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The House Of God by Samuel Shem

GOMERs go to ground
but they never die.
This book is as old as I am. Not necessarily the copy I own (that was reprinted in the 1990s and I got hold of it through the amazing Free Books Carmarthen initiative that is keeping books from adding to landfills), but it was written in 1978, a good year for the world by all accounts*. Back then, it wrought much anger from the medical community in America, leading the author and psychiatrist Stephen Joseph Bergman to assume a pen name to avoid suffering the professional backlash - it didn't work, but then he says his patients didn't seem to care.

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:
  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 #14G 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.

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:

  1. Connection comes first.
  2. Learn empathy.
  3. Speak up.
  4. 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.


How's about that then?

Metaliterature - what meaning to have is this for meaning?

Not a review this time, more of a curiosity. It seems I'm receiving lots of hits from Russia (Здравствуйте России!) from people searching for the definition of "metaliterature". As such, it is something of a bespoke word, created to fit a need and probably not yet recognized outside literary theory / criticism circles (Merriam-Webster Online certainly don't like it). I was wondering what they typed in to end up here, so, for fun (it's not fun, sorry) I thought I'd bung it in Google Translate and see what came out. As it turns out, one needs a little hyphen for the rather ponderous machine to understand it, and even then only does half the job (meta seems to be meta in any language). 
Incidentally, below is, ironically, a Google Chrome Thesaurus definition* of "meta":

met·a Adjective/ˈmetə/
(of a creative work) Referring to itself or to the conventions of its genre; self-referentialInterestingly (not interesting, sorry) it says this for the full term, t…

Under The Dust by Jordi Coca

So, wheel of fortune, count to 29, pin the tail, freebies off of peeps on Twitter etc. etc. Whatever the methods sometimes employed to pick the next book in my intertextual experience, the one that brought me to Jordi Coca brought me to a whopping great slice of nostalgia. Before I'd even opened it, it brought to mind Richard Gwyn, himself a published poet, author, biographer, translator and course director of the MA Creative Writing course at Cardiff University, who I recall for some odd reason gently encouraging me to read this novel, and by whose own work I was quietly impressed at the time. He was also an advocate of Roberto Bolaño, another writer in whose work I can immerse myself but from which I emerge drained, as mentioned previously. Before that, though, there is this sticker on the front, declaring 'Signed by the Author at Waterstone's'. It is indeed signed by Jordi Coca, not adding any particular intrinsic value to the book, not for me anyway, but more impor…

Hereward: The Last Englishman by Peter Rex

By all accounts, Hereward was the guerrilla scourge of the invading Norman armies in eleventh century Cambridgeshire and Norfolk, famous for isolating and dismembering members of the Norman nobility who strayed too far from home, and also for trashing Peterborough and hiding on an island. Called variously (and often erroneously) The Wake, The Exile or The Outlaw, his infamy was such that families in search of noble English lineage have usurped his "heroism" for their own glory even until this very day. Rex delights in highlighting one author's particular folly, entitled Hereward, The Saxon Patriot, in which Lieutenant-General Harward attempts to run his antecedents right back to the loins of the eponymous gentleman-rogue. 

Having only read the introduction to Peter Rex's myth-busting (and often ill-edited) work, I was already struck by an initial thought which ran thus: if as Rex asserts Hereward was the son of Asketil Tokison, a descendant of a wealthy Danish family …

A Death In The Family: My Struggle Volume 1 by Karl Ove Knausgaard

I sit here, wearing my limited edition Knausgaard t-shirt, immensely grateful to the kind people at Vintage Books for their surprising gift of the first four novels (and aforementioned t-shirt) simply as a result of being able to post a comment on their YouTube Vlog. There may have been a hidden agenda, considering I'm a book blogger (What, interrobang, a book blogger, interrobang and so on...) but I prefer to believe they picked me at random. Because I'm ace. 
Nonetheless, I had no idea what to expect of these books. I did do a little reading, and found lots of very interesting articles about Karl Ove Knausgaard, including this entertaining one in the Wall Street Journal. But in all honesty, nothing prepared me for reading them, and I can see why they cause controversy and consternation wherever they are translated (which is pretty much everywhere).
First off, being intelligent and perspicacious readers as I trust you all to be, you will no doubt have spotted the whole Godwin&#…