medical training reflection

House of God was a controversial book when it was first published and remains so to this day. With graphic descriptions of sex, violence, and unbridled frustration with a system that does not acknowledge any of the participants as human, it provides shocking insight into the private world of medical training. While many readers were probably revolted by the crudity and cruelty displayed in the hospital, as John Updike writes in the introduction, Shem simply reveals the dark thoughts that have crossed many a mind during medical training—it is just that no one else is willing to admit that they are capable of such cynical and sadistic thought.
The transformation of Roy over the course of the novel is profound. On the first day of his internship, he is dropped off at the hospital (a thinly-disguised Beth Israel Hospital) by Berry as though he were a child entering his first day of school. His idealistic enthusiasm to be a powerful doctor, a kind doctor, and to save people’s lives, are quickly shattered—gently and hilariously by the Fat Man, and painfully by his actual experiences. By the end of his first year, he is broken, and grasps for the fleeting shards of his compassion. One motif through which we see this transformation occur is love: his love for Berry was sensual and romantic, and as the novel progresses, he turns to sex (with other women) as a hollow expression of love that is physically rough and perverted. His relationship with Berry sours, and he contemplates breaking it off with her.
The other interns fare no better. Hooper is allowed to indulge in his morbid interests and is even rewarded for it through the Black Crow Award. The Runt practically becomes a sexaholic, and it is the only thing that seems to get him through the day. One of the interns self-medicates to the point of losing all empathy. Chuck turns to alcohol, and Roy describes his brokenness as particularly sad because he had been so happy before coming to the House of God. All the interns suffer personal loss and are psychologically scathed.
One particularly moving narrative is that of Potts, who commits suicide by plunging to his death from one of the upper floors. Potts is described as a North Carolina fish out of water, from the “Potts of Legare Street,” whose sensitivity and guilt consume him. He is haunted by the Yellow Man, a patient whose death he theoretically could have prevented by administration of steroids. While the other interns and the Fat Man console him, he refuses to let go of his sense of failure. Although resources are technically available for him and other distressed interns, seeking out these resources is interpreted as a sign of weakness and thus infeasible. The higher-ups response to his death is chilling: virtually none.
In fact, the superiors—such as the attending physicians and the administration—are portrayed as distant, incompetent, and mechanical humans who do not seem to remember the trauma of their own medical training. They seem to impose the golden days of their training on the interns, who are working in a much different hospital environment from their time. Near the end of the book, Dr. Leggo has trouble comprehending why the interns are so angry with him—he cannot understand why he is doing a bad job. Hopefully, in medicine nowadays, there is greater communication across the hospital hierarchy. House of God is a frank warning to those who believe medical training is simply a rite of passage. As Shem describes it, it is more like a hazing which not all survive.