House of God Read online

  About the Author

  Samuel Shem (Stephen Bergman M.D.) graduated magna cum laude and Phi Beta Kappa from Harvard College and earned a Ph.D in physiology from Oxford University, where he was a Rhodes Scholar. He graduated from Harvard Medical School. He is the author of the novels The House of God, Mount Misery and Fine and seven plays, including, with Janet Surrey, Bill W. and Dr. Bob. He is on the faculty of Harvard Medical School and the Stone Centre, Wellesley College. He lives with his wife and daughter near Boston.

  ‘Undiluted fun for the physician reader, with abundant self-reminiscing prompted by each of the mad situations described . . . It takes off in the first chapter at a fast, hilarious pace reminiscent of M*A*S*H and never slows down’ Medical Tribune

  ‘A wonderfully wild, ribald, erotic, bitter, compassionate, at times disgusting novel about the lives of interns in a major hospital’ Seattle Daily Times

  ‘Wildly funny, sad, laugh-out-loud, outrageous, moving . . . a story of modern medicine rarely, if ever, told’ Houston Chronicle

  www.booksattransworld.co.uk

  Also by Samuel Shem

  MOUNT MISERY

  and published by Black Swan

  THE HOUSE OF GOD

  Samuel Shem

  BLACK SWAN

  To J and Ben

  We shall forget by day, except

  The moments when we choose to play

  The imagined pine, the imagined jay.

  – Wallace Stevens

  The Man with the Blue Guitar

  This eBook is copyright material and must not be copied, reproduced, transferred, distributed, leased, licensed or publicly performed or used in any way except as specifically permitted in writing by the publishers, as allowed under the terms and conditions under which it was purchased or as strictly permitted by applicable copyright law. Any unauthorised distribution or use of this text may be a direct infringement of the author’s and publisher’s rights and those responsible may be liable in law accordingly.

  Epub ISBN: 9781407071657

  Version 1.0

  www.randomhouse.co.uk

  THE HOUSE OF GOD

  A BLACK SWAN BOOK: 9780552991223

  Originally published in Great Britain

  by the Bodley Head Ltd

  PRINTING HISTORY

  Bodley Head edition published 1979

  Corgi edition published 1980

  Black Swan edition published 1985

  30

  Copyright © Samuel Shem 1978

  The author wishes to express appreciation for permission to quote from the following: The Man with the Blue Guitar by Wallace Stevens from the Collected Poems of Wallace Stevens © 1971 Faber & Faber Ltd. Lines from Let the Mermaids Flirt with Me are by Mississippi John Hurt. © Wynwood Music.

  The right of Samuel Shem to be identified as the author of this work has been asserted in accordance with sections 77 and 78 of the Copyright Designs and Patents Act 1988.

  All the characters in this book are fictitious, and any resemblance to actual persons, living or dead, is purely coincidental.

  Conditions of Sale

  This book is sold subject to the condition that it shall not, by way of trade or otherwise, be lent, re-sold, hired out or otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.

  Black Swan Books are published by Transworld Publishers,

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  a division of The Random House Group Ltd.

  Addresses for Random House Group Ltd companies outside the UK

  can be found at: www.randomhouse.co.uk

  The Random House Group Ltd Reg. No. 954009.

  Contents

  I. France

  II. The House of God

  III. The Wing of Zock.

  Laws of the House of God

  Glossary

  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 mêlée 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.

  Not that the young interns and residents and nurses conjured up by Samuel Shem are not sympathetic; they all bring to the grisly fun house of hospital care a residue of their initial dedication, and the most cynical of them, the Fat Man, is the most effective and expert. Our hero, Roy Basch, suggests Voltaire’s Candide in his buoyant innocence and his persistent – for all the running hypochondria of his hectic confessional narrative – health. Three things serve him as windows looking out of the claustral hospital fun house onto the sunlit lost landscape of health: sex, boyhood nostalgia, and basketball. The sex is most conspicuous, and in the orgies with Angel and Molly acquires an epic size and pornographic ideality. A glimpse of Molly’s underpants becomes, in one of the book’s many impetuous parlays of imagery, a sail bulging with the breath of life:

  . . . in the instant between the sit down and the leg cross, there’s a flash of the fantasy triangle, the French panty bulging out over the downy mons like a spinnaker before the soft blond and hairy trade winds. Even though, medically, I knew all about these organs, and had my hands in diseased ones all the time, still, knowing, I wanted it and since it was imagined and healthy and young and fresh and blond and downy soft and pungent, I wanted it all the more.

