During my medical training, doctors around me referenced Samuel Shem’s The House of God as the classic story of young doctor’s experience in an American hospital. I can’t recall anyone sharing particular details from the text. It was mentioned more in passing, with raised eyebrows, the look of an inside joke, the kind of look I never asked to be explained for fear that my ignorance would be laughed at. At that point I had already dabbled in writing about my experiences in medicine, starting with the anatomy lab. I decided I needed a copy of Shem’s book. I needed to know what the precedent was, what I was up against in trying to enter this particular niche in the literary field.
History is a little blurry at this point, but I think my husband’s grandmother gave me the book for my birthday while I was an intern at a Boston-area hospital. I held the thick yellow paperback, felt its weight and gave it a spot on the shelf where I could gaze at it in reverence. I didn’t have time to read it right then.
A couple of years passed. I left medicine, but I continued to write. Now I was working on a piece about one call night from my internship. The entire manuscript was about one night. I wanted to convey how long those nights felt, how much could happen, how the events could change you. I thought about reading The House of God at that point, for research purposes, to see how it was told in a way that was embraced so widely, in a way that sold so well. In the end, I left it on the shelf. I didn’t want to be influenced by someone else’s style. I wanted to tell my story and know it was purely my own.
I finished my piece and passed it around to friends. Their overall question after reading it was: why was this doctor so upset? The protagonist of my story looks on her job with dread and cynicism, and it’s almost funny how I assumed the reader would understand why. I wrote about shocking events, episodes that I hoped would communicate to the reader the strenuousness and at times near absurdity of practicing medicine. I wasn’t sure how to edit my work to bridge the gap between my story and the reader’s understanding. I let it rest.
More than several years passed.
This year I started a new piece, a memoir about becoming a family of six. Medical writing was, for the moment, something of the past. Sure, I have two and a half manuscripts that I would like to revisit someday, but I have other words in me I need to work out first.
At the same time, this year has provided space to work on projects I’ve been putting off -- cleaning out the basement, organizing photos, finishing quilts...and reading those books on the shelf that for years I only stared at. I decided to crack open The House of God. It was time. There were years of mental distance between me and medicine, even between me and my writing about medicine. I could read it more objectively now and not worry about how it may affect my writing style.
Right away I could see parallels between our tales. Shem’s protagonist Roy Basch is nearly nauseated by the fear and anxiety he feels when he thinks of starting his internship. (I could relate.) He grows angry and cynical and depressed with each shocking and strenuous patient encounter. (I could relate.) When patients die, he and his fellow residents aren’t provided with a supportive environment to debrief events and grieve. (I could relate.)
Stylistically, I found myself in my own readers’ shoes as I criticized the story. Why was he so afraid to start the internship? What had happened before to give him the impression that it was something to fear? And as his mental health spirals downward, I wanted Shem to carry the reader into that with discrete examples explaining why, examples that I found were glossed over in order to focus on Basch’s reactions to them. I started to develop a checklist for what to look for when I went to revise my own work.
But this doesn’t scratch the surface of my main objections to this book and why I absolutely cannot recommend it to you. If you have read this book and think it is an important work, will you please share your insights with me? Because while I tried to peer through the fog of distracting issues to discern what it was like to practice medicine at that point, I grew nauseated myself as I read of his sexual exploits with the nursing and house staff, the way he continually cheated on his girlfriend, the racist language, the sexist language and the fact that the only female doctor described was the most difficult, uncaring, repressed creature on the ward. Is this one of those books that you’re supposed to read “in context”? Hey, it was the 70s. Loose morals. Paternalistic medicine. White tights on nurses. Condescension for foreign or non-white doctors.
Well I didn’t want to “read in context”. I wanted to burn my copy and thank God that medicine had changed. Perhaps it needs to continue to evolve -- after all, I was just as angry and cynical and depressed during my own internship, although my behavior was saint-like compared to Shem’s characters.
I finished the book and knew I had work to do.
I have stories to tell. I want my readers to understand why interns might feel that dread about going to work. I want them to understand why we might get angry and cynical and depressed. And I want to update this story with the times. My graduating class from medical school was greater than 50% women. Times have changed.
In a recent afterward to his book, Stephen Bergman (Samuel Shem is a pen name) suggests that his intended audience was other interns. He felt good when other interns read his work and could laugh and cry along and not feel so alone. I could not get over my disgust of the language and certain events in order to relate to the characters as fellow interns, but reading his intentions made me want to reconsider my own intended audience. I wanted to make the experience of medical education accessible to those outside the field. I wanted people to sympathize with doctors in a day and age when paternalism has long faded and patients, being more informed than ever, demand near perfection from their providers.
I have stories to tell, and, if I hold onto no other redeeming quality, Shem’s book inspired me to continue the work I started so many years ago.
Here you will find a catalog of my writing and reflections.