When it comes to modern medical slang, there’s Before Shem and After Shem. Shem refers to Samuel Shem, the pen name of Dr. Stephen Bergman, psychiatrist and author of the blockbuster novel The House of God, which introduced millions of readers — and generations of doctors — to the argot that is the lingua franca of residents and interns then and now. I call Bergman the Slangmeister because until he arrived on the scene in 1978 with his satirical novel, little had been published about medical slang.
The House of God gave the public the first insider’s look at the underbelly of hospital life, revealing the hazing, abuse and psychological damage inflicted on medical interns back then and introducing the public and generations of doctors — especially young ones — to a jarringly new kind of medical slang. In doing so, Bergman shook the culture of modern medicine to its very foundation.
By far the most important argot to come from The House of God is the term GOMER — an acronym for “get out of my emergency room.” In his book, Bergman describes a GOMER as a patient who is frequently admitted to hospital with “complicated but uninspiring and incurable conditions.” It’s unlikely there’s a doctor who has graduated since The House of God was published who hasn’t heard GOMER used in that context.
And there are lots more where that came from. Turf is a verb that appears frequently in the novel; it refers to finding any excuse to refer a patient to a different department or team. Buffing a patient means sorting out medical problems like dehydration before trying to turf. Bounced is slang for when a patient who has been turfed is returned to the department or team that turfed her in the first place. Turf and bounce are used everyday in hospitals across North America; I hear residents at the hospital where I work use them all the time.
Bergman not only introduced those terms, he also acted as a purveyor and catalyst of modern medical slang. Generations of doctors have been influenced and instructed — some might say infected — by Bergman’s work. Many of the terms invented since his book was published have their roots in his original slang.
My visit with Bergman in October 2012 at his home in Newton, Massachusetts, a picturesque patchwork of thirteen villages eleven kilometres west of Boston, was like going on an archeological dig through slang history. Bergman and his partner, Janet Surrey, live in a rambling brick building bordered by an old stone fence and with an even older gnarly tree in front. I entered through a back door into a massive white kitchen, where I found Bergman standing beside a large rectangular table, peeling and eating a grapefruit with gusto.
Bergman shook my hand with a strong grip. He looked a bit older than his publicity photos — as if he’s gotten leaner as he approaches the end of his seventh decade of life. He appeared comfortable in jeans and a charcoal grey, round-necked T-shirt. He has lost almost all of his hair on top. He had longish hair on the sides and a neatly trimmed beard — both of which were nearly white. Bergman’s expression was kind and peaceful. He seemed at ease inside his own skin.
“Have you got a good agent!” Bergman exclaimed almost as soon as we shook hands. He said he’d had lousy agents over the years. As proof, he said that numerous publishers rejected The House of God before Richard Marek/Putnam published it. Despite an uncertain beginning, the book has been in print continuously ever since.
I first heard about The House of God during my final year of medical school in 1979, just a year after it was published. When my senior resident, George Rutherford III, asked how many patients I’d “boxed” on my first night on call on the cardiology floor at the Hospital for Sick Children, the year was 1980, just two years after The House of God was published. Rutherford mentioned the book by name, which made me want to read it. Meanwhile, more and more fellow residents read the book and were starting to quote from it.
After finishing his grapefruit, Bergman — born Jewish but now a practising Buddhist — led me out the back door into the garden and along a path that led to an old two-storey carriage house at the back. He took me up a narrow wooden staircase to a large attic, wherewhere he has his office. He sat at a large rectangular desk; behind him, shelf after shelf was crammed with books.
I felt as if I were meeting the proverbial man behind the curtain. I was in the presence of the Wizard: the Great and Powerful Doctor of Medical Words. I asked him many things, but what I wanted to know most of all was where he got the vivid slang he used in The House of God. How many of the words were taught to him in medical school and internship? After all, if generations of interns and residents read The House of God and learned slang like turfing and bouncing from Bergman, then Bergman must have borrowed argot he heard on the hospital wards in much the same way. Bergman’s answer was startling.
“Well, I don’t think actually any of them were taught to me when I was a medical student,” he said. But when he started his internship at Beth Israel Hospital in Boston in 1973–74, “GOMER was in use. I didn’t invent that. I did invent GOMERE (pronounced “gomare”), which is the female. Either I invented most of the others in the novel when I was writing it or I did so joking around with some guys. I can’t remember now which is which, but buff and turf, I think that was sort of a group thing that evolved. I’m sure I thought of the bounce. The thing is, it’s one thing to have this language. I codified it. I took it further.”
Brian Goldman is an emergency physician and author of The Secret Language of Doctors: Cracking the Code of Hospital Culture. He blogs at White Coat, Black Art.