  In the prevailing morbid milieu, spurts of lust arrive from a world as remote as the world of Basch’s father’s letters, with their serenely illogical conjunctions. Sexual activity between female nurse and male doctor figures here as mutual relief, as a refuge for both classes of caregiver from the circumambient illness and death, from everything distasteful and pathetic and futile and repulsive about the flesh. It is the coed version of the groggy camaraderie of the novice interns: ‘We were sharing something big and murderous and grand.’

  The heroic note, not struck as often and blatantly as the note of mockery, is nevertheless sounded, and is perhaps as valuable to the thousands of interns who have put themselves to school with the overtly pedagogic elements of Shem’s distinctly didactic novel: the thirteen laws laid down by the Fat Man; the doctrines of gomer immortality and curative minimalism; the hospital politics of TURFING and BUFFING and WALLS and SIEVES; the psychoanalysis of unsound doctors like Jo and Potts; the barrage of medical incidents that amounts to a pageant of dos and don’ts. It would be a rare case, I imagine, that a medical intern would encounter and not find foreshadowed somewhere in this Bible of dire possibilities.

  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 ho
t 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.

  We have here thirty-year-old Roy Basch’s belated bildungs-roman, the tale of his venture into the valley of death and the truth of the flesh, ending with his safe return to his eminently sane and sanely sensual Berry. Richard Nixon – the most fascinating of twentieth-century presidents, at least to fiction writers – and the mounting Watergate scandal form the historical background of the novel, pinning it to 1973–74. 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

  Part I

  France

  Life’s like a penis:

  When it’s soft you can’t beat it;

  When it’s hard you get screwed.

  —The Fat Man, Medical Resident in the House of God

  1

  Except for her sunglasses, Berry is naked. Even now, on vacation in France with my internship year barely warm in its grave, I can’t see her bodily imperfections. I love her breasts, the way they change when she lies flat, on her stomach, on her back, and then when she stands, and walks. And dances. Oh, how I love her breasts when she dances. Cooper’s ligaments suspend the breasts. Cooper’s Droopers, if they stretch. And her pubis, symphasis pubis, the bone under the skin being the real force shaping her Mound of Venus. She has sparse black hair. In the sun, she sweats, the glisten making her tan more erotic. In spite of my medical eyes, in spite of having just spent a year among diseased bodies, it is all I can do to sit calmly and record. The day feels smooth, warm, pebbled with the nostalgia of a sigh. It is so still that a match flame stands upright, invisible in the clear hot air. The green of the grass, the lime-white walls of our rented farm-house, the orange stucco roof edging the August blue sky—it is all too perfect for this world. There is no need to think. There is time for all things. There is no result, there is only process. Berry is trying to teach me to love as once I did love, before the deadening by the year.

  I struggle to rest and cannot. Like a missile my mind homes to my hospital, the House of God, and I think of how I and the other interns handled sex. Without love, amidst the gomers and the old ones dying and the dying young, we had savaged the women of the House. From the most tender nursing-school novitiate through the hard-eyed head nurses of the Emergency Room, and even, in pidgin Spanish, to the bangled and whistling Hispanic ones in Housekeeping and Maintenance—we had savaged them for our needs. I think back to the Runt, who had moved from two-dimensional magazine sex into a spine-tingling sexual adventure with a voracious nurse named Angel—Angel, who never ever did, the whole long year, to anyone’s knowledge, string together a complete sentence made of real words. And I know now that the sex in the House of God had been sad and sick and cynical and sick, for like all our doings in the House, it had been done without love, for all of us had become deaf to the murmurs of love.

  ‘Come back, Roy, Don’t drift off there, now.’

  Berry. Finishing our lunch, we are almost to the hearts of our artichokes. They grow to enormous size in this part of France. I had trimmed and boiled the artichokes, and Berry had made the vinaigrette. The food here is exquisite. Often we eat in the sun-dappled garden of our restaurant, under the lattice of branches. The starched white linen, delicate crystal, and fresh red rose in the silver vase was almost too perfect for this life. In the corner, our waiter attends, napkin over his arm. His hand trembles. He suffers from a senile tremor, the tremor of a gomer, of all the gomers of the year. As I come to the last leaves of the artichoke, their purple surpassing their edible green, and throw them toward the garbage heap for the farmer’s chickens and glass-eyed gomer of a dog, I think about a gomer eating an artichoke. Impossible, unless it were pureed and squirted down the feeding tube. I remove the thistly hairs, green abundant, covering the mound of choke, and come to the heart, and I think back to eating in the House of God, and to the one best at eating, best at medicine, my resident, the Fat Man. The Fat Man shoveling onions and Hebrew National hot dogs and raspberry ice cream into his mouth all at once at the ten-o’clock supper. The Fat Man, with his LAWS OF THE HOUSE and his approach to medicine that at first I thought was sick but that gradually I learned to be the way it was. I see us—hot, sweaty, Iwo Jima-heroic—hovered over a gomer:

