The House of God

by Samuel Shem

The House of God, a novel first published in 1978, is a provocative journey into the lives of Roy Basch and five fellow interns at the most renowned teaching hospital in the country. Now in its 50th year of publication and with more than 2 million copies sold nationwide, The House of God by Samuel Shem (pseudonym for Dr. Stephen Bergman) is considered one of the most important medical novels of the past century.

This unique feature article for agenda includes excerpts from the book’s “Introduction” by John Updike and the “Afterword” by author Samuel Shem.

Introduction
We expect the world of doctors. Out of our own need, we revere them; we imagine that their training and expertise and saintly dedication have purged them of all the uncertainty, trepidation, and disgust that we would feel in their position, seeing what they see and being asked to cure it. Blood and vomit and pus do not revolt them; senility and dementia have no terrors; it does not alarm them to plunge into the slippery tangle of internal organs, or to handle the infected and contagious. For them, the flesh and its diseases have been abstracted, rendered coolly diagrammatic and quickly subject to infallible diagnosis and effective treatment.

The House of God is a book to relieve you of these illusions; it does for medical training what Catch-22 did for the military life – displays it as farce, a melee of blunderers laboring to murky purpose under corrupt and platitudinous superiors. In a sense The House of God is more outrageous than Catch-22, since the military has long attracted (indeed, has forcibly drafted) detractors and satirists, whereas medical practitioners as represented in fiction are generally benign, often heroic, and at worst of drolly dubious efficacy, like the enthusiastic magus Hofrat Behrens of Thomas Mann’s The Magic Mountain.

Useful even to its mostly straight-faced glossary, The House of God yet glows with the celebratory essence of a real novel, defined by Henry James as “an impression of life.” Sentences leap out with a supercharged vitality, as first novelist Shem grabs the wheel of that old hot rod, the English language.

The jackhammers of the Wing of Zock had been wiggling my ossicles for twelve hours.

From her ruffled front unbuttoned down past her clavicular notch showing her cleavage, to her full tightly held breasts, from the red of her nail polish and lipstick to the blue of her lids and the black of her lashes and even the twinkly gold of the little cross from her Catholic nursing school, she was a rainbow in a waterfall.

We felt sad that someone our age who’d been playing ball with his six-year-old son on one of the super twilights of summer was now a vegetable with a head full of blood, about to have his skull cracked by the surgeons.

The House of God could probably not be written now, at least so unabashedly; its lavish use of freewheeling, multi-ethnic caricature would be inhibited by the current terms “racist,” “sexist,” and “ageist.” Its ‘70s sex is not safe; AIDS does not figure among the plethora of vividly described diseases; and a whole array of organ transplants has come along to enrich the surgeon’s armory.

Yet the book’s concerns are more timely than ever, as the American healthcare system approaches crisis condition – ever more overused, overworked, expensive, and beset by bad publicity, as grotesqueries of mismanagement and fatal mistreatment outdo fiction in the daily newspapers. As it enters its second million of paperback sales, The House of God continues to afford medical students the shock of recognition, and to offer them comfort and amusement in the midst of their Hippocratic travails.

John Updike, April 1995

Afterword
It’s taken me all these twenty-five years to understand The House of God. But that’s often the way it is. You think that you’re more or less aware of what’s going on, and then, many years later, you find out that you weren’t all that aware but that you were being pushed along by unseen historical forces all the while. And so it was with my internship at the Beth Israel Hospital in Boston in 1973-74, the Nixon-Watergate year.

When we entered our internships, we were taught to treat our patients in ways that we didn’t think were humane. We ran smack into the conflict between the received wisdom of the medical system and the call of the human heart.

It was a series of moments – “Hey, wait a second!” moments – that we experience every day when we see, hear, or feel that something is unjust, cruel, militaristic or imperial, or simply not right. Usually we let these moments pass. We do nothing to resist them. But the moments came so fast and furious during our internships, they could neither be ignored nor passed by. We had been brought up to notice, to take “life as it is” and turn it on the spindle of compassionate action to make it more like “life as it could be.” We resisted. We actually did. We stuck together and used classic nonviolent methods – especially humor – to resist. Not that there weren’t casualties. Some interns got suicidal, many got depressed, and a few went through transient psychoses. But we secretly treated people humanely.

I began writing The House of God for catharsis, to share with my buddies what had been the worst year of our lives. I realized that what I was describing was so awful that if anyone was to read it, it had to ride on humor – as we had done, living it. Seven rewrites later, it was finally a novel.

In August of 1978 The House of God came out. I imagined that everyone would love it. The younger generation of doctors did; the older generation hated it, and pilloried me. The abuse didn’t faze me; I knew what I had written was authentic. I had told only the truth, with humor and some art. Immediately the book took on a life of its own.

Twenty-five years and 2 million copies later, The House of God is commonly referred to as “a classic.” I look back on it now, and on the young man who wrote it, with gratitude. The novel has had an impact in addressing the brutality and inhumanity of medical training and practice. My buddies are now in their fifties, in positions of power in medical schools, in health science and public policy. Treated cruelly in their training, they’ll be damned if they’ll treat their trainees cruelly.

Another great advance is the status of women – now at least fifty percent of medical school students (in 1973 they were ten percent). As carriers of caring in our culture, women bring these qualities to the care of patients and relationships with peers. Biotechnology is now being used with more understanding – and is bringing remarkable results in cancers, hereditary illness, and medical devices. “Alternative” health care is no longer alternative. Almost everyone meditates in some form or another, and many acupunct.

What do I understand now about The House of God that I did not before? First, connect. Isolation is deadly; connection heals. In power-over systems like “The House,” members of the subordinate group get isolated from each other – and each gets isolated from his or her authentic experience of the system itself. Each may start to think, “I am crazy” rather than “This is crazy.”

Learn your trade, in the world. We have to be competent to be compassionate. But that patient of ours is never only our patient– the patient is the spouse, the family, the community, the toxins, and the world. Medicine is part of life, not vice versa. We are not only doctors in the world, but of the world. Medecins sans Frontieres.

Speak up. When we notice injustices and cruelties, we must speak up. Speaking up is not only necessary to call attention to the wrongs in the system – whether it be medicine or America or the planet – speaking up is essential for our survival as human beings.

Learn empathy. How do we learn to see, in our patients, ourselves? How can we transform our roles from “power-over” to “power-with”? How do we play our parts in those moments that heal, moments of “mutual empathy.” To create mutuality in a power-over system is transforming, a great alchemy of life.
 

About the Author
Samuel Shem is the pen name for Steve Bergman, a Rhodes scholar and a doctor on the faculty of Harvard Medical School. The House of God was first published in 1978. Shem’s books can be ordered through Amazon.com. His newest work, The Spirit of the Place, is also available at www.literaryventuresfund.org.