The House of God = Important American medical novels

August 6th, 2009 by admin

Samuel Shem’s classic novel about medical internship, THE HOUSE OF GOD (1978), was named by the British medical journal The Lancet as one of the two most important American medical novels of the 20th century, the other being Sinclair Lewis’ ARROWSMITH.

Read John Updike’s new introduction below:

“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 melee 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, wheras medical practitioners as represented in fiction are generiffiy 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 claustra! 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 hot 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 !o 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 witlh his six-year-old son on one of the super twilight, 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 bildungsroman. the taste of his venture into the valley of death and the truth of the flesh, ending with his eminently sane and sanely sensual Berry. Richard Nixon-the most fascinating of twentieth-century presidents, at least to fiction writers-and the mounting Walcrgate scandal fonn the historical background of thenovel, pinning it to 1973-74. The House of God could probably not be written now, at least so unabashedly; its lavish use of freewheeling, multiethnic caricature would be inhihited by the current tenns “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 health-care systemapproaches 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″

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