  ‘They’re hurting us,’ the Fat Man would say.

  ‘They’ve got me on my knees,’ I’d reply.

  ‘I’d commit suicide, but I don’t want to make the bastards happy.’

  And we’d put our arms around each other and cry. My fat genius, always with me when I needed him, but where is he as I need him now? In Hollywood, in Gastroenterology, in bowel runs—as he always put it—‘through the colons of the stars.’ I know now that it was his zany laughter and his caring, and that of the two policemen of the Emergency Room—the two policemen, my Saviors, who seemed to know everything and who almost seemed to know it in advance—that had gotten me through the year. And despite the Fat Man and the policemen, what had happened in the House of God had been fierce, and I had been hurt, bad. For before the House of God, I had loved old people. Now they were no longer old people, they were gomers, and I did not, I could not love them, anymore. I struggle to rest, and cannot, and I struggle to love, and I cannot love, for I’m all leached out, like a man’s shirt washed too many times.

  ‘Since you drift off there so much, maybe you’d rather be back there after all,’ says Berry sarcastically.

  ‘Love, it’s been a bad year.’

  I sip my wine. I’ve been drunk much of the time we’ve been here. I’ve been drunk in the cafés on market days as the clamor ebbs in the market and flows in the bars. I’ve been drunk while swimming in our river, at noon the temperature of water, air, and body all the same, so that I can’t tell where body ends and water begins and it’s a melding of the universe, with the river curling round our bodies, cool and warm rushes intermingling in lost patterns, filling all times and all depths. I swim against the current, looking upstream where the winding riverpath rests in a cradle of willow, rushes, poplar, shadow, and that great master of shadow, the sun. Drunk, I lie in the sun on the towel, watching with blossoming arousal the erotic ballet of the Englishwomen changing into and out of swimsuits, glimpsing an edge of breast, a wisp of pubic hair, as so often I had glimpsed edges and wisps of nurses, as they changed into and out of their costumes before my eyes, in the House. Sometimes, drunk, I ruminate on the state of my liver, and think of all the cirrhotics I have watched turn yellow and die. They either bleed out, raving, coughing up and drowning in blood from ruptured esophageal veins, or, in coma, they slip away, slip blissfully away down the yellow-brick ammonia-scented road to o
blivion. Sweating, I tingle, and Berry becomes more beautiful than ever. This wine makes me feel like I’m bathed in amnion, breathless, fed by the motherblood-flow in the umbilical vein, fetal, slippery and tumbling over and over in the warmth of the beating womb, warm amnion, warmnion. Alcohol helped in the House of God, and I think of my best friend, Chuck, the black intern from Memphis, who never was without a pint of Jack Daniels in his black bag for those extra-bitter times when he was hurt extra bad by the gomers or the slurping House academics, like the Chief Resident or the Chief of Medicine himself, who were always looking at Chuck as illiterate and underprivileged when in fact he was literate and privileged and a better doc than anyone else in the whole place. And in my drunkenness I think that what happened to Chuck in the House was too sad, for he had been happy and funny and now he was sad and glum, broken by them and going around with the same half-angry, half-crushed look in his eyes that I’d noticed Nixon had had yesterday on our French TV, as he stood on the steps of the helicopter on the White House lawn after his resignation, giving a pathetically inappropriate V-for-defeat sign before the doors closed over him, the Filipinos rolled in the red carpet, and Jerry Ford, looking more flabbergasted than awed, put his arm around his wife and walked slowly back to the presidency. The gomers, these gomers . . .

  ‘Damnit, everything makes you think of those gomers,’ says Berry.

  ‘I hadn’t realized that I’d been thinking out loud.’

  ‘You never realize it, but these days, you always do. Nixon, gomers, forget about the gomers. There aren’t any gomers here.’