How do Healthcare Professionals Cope with Death? Representations of Death-related Terminology in “The House of God” by Samuel Shem

An analysis of a one year experience at the Best Medical Center in Boston


Seminar Paper, 2013

18 Pages, Grade: 1,7


Excerpt


Table of Contents

1 Introduction

2 Materials and Methods
2.1 The Novel “The House of God” by Samuel Shem
2.2 Death Notices/ Obituaries
2.3 Death in the Sample Obituaries in Contrast to the Novel

3 Data Collection and Results
3.1 Collection of Samples from Contemporary Newspapers
3.2 Concordancer- Aided Analysis of “The House of God”
3.2.1 pass/ passing (of)/ passed/ passed away
3.2.2 loss (of)/ demise (of)
3.2.3 death (of)/ death/ death occurred/ died/ die
3.2.4 was killed/ killed/ kill

4 Discussion and Conclusion

References

Appendix

List of References- Newspaper Obituaries

Charts

Table of Charts

Chart 1: Newspaper Findings Jan- Sep 1977

Chart 2: Jan 11, 1977

Chart 3: Jan 31, 1977

Chart 4: Feb 22, 1977

Chart 5: Feb 28, 1977

Chart 6: Mar 7, 1977

Chart 7: Mar 24, 1977

Chart 8: Apr 5, 1977

Chart 9: Apr 25, 1977

Chart 10: May 3, 1977

Chart 11: May 30, 1977

Chart 12: Jun 23, 1977

Chart 13: Jun 28, 1977

Chart 14: Jul 7, 1977

Chart 15: Sep 17, 1977

1 Introduction

Healthcare professionals working in the hospital setting are in the first line concerned with the medical condition of their patients. Moreover, they are trained to master and to alter nearly every possible medical condition they find a patient in and change it for the better. While the aim of every hospital treatment is to cure diseases and to treat injuries until the patients discharge from the institution, the death of a patient counteracts this aim. Where the condition of nearly every disease can be altered or, in the light of a growing number of chronic diseases at least be transformed to a resilient state, death is the ultimate end of these endeavors. The Oxford English Dictionary (OED) describes death as “…the act or fact of dying; the end of life; the final cessation of the vital functions […] of an individual.” (Oxford English Dictionary, 2013a) Away from this objective description, the death of a patient, especially when it occurs suddenly and is not expected may be a burdensome event even for medical staff. Samuel Shems novel ”The House of God” is about the young intern Roy Bash who experiences his first year in the world of professional medicine at the Best Medical Center in Boston, MA. In the course of this year the protagonist experiences various events that revolve around living and dying of patients, colleagues and friends. Since these events take place in the setting of a hospital, they are meant to be dealt with professionally. The way how death is depicted, how it is reflected in the language of the professionals’ at Best Medical Center may differ from the way “the outside world”, the rest of society deals with this topic. Moreover, since professionals are but human beings do they, when it comes to death use the same terminology as the rest of society does? What is the widely accepted way of addressing the topic of death and dying? As a healthcare professional, the author of this paper is acquainted with real world communication in the hospital setting. The knowledge of this special field of professional vernacular shall also find expression in these humble efforts of academic writing.

In this paper, the representations of death and dying will be analyzed on the basis of authentic material. Specific terminology used by society when addressing this field of topic will be detected and evaluated. In the following paper, the novel “The House of God” will be scanned for representations of that terminology through concordance software. The reflection of publicly used terminology within the novel will to a certain extend show the special relevance of death in the hospital setting and in how far death differs from normality in this field. Furthermore it will allow to draw conclusions on how the characters feel towards this topic and to which extend the novel depicts the hospital and the behavior of those who work in it as inhuman and deviating from what is regarded to be the social norm.

2 Materials and Methods

In this section, the theoretical background of this paper is presented. Information on the research conducted so far on Samuel Shem’s novel “The House of God” as well as on the source of the authentic language samples extracted from obituaries will be provided. At the end of the section, the aims of the following analysis will be specified.

