One of my favourite novels is The House of God by Samuel Shem. Published back in 1978, it covers the first year of work in a hospital of a doctor who has just graduated from medical school. A lot of medical students read it at some point during medical school, and think it’s a satire of what goes on in a hospital. Then they start to work and realize it’s actually an autobiography.
A new book by Seamus O’Mahony, The Ministry of Bodies, is a fitting counterpart to The House of God. In fact, it’s so fitting that I find it hard to believe that the way the title of the new book juxtaposes so well with the name of the old one is just an accident.
While House of God covered the first year of work of a new doctor, The Ministry of Bodies covers the last year or so of work of a doctor who is about to retire. And while House of God was written as a novel and published under a pseudonym, The Ministry of Bodies is written more as a sort of diary and is openly autobiographical. I guess when you’re at the end of your career you don’t have to worry so much about personal consequences from telling the truth.
The author, Seamus O’Mahony, graduated from medical school in 1984, and has spent his career working as a gastroenterologist (a specialist in diseases of the stomach and intestines), partly in the UK, and partly in Ireland. Over the course of his career, O’Mahony has become increasingly disillusioned with much of what happens in medicine, and he has previously written the excellent Can medicine be cured?: the corruption of a profession, which should in my view be required reading for medical students and doctors, and which outlines much of what is wrong with the modern practice of medicine.
That book is a serious book. So is this one in a way, although the tone is much lighter. There are numerous absurd anecdotes. For example, we get to meet the elderly nun who wants “all measures taken” to prevent her from dying, and the man who wakes up after a suicide attempt and immediately asks to see a cardiologist, because he’s been having some chest pain recently and he’s concerned he might have angina.
While The House of God introduced the term “gomer”, to refer to the oldest, frailest patients, who frequently fill up emergency rooms and hospitals, but whom doctors are usually powerless to do anything for, The Ministry of Bodies introduces its own new term, “super-tanker”, to refer to patients so demanding, and so difficult to “steer”, that all decisions relating to their care need to be made by a single physician, who is willing to act as their “captain”.
Through a large number of short and often amusing vignettes, O’Mahony showcases much of what is wrong about modern medicine. As an example, he shows how the subconscious belief in immortality that seems to grip much of the population drives decision making in the health care system, resulting in absurd overtreatment of people at the end of life.
He also points his finger damningly at what is perhaps the biggest problem there is in health care in many western countries at the moment – the chronic shortage of hospital beds, and how this, when combined with an ever increasing “management by metrics”, has resulted in a gaming of the system that often leads to those with the least need getting care ahead of those with the greatest need.
The book is both hilarious and depressing, and should be read by anyone with an interest in what happens in hospitals and in what doctors do. That probably means it should be read by everyone.