Law I: Gomers don't die

I recently read The House of God, by Samuel Shem, loosely based on his experiences as an intern ( American F1/PRHO equivalent) at an eponymous hospital in the 1970s.

One of the more appealing roles is the Fat Man - an indomitable character who, although with only a year's experience under his vast belt, has learnt to work the system to the benefit of all. He takes Roy, from whose viewpoint the story is written, and his fellow interns under his wing, and shows them that real medicine is very little like what is learnt in all the years spent at medical school.

Thirteen laws form the basis of the Fat Man's teachings. They were applicable in an American inner city hospital (albeit a fictionalised one) thirty years ago; will they be relevant in a small county hospital in semi-rural England? Taking each law in turn, I plan to find out.

I: Gomers don't die

A gomer (f: gomere) stands for Get Out Of My Emergency Room. An umbrella term for all the heart-sink cases sent in from residential/nursing homes. The only obvious reason for their admission is usually that the staff at the home have suddenly (and this is usually in the middle of the night) tired of caring for the resident and choose to send them into hospital and await a new resident (as in the House of God and here, homes usually fill up a bed just as the paramedics are carting away the previous occupant*). These patients - elderly and for the most part also demented - are sent in with complaints of "off legs" or "confused". Never mind that they have required hoisting in and out of bed/chair for the last six weeks, or that they have been living in the 1910s for the past two years.

The Fat Man describes them well:

'Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them. We're cruel to the gomers, by saving them, and they are cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them.'

The patients are no different. And for the most part, they don't tend to die. Of all the patients I've looked after over the past seven months, 65% have been 'gomers', and only one has died. Surprisingly they usually manage a pretty long stay in hospital, without picking up an infection until three months later a bed at a residential/nursing home is found, with little change to their condition and medication**.

.......True.

*only slight exaggeration
** if there is a change, it is not usually for the better.