Train wrecks!

I think that as nurses we need to blow off steam sometimes. I think train wreck suits some patients with multiple co morbidities and complications that thier hospital course resembles the conflagration and chaos that resembles a train wreck. I don't think nurses or ohysician for the matter, mean this as a derogatory term....it's more of a descriptive term and is never said to the patient.

Some of these references come from a book....The House of God...The House of God is a satirical novel by Samuel Shem (a pseudonym of the psychiatrist Stephen Bergman), published in 1978. It portrays the psychological harm done to medical interns during the course of medical internship in the early 1970s.

Laws of the House of God

1. GOMERS DON'T DIE.
   
2. GOMERS GO TO GROUND
   
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
   
4. THE PATIENT IS THE ONE WITH THE DISEASE.
   
5. PLACEMENT COMES FIRST.
   
6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.
   
7. AGE + BUN = LASIX DOSE.
   
8. THEY CAN ALWAYS HURT YOU MORE.
   
9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
   
10. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.
    
11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
    
12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
    
13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
    

Several of the terms common to the jargon of junior hospital staff were widely popularized by the book:

• To turf (verb: to find any excuse to refer a patient to a different department or team)
  
• To bounce (verb: a turf that has returned to its first department)
  
• Gomer (noun: "get out of my emergency room" - a patient who is frequently admitted with complicated but uninspiring and incurable conditions)
  
• LOL in NAD (noun: "little old lady in no apparent distress" - an elderly patient who following a minor fall or illness, would be better served by staying at home with good social support, rather than being admitted into a hospital with all the iatrogenic risks of modern medicine. Compare "NAD" = "no abnormality detected" or "no apparent distress" (used to record the absence of abnormal signs on examination).
  
• Zebra (noun: a very unlikely diagnosis where a more common disease would be more likely to cause a patient's symptoms - from the common admonition that "if you hear hoof beats, think horses, not zebras").
  
• Buff the charts (verb: to make a patient look well treated in the charts or medical records, without actually receiving any treatment.)
  

The book takes place during the Watergate scandal, and follows such events as the resignation of Spiro T. Agnew and the stepping-down of Richard Nixon.

The book is very likely autobiographical, as the BMS is a thinly veiled Harvard Medical School (commonly called HMS), and The House of God representing the Beth Israel Hospital, now a part of Beth Israel Deaconess Medical Center, one of the HMS-affiliated hospitals in Boston, Massachusetts; "Man's Best Hospital" (MBH) represents Massachusetts General Hospital (MGH). There are also references to a community hospital called Mt. St. Elsewhere or Mt. St. E.'s, which likely represents Boston City Hospital (The scenes of the hospital on TV show it to be near the old elevated orange line. Boston City Hospital was near this line. St Elizabeth's is near the green line. )St. Elizabeth's Medical Center or Mount Auburn Hospital (Cambridge) which was part of the Harvard Medical School teaching hospital system.

Some American doctors felt that The House of God resonated with their own experiences during their internship training. The House of God - Wikipedia, the free encyclopedia

35 years later, author revisits 'The House of God' - The Boston Globe

Great book by the way.