2.1 The Novel “The House of God” by Samuel Shem

In his 1978 Novel “The House of God” Samuel Shem[1] writes about the experiences of the medical intern Roy Basch in his first year of practice. After finishing medical school, Basch has to complete several stages of training at a hospital called “Best Medical Center” (BMC) located in Boston, MA. The young medical professional has to undergo a tough training where he experiences the true meaning of being a physician. Accompanied by his fellow interns and under the supervision of “The Fat Man”, who is the “Senior Resident” in charge for their training, Basch realizes that modern medicine does not necessarily mean doing everything to heal every patient. He discovers that there are patients that, at a young age, die in spite of extensive treatment. On the other hand he has to deal with a large number of old and chronically ill patients that enter and leave the BMC in a constant revolving- door like manner. When in the beginning Basch seems to learn to cope with all the inhumanity and injustice he has to meet with, in the course of the novel he gets more and more emotionally and mentally involved. His attitude towards death changes when an associated intern cannot handle the situation any longer and commits suicide. Under the pressure of at least doing anything for his patients, Basch kills a patient out of mercy. Before he entirely loses himself in the mixture of death and sex he finds himself in, he is finally rescued by his girlfriend Berry.

There has not been much of research carried out on “The House of God” let alone the language used in the novel. When Delese Wear took “Another Look” on its relevance for professional medicine, she did not find publications “…other than several book reviews [and] only two critical articles on the novel itself.” (Wear, 2002, p. 496) Actually the articles written so far concentrate on the satiric depiction of physicians in the novel (Hunter, 1983) or the qualities of Shems Novel as a “medical Bildungsroman”. (Jones, 1996) Even if the novel did not attract much public attention when it was published, it had an impact on the medical community and even 35 years later is still a must- read for every medical student. When Kathryn Montgomery Hunter wrote about “The House of God” in 1983 she stated that it is: “…not a great book, for the moment- particularly for doctors and teachers of doctors- it is an important one”. (Hunter, 1983, p. 136; Wear, 2002, p. 496) Actually the novel caused certain uproar in the medical community when physicians from all over the world remarked that the depiction of hospital medicine in the novel does not resemble reality. The language in the novel was stated to be “unprofessional and unethical” (Wear, 2002, p. 498) And in fact- it is. When “The Fat Man” states his personal rules of the “House of God”, his first rule is “GOMERs don´t die”. GOMER, which is an acronym for “Go out (of) my emergency room” describes the numerous elder patients that are brought to the BMC over and over again from nursing homes where the overworked staff is no longer able to cope with them. This rule arises from one of the basic problems the novel is about: Modern medicine produces a lot of individuals that should have died before they reach the state of being a “GOMER”. They cannot be treated but have to be taken care for and they do not die. Young patients that are terminally ill come to the “House of God” and die although treated by all available means. In this way the traditional image of young patients that can be healed and geriatric patients that die after a long life is tragically distorted. This bitter lesson of experience affects the mental state of the protagonist and those around him as well as their language. Death is no longer the tragic ending point of an unsuccessful case, it is daily business.

2.2 Death Notices/ Obituaries

Due to the subject area of this paper, the linguistic material collected for further analysis has to meet certain requirements. Since “The House of God” was published in 1978 and is set in the 1970´s, the language data should also date back to a similar period date. Most of the plot takes place in the area of Boston, MA so the material should also have a similar point of origin. In contrast to the professional language supposedly used by the physicians and hospital staff in the novel, the data collected should represent the normal, popularly accepted variety spoken and written in this place at that time. There are several possible ways to collect authentic language data of the quality described above. Contemporary recorded interviews, radio broadcasts or TV programs concerned with the relevant field of topic can be transcribed to use the transcripts for further analysis. Certainly, authentic, contemporary spoken language data is hard to access and can only be processed with immense effort that clearly goes beyond the scope of this paper. However, written data easily can be gained from non- fictional prose such as newspapers from that period of time. When it comes to the topic of death and dying, nearly every local newspaper comes up with a number of obituaries on a daily basis. The OED describes obituaries as follows: “A record or announcement of a death, esp. in a newspaper or similar publication; […] typically including a brief biography.” (2013b) According to that description, among the announcement of death, obituaries should contain descriptions of death and therefore lend terminology which can be used in this paper. Although there is a large number of newspaper archives that can be accessed online and at no charge, contemporary daily newspapers from the area of Boston, MA are not available. The good news is the New York Times provides full access to their archives and is also suitable due to geographical proximity.

