In August 1978, “Samuel Shem” published “The House of God,” a bawdy, satirical novel based on his experiences as an intern at Boston’s Beth Israel Hospital. “Shem” is the pen name of now-retired Harvard psychiatrist Stephen Bergman. Though he’s written several other novels, plays, and works of nonfiction, “The House of God,” his first book, remains his best known. Often compared to Joseph Heller’s “Catch-22,” “The House of God” exposed the dark side of medical training, in which savagely overworked young doctors found themselves seeing their patients as enemies.
Today, with controversy about whether medical trainees’ hours should be regulated more heated than ever, “The House of God” remains relevant. On the novel’s 35th anniversary, Dr. Bergman spoke at his home in Newton about how and why he wrote it — and what he thinks of medical training today.
Q. While you were going through your internship, were you saying to yourself, “There’s something very wrong with this” ?
A. Yes, all of us were. We were of the ’60s and we were full of idealism in those days. We never took black bags [as gifts] from the pharmaceutical companies. We went on strike when Kent State happened, with all the rest of the university. We were starting the kidney block my freshman year at Harvard Med and we had to decide whether to join the rest of the university on strike or learn the kidney. So we had a big meeting and people stood up and said, “If we go out on strike we’ll never learn the kidney.” And other people said, “To hell with the kidney, let’s go.” So we went out on strike and I never learned the kidney.
Q. So you had to be a psychiatrist!
A. Yes, and you’ll notice in “The House of God” the biggest villain in the book is the kidney doctor!
So when we entered the internship, without realizing it, we were primed to respond if our idealistic notion of how medicine should be practiced —
Q. When you were an intern, did you already see yourself as a writer?
A. Yes. It’s said that writers and artists don’t come from happy childhoods, and mine was not good. I thought I might be a sculptor. [In 1968, while at Oxford on a Rhodes scholarship] I started to write: plays, short stories, poems. I loved writing, but in 1969 the very easy choice came between Vietnam or Harvard Med, so I chose Harvard Med.
Q. Did you keep a journal during your internship?
A. That was the one year I didn’t keep a journal.
Q.What inspired you to write “The House of God”?
A. All of my writing is about one thing: the danger of isolation and the healing power of good, mutual connection. If you get isolated, as in “The House of God,” you can go crazy. You can commit suicide. It happens in medicine. To put it very simply, during internship, each of us got isolated. We not only got isolated from each other, we got isolated from our authentic experience of the system itself. You start to think: I’m crazy for thinking this is crazy.
Q. It was published under a pseudonym. Did anybody know you’d written it?
A. People in the Boston medical world knew it was me. I was just starting my practice as a psychiatrist and I thought I could prevent my patients from seeing me as this radical, sexy, young guy. But they all found out immediately.
Q. How was the book received by your colleagues?
A. My generation loved it. The older generation hated it and tried to discredit me by saying “He wasn’t a very good intern.” That bothered me. I really broke my ass to be a good intern.
Q. When you got to your psychiatry residency, did that seem more humane to you?
A. Unfortunately, the people I thought would be the most humane in dealing with their patients —
Q. Does anyone still hold a grudge against you from those days?
A. No, now it’s kosher, after all these years. In 2009 I was the commencement speaker at Harvard Medical School, which I felt very good about. And about two years ago I was invited to give grand rounds at Beth Israel Deaconess. And I got up and said: “If you live long enough, the people who hate you either die or retire.”
Q. When you heard about the Libby Zion verdict in 1984 [the result of a successful lawsuit brought by the family of a young woman who died while in the care of trainees] did you think: “Now things will finally change?”
A. I definitely did. My first reaction to the verdict was “Hooray.” There are two sides to it, though. I come down barely on the side of what has come to pass, which is making sure doctors are not so tired that they can’t function.
Q. That’s not what I expected you to say. You barely come down on the side of limiting trainees’ work hours?
A. It allows people to have lives and it allows care to be better. I really do think that. The only thing I’m a little concerned about is that since I believe good connection is essential for good medicine, this kind of fragments it a little bit. On the other hand, connecting with the patient is not only a matter of time. It’s a matter of understanding and awareness. Those old docs just could come in and put a hand on your shoulder and make it so the patient wanted to talk to them. But now we don’t always select the people who know how to do it.
Q. In what way are we not selecting those people?
A. We select the smartest, but so many of the smart guys who rise in these hierarchies have no sechel [the Yiddish word for sense]. I’ve said this for 30 years. Look at “The House of God.” The Fat Man [a wise and irreverent resident] is smart as hell and also intuitive and compassionate. I wish he’d really existed when I was an intern.
Q. In the years since “The House of God,” you’ve written many novels, essays, and plays, including your most recent novel, “The Spirit of the Place,” and “Bill W. and Dr. Bob,” [co-authored with his spouse, Janet Surrey] about the founders of Alcoholics Anonymous, now running off-Broadway. Is there a theme that runs through your writing?
A. Everything I write has to do with two things. One is resistance to injustice. The other is the power of connection to heal.
Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. She can be reached at firstname.lastname@example.org.