Reflections on Samuel Shem's The House of God

We live in a society where, as sociologists like Charles Derber have argued, the professional classes--their self-interest, their ethos and prejudices--are a hugely powerful force in our life, especially insofar as the professional group in question is itself powerful. Few such groups compare with doctors in that respect, with the result that, even in a society where the glorification and glamorization of professionals to a preposterous degree is the pop cultural default, the propaganda for the image of the doctor as a "god in a white coat" stands out for its sheer relentlessness.

Naturally, when I learned about Samuel Shem's The House of God in an Internet forum discussing the film version of the novel and claiming that the movie's (alleged) suppression was the work of an outraged American Medical Association, I was intrigued. As it happened I found absolutely no evidence whatsoever that this actually happened--but that people would think (even falsely) that the book's content is so offensive to the medical Establishment that it would take such drastic action still interested me, and eventually I found my way to the novel (not the film, which as of the time of this writing I have not seen).

As the blurb on the back of my paperback edition explains, it is about the experience of medical school graduates through their first year of residency training at a thinly veiled version of the Harvard Medical School's teaching hospital in what (as we are reminded time and again by way of the references to current events) the Watergate era. What that basically comes down to is that the narrator-protagonist and his colleagues are thrust into an exceedingly difficult situation without preparation or guidance by seniors who, the wise and humane figure like the Fat Man apart, seem to be either complete idiots, or completely corrupted careerists--with the resulting nightmare threatening their humanity, and even their lives. (Before the tale is over one of their group will take his own life--amid far, far more death, not least due to these residents' own mistakes and worse.)

There is a great deal of reckless and revolting behavior on the part of the residents as they struggle to get through it all--which, wherever one finds a discussion of the book, is the subject of enormous amounts of sanctimonious commentary. As my use of the words "reckless" and "revolting" to characterize their behavior I do not at all approve or defend what they do, but the sanctimoniousness--which, characteristically, seems to focus overwhelmingly on the sexual antics rather than the cynical and often terrifying medical stuff (again, a lot of patients are treated horrendously, and frequently die), as is usual with people whose minds run to such things in such ways--only shows that those readers completely missed the point. This is a story not about a few young folk conducting themselves in a manner unbecoming, but rather the evils of a system that tortures and destroys patient and doctor alike out of venality as well as stupidity. It is the essence of the matter that at this point in the development of the state of the art there are a great many situations in which, for all its pretensions and airs, medicine can do nothing, but does it anyway, painfully and expensively. ("Most of us wouldn't know a cure if we found one in a Cracker Jack box . . . I haven't cured anybody yet and I don't know an intern who has," one says at the end of that year, and it is not flippancy.) This is not least a matter of the profession's keeping people alive as "gomers," preventing their passing but only extending their span of life under conditions in which they are "human beings who, through age and sickness, [have] lost . . . what goes into a human being"--a problem the older generation of doctors did not have to face at that stage of their careers, and completely failed to appreciate. Indeed, never have I seen such a strong case made for "medical nihilism" (against which the taboo in this society is, predictably, overwhelming). Yet at the same time, while one can only be horrified at what awaits patients passing into such hands as these, never has a work of fiction made me feel such empathy for what awaits those who enter the medical profession--especially if, like our hero, they do so with hopes of doing good rather than just doing well.

I have read that there has been some reform of the system of medical training since this book's publication, prompted in part by this book (which many in the medical community found all too true of the experience). However, it remains the case that the health care system is far from what anyone would like it to be, in this respect as in so many others--be it the grueling hours worked, the ever-more grinding testing system, the lack of solidarity and support, all far worse than it has to be, and that a function of that same business-mindedness. The result is that a novel by some newly minted doctor taking an equally frank look at their profession would seem way overdue these days. Alas, it seems likely to remain overdue, publishing a very different thing from what it was when Shem came out with his book, such that I would not hold my breath for the arrival of such a forcefully critical work in print, at least by way of the Park Avenue types who have decided that they and they alone decide what deserves to be read as they slap the names of the superannuated bestselling hacks of yesteryear on as many books as they can for the sake of shaking a few more pennies out of the pockets of what remains of a reading public.