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June 13, 1980
The Dean was a gentle, bearded man, a pipe-smoking neurologist. He loved to sail in the San Juan islands. He was a far-seeing person and was not given to anger. The failures, large and small, of his medical students were duly noted, but the Dean always saw past these failures to the future successes of his embryo physicians. The only times I ever saw the Dean angry was when he heard someone using the term “gomer.”
Many say that this term is an acronym for “Get out of my emergency room!” a phrase frequently yelled at gomers by emergency room physicians. The gomers themselves were down-and-outers. They were the alcoholics, the addicts, and the senile, raging geriatrics. The term was ubiquitous among the students and house staff at the hospitals in our university system. Underground pamphlets circulated that described the classification of gomers, competitions of legendary gomers, and even gomer olympics. Elaborate point systems were invented to differentiate the ordinary gomer from the supergomer, the title supergomer being awarded for accumulating 150 gomer points. Making ward rounds on these devastated human beings was always turbulent. Gomers always had every possible complication, and treating them was terribly frustrating.
The house staff was surprised at the vehemence with which the Dean attacked the term gomer but was not deterred in its use. We intimated among ourselves that the Dean was obviously far removed from clinical medicine and had forgotten what things were like on the wards.
On the pediatric service a few years later, I supervised the care of a 3-year-old boy named Allan who was dying of hepatic failure. The medical details are not relevant, but it would be difficult to imagine a more depressing case. Bleeding complications rather than hepatic coma threatened to become the terminal event, and the child was in pain.
I noticed that the house staff always became paradoxically whimsical as we discussed Allan’s case. They indulged in what I considered to be medical fantasy, that is, going off on tangents related to remote and horrendous complications. There was a great deal of inappropriate levity and hilarity. I knew that it was not malicious; individually they were as upset about the illness and their inability to affect it as I was. It reminded me of the way we had talked about gomers, and that disturbed me.
One particularly grim day we made rounds on Allan the morning after his most serious hemorrhage. His parents had finally gone home to rest, and he was sitting alone on his hospital bed. As we were leaving the room he suddenly asked, “Will you read to me for a few whiles?”
Our silence was deafening, and the looks of sheer panic on the faces of my colleagues surprised me. Suddenly I realized that all of the inappropriate hilarity, the medical fantasy, and the talk of gomers was a defense against the terrible fear of failure and death. I realized how I, too, had hidden behind the jesting, cynical demeanor and brusque, busy professionalism. At that moment I saw the callow inexperience clearly revealed in myself and in my colleagues by all those years of gomer talk.
We read The Cat in the Hat twice, followed by The Golden Book of Dinosaurs, and were about a third of the way into Selected Mother Goose when my little patient fell asleep.
Gomers. JAMA. 2019;322(6):585. doi:10.1001/jama.2018.15462
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