When Moses and Giana analyzed obituaries from the New York Times dated 1983- 2002, they found two different types. On the one hand there are “edited” obituaries written by professional journalists on the top of the page. Edited like a newspaper article, they are written in honor of important persons or public figures that recently passed. The other section consists of large quantity of smaller printed death notices paid for and written by family and friends of the departed (2003, p. 124). Since the edited obituaries are more consistent in terms of style and content and display rather a public image of the deceased in contrast to personal feelings and concerns in those written by friends and family, this paper will focus on the latter. The family- written death notices differ in terms of style and content. Still, there are similarities they have in common:

The circumstances of the death are optionally included in the family authored obituaries. The place of death and an adjective modifying the death are examples of these cited circumstances: naming the city, hospital, or home and using modifiers like “peacefully,” “suddenly,” “in his sleep,” or “surrounded by family.” These descriptions reflect the subjectivity of these texts. Only 10% of the family authored texts give a medical cause of death. (Moses & Marelli, 2003, p. 128)

The properties described by Moses and Marelli for the New York Times´ obituaries from 1983- 2002 are also valid for those dating from the target period of this paper. The relevant sections of the New York Times from January to September 1977 accessed by the author can be also subdivided in professional- and “family authored” death notices. On these grounds, it is possible to scan the contemporary obituaries for descriptions of death and dying and to extract relevant material for the following analysis.

2.3 Death in the Sample Obituaries in Contrast to the Novel

Within the preceding paragraph, obituaries have been identified as a means to gather authentic material that allows revealing how death is depicted in society. The sample material drawn from contemporary issues of the New York Times can be seen as a widely accepted way of dealing with this topic in public at that time. In contrast to the public image of death created by mass media, “The House of God” is set in the professional spheres of a hospital. Since the novel primarily represents how death is experienced by the protagonist, his friends and associated hospital staff, it seems probable that the language deviates from “normal”, from what is publically accepted and regarded as appropriate parlance. In this case the language used in the “The House of God” will not reflect the terminology used in contemporary death notices. This paper takes up on the question in how far concepts to describe death in the medium of newspaper obituaries can be found in Samuel Shem’s novel “The House of God”. The empirical findings will show the degree of deviation between the representation of death in the death notices and in the novel. These results can be interpreted in terms of the attitude of the characters in the novel towards the topic of death.

3 Data Collection and Results

For the following analysis, obituaries from the New York Times were collected and analyzed in terms of the specific types of depiction of death and dying. The findings were evaluated and numerically ordered. Afterwards a concordance- software based scanning process was conducted on the text of the Novel “The House of God” by Samuel Shem.

3.1 Collection of Samples from Contemporary Newspapers

Since it was not possible to access newspaper archives from Boston, MA, sample obituaries had to be taken from the New York Times (also see 2.2). The archives of the New York Times can be accessed online via the “ProQuest” Database. For this paper, the “Deaths” sections of 14 Issues of the New York Times from January to September 1977[2] were randomly selected. This resulted in a total number of 999 obituaries. Every death notice was scanned for terms that bear a meaning associated with death and dying. The relevant units were extracted and sorted into a chart. Due to the method of data storage, it was not possible to scan the obituaries automatically what, in the scope of this paper, drastically limited the sample size. Every representation of death/ dying that appeared in at least one of the obituaries was included in the chart shown below:

illustration not visible in this excerpt

Chart 1: Newspaper Findings Jan- Sep 1977

[...]


[1] All references to the novel in this paper refer to the (2003) Bantam Books edition and are marked “HoG”

[2] For a detailed list of references see Appendix “List of References- Newspaper Obituaries”

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Details

Title
How do Healthcare Professionals Cope with Death? Representations of Death-related Terminology in “The House of God” by Samuel Shem
Subtitle
An analysis of a one year experience at the Best Medical Center in Boston
College
University of Münster  (Englisches Seminar)
Course
Phraseology
Grade
1,7
Author
Year
2013
Pages
18
Catalog Number
V302803
ISBN (eBook)
9783668012073
ISBN (Book)
9783668012080
File size
553 KB
Language
English
Keywords
Phraseology, Obituaries, House of God, Death
Quote paper
Jan Stolzewski (Author), 2013, How do Healthcare Professionals Cope with Death? Representations of Death-related Terminology in “The House of God” by Samuel Shem, Munich, GRIN Verlag, https://www.grin.com/document/302803

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