Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

At the end of his career, a physician reflects on the House of God

Bill Kinnard, MD
Physician
September 16, 2019
Share
Tweet
Share

I read Samuel Shem’s House of God twice — once in my late college/early med school years and another sometime during my pulmonary/critical care fellowship. The first time, I recall thinking it was drop-dead hilarious. I eagerly shared it with friends and family. Absorbing the wisdom of the fat man, the catchy vocabulary, and the cynicism of the narrator made me feel somehow like an insider wise to the game even before I’d gotten on the field.

The second time, I was horrified. By that time I had completed a (pre-1990) internal medicine residency, as well as an even harder spell of every other night call as an ICU fellow … which is to say that I had many more sleepless nights than Roy Basch did in his one year in the House of God. I realized that the book probably reflected a lot more about the author than it did the patients he was privileged to serve. After several years of casually using the term “gomer” (get out of my emergency room) to describe older patients, I dropped that word from my vocabulary and encouraged others to do the same. I didn’t buy the idea that one could use that language behind the scenes and not be impacted by it. I considered the author to have abandoned those LOLs in NAD (little old ladies in no acute distress) that he claimed to have such tender feelings for.

Then, for a long time, I forgot about it. A career of taking care of the sickest of the sick — and often confronting times when caring did not mean curing — happened. If “The HOG” informed my actions or thoughts at all, I was not aware of it.

But, as my career in the ICU wound down, well past the age where most practitioners have “burned out,” I began looking at the ICU differently. Not as a place where we skillfully employ advanced sepsis care, sophisticated ventilator management, and slick technical skills to turn around unstable patients. Not even as a place where we gently transition to palliative care and helped loved ones deal with devastating losses. Rather, it is a place where failures land. Where failures of elder care, child protection, addiction treatment, affordable housing, mental health services, and equitable delivery of primary care to the whole community all lead to catastrophe, and to me.

Especially elder care. Day after day, I meet frail people who have fallen. At home, at the SNF, at assisted living, even upstairs on the wards. And when they fall, they break things. Hips. Ribs. Subdural blood vessels.

So it was that I took note a recent salvo of remembrances about the House of God. And I was reminded most particularly the second of the fat man’s rules: Gomers go to ground.

My ICU is the place where gomers go when they go to ground. I still reject that term — but the law has an important kernel of truth. It’s gravity that gets us. We’re all going to go to ground. Every human being lives with gravity every moment of our lives( shush about astronauts). We obey this law without fail every day. So why are we so surprised by it? Why don’t we plan for it? Why do we spend billions on ICU care, and now on “post-acute care” that simply returns our frail elderly to the perilous 1G world? Where they will, without fail, go to ground again.

There are many complicating factors underlying these questions — cultural, economic, political, spiritual, and more. The answers, however, depend on accepting the truth of rule number 2. The author of the House of God may ( or may not have) written that law from a place of self-pity and smug superiority — but he was right. And I, who sent two (great) kids to college and built a nice mountain home on income generated thanks to gravity— what was I?

Bill Kinnard is a critical care physician.

Image credit: Shutterstock.com

Prev

The broader mission for hospice care

September 15, 2019 Kevin 1
…
Next

Do physicians betray patient confidentiality by signing insurance contracts?

September 16, 2019 Kevin 1
…

Tagged as: Critical Care

Post navigation

< Previous Post
The broader mission for hospice care
Next Post >
Do physicians betray patient confidentiality by signing insurance contracts?

ADVERTISEMENT

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Pursuing a career as a physician: A reminder why

    Sangrag Ganguli
  • More physician responsibility for patient care

    Michael R. McGuire
  • Health care needs more physician CEOs

    Alexi Nazem, MD

More in Physician

  • Life’s detours may be blessings in disguise

    Osmund Agbo, MD
  • Inside the heart of internal medicine: Why we stay

    Ryan Nadelson, MD
  • The quiet grief behind hospital walls

    Aaron Grubner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Civil discourse as a leadership competency: the case for curiosity in medicine

    All Levels Leadership
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

At the end of his career, a physician reflects on the House of God
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...