I’d like to give a shout-out to Louis CK, if I’m even ever allowed to do that, and if my memory serves me correctly. I believe I heard him in an interview describing this book, and without doing much research on it I bought it, because I basically trust Louie under all circumstances. Reading this book only further underscored how good a policy that is. It’s a keeper.
The way this book is described in the praise section preceding the prose, that it’s basically Catch-22 but for medical school, is totally accurate, and maybe a little reductive, except none of that comparison is an insult so it’s completely fine. This book makes you feel awful, even sick at times, for the way that medical students are treated and because of the way that they act, in the same way that Joseph Heller makes you vehemently repulsed by the life of a soldier in combat. House of God is about a different kind of soldier in a different kind of combat — the war against the GOMERs.
Samuel Shem, a pen name for Stephen Bergman, wrote something scathing and brutal and honest and beautiful when he wrote this. So much so that he had to use that pen name for fear of retaliation, which definitely happened. House of God is honest in the way that’s hard to read, but even harder not to. No matter how despicably the protagonist, Roy Basch, acted, I never disliked him because even though I was immersed in his mind and his decisions, I didn’t actually have to make them myself. He deals with decay, rot, excrement, death, and very little victory, and he is one of many who do this. He also scientifically foretells the lives of many people and prioritizes their health and care accordingly. It sounds humane, and even at its most frightening in the book, it’s still humane. And all of these interns put themselves through this horrible process because they have to, because it’s all they’ve ever known, because their parents expect them to. “In fifth grade, when I’d asked an Italian kid why he liked having sex, he’d said, ”Cause it feels food.’ I couldn’t understand someone doing something because it felt good. What sense was there in that?” (p. 42). Because they’ve already invested so much time and money that they can’t really turn back, because they know that the world needs doctors. They’re saints and sinners simultaneously.
Roy experiences a lot of emotional tumult while interning at the House of God – a not-so-thinly-veiled reference to the post-Harvard experience, I might add. (Bergman went there.) Right along with him, I experienced the joys of helping people, the interminable agony of dealing with old people who don’t die (the GOMERs), the wretched guilt of feeling inclined to cheat on one’s partner with a nurse, the hatred for a supervising physician, the plaguing self-doubt, the frowned-upon attachment to on particular patient, Saul: “He was all of our grandfathers. With the laconic resignation of a Diasporic Jew he was watching the latest Nazi–leukemia–force him from his only real home, his life. Leukemia was the epitome of my helplessness, for the treatment was to bomb the bone marrow with cell poisons called cytotoxins until it looked, under the microscope, like Hiroshima, all black, empty, and scorched” (p. 110).
And then there’s the vehemence with which conflicting supervisors treat each other and force interns to choose. “The House medical hierarchy was a pyramid–a lot at the bottom and one at the top. Given the mentality required to climb it, it was more like an ice cream cone — you had to lick your way up. From constant application of tongue to next uppermost ass, those few toward the top were all tongue” (p. 13). It’s enough that these young people are trying to fit all the information about the human body into their brains, but to deal with bureaucracy and egos as well? It’s so much pressure. Shem builds and releases the pressure in really creative ways as he writes; most of the pressure release is, in fact, in the form of raunchy daydreaming sex scenes, but occasionally, Basch goes off on non-sexual tangents and we get to go with him while his mind takes a break. Or when he takes a break from his own emotions, a common tactic used by many interns: “We imagines that our feelings could ruin us, like the great silent film stars had been ruined by sound” (p. 247). The rest of Basch’s compatriots and enemies are easy to get to know: there’s the Fat Man, one of his supervisors, and the creator of all the rules that Basch is compelled to follow. There’s Chuck, the guy who got into med school by the skin of his teeth. There’s the Runt, bent on telling everyone about his sexual escapades. There’s Jo, another supervisor, who’s never had fun in her life. These people are all sort of caricatures, and even Roy himself is one, but they’re all real people, wearing scrubs in a fictional hospital in your mind. You’re there with them, instantly. You’re in Roy’s head, looking at them, fuming when he fumes and laughing when he laughs and intubating when he intubates.
Even with Roy’s dalliances into fantasy land, when he imagines bending a nurse over a sleeping patient and railing her right there, he is never far from work. Work is with him when he’s not at work. It’s with him when he’s with Berry, the love of his life, and it creates a palpable tension between them: “Our fight was not the violent, howling, barking fight that keeps alive vestiges of love, but that tired, distant, silent fight where the fighters are afraid to punch for fear the punch will kill” (p. 134). It’s with him when he’s home, unable to enjoy the peace and simplicity of his parents’ house: “The tundra. Whaling town, whoretown, bartown, churchtown, it had reached its peak in population just before the American Revolution, and was now supported by two cement plants that nightly covered it in cement dust, the cement workers supporting the whores, bars, churches, Lions, Elks, Mooses, and all the other remnants of man’s bestiality to man” (p. 173). He’s never truly free, and that’s the doom that this book presents, but it doesn’t leave you unhappy. It just makes you thankful that you’re not a doctor, I suppose, and even more thankful that at least some of the people in the medical profession have this kind of sense of dark humor. It’d be hard not to.