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Samuel Shem treats the healthcare problem with a dose of dark humor

“I am in recovery from having been a psychiatrist,” said Samuel Shem — the pen name adopted by Stephen Bergman back when he was an intern at Boston’s Beth Israel Hospital and writing his first novel, the 1978 cult classic “The House of God.” He always wanted to write a sequel, but it took years before he found his subject. After decades in practice and on the faculty of the Harvard Medical School, other projects had gripped him, including novels and an Off-Broadway play, “Bill W. and Dr. Bob,” about the founding of Alcoholics Anonymous.

But five years ago, when NYU called and asked him to teach a course about the issues raised in “The House of God,” Shem found himself back in the world of doctors, patients, and hospitals. “I spent a night in the Bellevue emergency room, and then I went on rounds a couple of times in medicine and surgery,” Shem said. And he noticed a new problem in the field: the outsized influence of money and screens, in particular the time and energy doctors must spend interacting with insurance companies through computers — time they might prefer to spend helping patients.


In his first novel, Shem said, “I was telling the truth with some humor and sex, but I was hitting a real vital issue, which is the brutality of medical training.” In his latest, “Man’s 4th Best Hospital,” he brings back many of the same characters — and the same rollicking, outrageous humor — to bear on what he sees as “the crippling of medicine by the for-profit part. Everybody knows how horrible it is, doctors and patients alike.”

What he didn’t realize for years, Shem said, “is that ‘The House of God’ is a novel of resistance, resistance to a system with a hope to change it.” With “Man’s 4th Best Hospital,” Shem is once again resisting.


Samuel Shem (i.e. Stephen Bergman) will read Wednesday at 7 p.m. at Harvard Book Store.