By Brad Zehr (BUSM 2018)
When it was published in 1978, the satirical novel “The House of God” was met with “ridicule and derision” by medical school deans and prominent physicians. Thirty years later, its author delivered the prestigious “Humanism in Medicine” lecture at the 2008 meeting of the Association of American Medical Colleges.
“The reason I write is to draw attention to and to resist injustice,” said Stephen Bergman, MD, D.Phil., the 2017 AOA Visiting Professor at BUSM. Dr. Bergman, now professor of medical humanities at NYU School of Medicine, is better known by his nom de plume, Samuel Shem. He spoke to a room packed with BUSM students, residents, and attendings Friday morning.
After experiencing a brutal and dehumanizing intern year at Beth Israel Hospital in Boston, Shem authored his best-known work – an irreverent send-up of the absurdities and irrationalities of medical training.
“The House of God” was rejected by most senior physicians at the time but gained a devoted following among subsequent generations of medical students and residents. The work is also recognized as a literary masterpiece and was recently named the No. 2 best satire of all time by Publishers Weekly. (No. 1 is “Don Quixote.”)
Shem’s talk at BUSM closely mirrored an article he wrote for The Atlantic in 2012. Below are several excerpts from that article that encapsulate Shem’s message.
I took this pseudonym because I was just starting my psychiatric practice and wanted to protect my patients from knowing that their therapist had written such an irreverent novel. (They all found out, and didn't care -- but "Shem" had arrived, and refused to depart.) I also felt that real writers had no place in going out and publicizing their novels. I refused all invitations. And then one day I got a letter forwarded from my publisher, which included the line:
"I'm on call in a V.A. Hospital in Tulsa, and if weren't for your book I'd kill myself."
I realized that I could be helpful to doctors who were going through the brutality of training. And so I began what has turned out to be a 35-year odyssey of speaking out, around the world, about resisting the inhumanity of medical training. The title of my talk is almost always the same: "Staying Human in Health Care."
The theme of my speaking out is simple: the danger of isolation, the healing power of good connection. And any good connection is mutual.
… The novel can be read as a model of nonviolent resistance. Big hospitals, like all large hierarchies, are "power-over" systems. The pressure comes down on the ones at the bottom, and they become isolated. Not only do they get isolated from each other, but each gets isolated from his or her authentic experience of the system itself. You start to think "I'm crazy," instead of "This is crazy." In The House one of the interns does go crazy, and another commits suicide.
The crucial question is how to find mutuality -- or "power-with" -- in a "power-over" system. Historically, the only threat to the dominant group -- whether of race, gender, class, sexual preference, ethnicity -- is the quality of the connection among the subordinate group.
… At a point toward the end of the novel, the fraught protagonist has to make a choice. He struggles with it until he hears a kind of voice in his head:
"Don't spread more suffering around. Whatever you do, don't spread more suffering around."
This is the culmination my learning so far. All of us will suffer -- it's not optional. Some will suffer more, some less. The issue isn't suffering, it's how we walk through it, and how we help others walk through it. If we decide to walk through suffering alone -- "stand tall, draw a line in the sand, tough it out" -- we will suffer more, and spread more suffering around.
This is where we health-care folks come in -- this is our job, to be with others in caring.
If you are curious to learn more about Shem’s philosophy of writing as an act of resistance and humanism, I recommend his 2002 essay “Fiction as resistance” in the Annals of Internal Medicine.