for those of us expecting a tragic ending. And it's a damned fine example of story telling.
I watched for a decade or so for the optioned film version of Spares to hit the cinemas, but Dreamworks' rights lapsed. They then turned out The Island which bears some suspicious similarities and which was wholly underwhelming IMHO. But it never reaches the moral horror and casual brutality of the novel on which they presumably based their watered-down (and not in a good, understated Kazuo-Ishiguro Never Let Me Go way) version. It's a hard read in places, presaging his future horror/thriller work, but eminently worthwhile.
Tuesday, 21 March 2017
|It's a good shag, Spec, but|
I wouldn't want to marry it.
But Scott Spectrum is no Ebeneezer Scrooge. He learns absolutely nothing about himself and, at its finalé, is left a cuckold, unaware that his frustrated wife Continence can't be impregnated by acts of fellatio, his baby suspiciously long of neck and skin mottled with giraffe-ish patterns, forced out of his house, his marriage and his life and left to live with Barry the ghost rhinoceros who until then kipped under Scott's sink.
Cock jokes abound, there is foul language and sledgehammer satire, and if you're going in expecting a grimly believable tale like King's debut novel, then you can take a hike. Jim Giraffe is comic surrealism with a dark and nasty bent, but it balances its nastiness with a strange sense of innocence, both Jim and Scott teetering on the edge of understanding but naively trapped in lives and loops from which there is no escape. And in essence, that's the scariest part of this ghost story; for all the surrealism, Scott's terminal parabolic arc doesn't end with a pot of gold, but with loneliness and despair - we all die alone. Although not all with a ghost rhino for company.