神的殿堂 (1978)

The House of God is a 1978 satirical novel by Samuel Shem (a pseudonym used by psychiatrist Stephen Bergman). The novel follows a group of medical interns at a fictionalized version of Beth Israel Hospital over the course of a year in the early 1970s, focusing on the psychological harm and dehumanization caused by their residency training. The book, described by the New York Times as "raunchy, troubling and hilarious", was viewed as scandalous at the time of its publication, but has since acquired a cult following and is frequently included in the discussion of humanism, ethics, and training in medicine.

Storyline

Dr. Roy Basch is an intelligent but naive former Rhodes Scholar and BMS ("Best Medical School")-educated intern ('tern') working in a hospital called the House of God after having completed his medical studies at BMS. Basch is poorly prepared for the grueling hours and the sudden responsibilities with limited guidance from senior attending physicians. He begins the year on a rotation supervised by an enigmatic and iconoclastic senior resident who goes by the name "The Fat Man". The Fat Man teaches him that the only way to keep patients in good health and to survive psychologically is to break the rules. The Fat Man provides his interns with wisdom such as his own "Laws of the House of God". One of his teachings is that in the House of God, most of the diagnostic procedures, treatments, and medications received by the patients known as "gomers" (see Glossary, below) actually harm these patients instead of helping them. Basch becomes convinced of the accuracy of the Fat Man's advice and begins to follow it. Because he follows the Fat Man's advice and does nothing to the "gomers", they remain in good health. Therefore, his team is recognized as one of the best in the hospital and he is recognized as an excellent intern by everyone even though he is breaking the rules.

Later, the Fat Man must leave for a rotation with another team. Roy is then supervised by a more conventional resident named Jo who—unlike the Fat Man—follows the rules, but unknowingly hurts the "gomers" by doing so. Basch survives the rotation with Jo by claiming to perform numerous tests and treatments on the "gomers" while doing nothing to treat them. These patients again do well, and Basch's reputation as an excellent intern is maintained.

During the course of the novel, working in the hospital takes a psychological toll on Basch. His personality and outlook change, and he has outbursts of temper. He has adulterous trysts with various nurses and social service workers (nicknamed the "Sociable Cervix"), and his relationship with his girlfriend Berry suffers. A colleague, Wayne Potts, commits suicide. Potts had been constantly badgered by the upper hierarchy and haunted by a patient—nicknamed "The Yellow Man" (due to the jaundice from his fulminant necrotic hepatitis)--who goes comatose and eventually (after months) dies possibly because Potts had not put him on steroids. Basch secretly euthanizes a patient called Saul the leukemic tailor, whose illness had gone into remission but was back in the hospital in incredible pain and begging for death. Basch becomes more and more emotionally unstable until his friends force him to attend a mime performance by Marcel Marceau, where he has an experience of catharsis and helps him recover his emotional stability.

By the end of the book, it turns out that the psychiatry resident, Cohen, has inspired most of the year's group of interns—as well as two well-spoken policemen, Gilheeney and Quick—to pursue a career in psychiatry. The terrible year convinces most of the interns to receive psychiatric help themselves. The book ends with Basch and Berry vacationing in France before he begins his psychiatry residency, which is how the book begins as well; the entire book is a flashback. But even while vacationing, bad memories of the House of God haunt Basch. Basch is convinced that he could not have gotten through the year without Berry, and he asks her to marry him.

Characters

Staff

Interns and residents

Dr. Roy Basch, the protagonist and one of the first-year residents.

Dr. Fishberg ("The Fish"), the Chief Resident; wishes to obtain a GI fellowship.

Jo, a high-achieving resident who wishes to obtain a cardiology fellowship.

"Fats" ("The Fatman"), an unconventional but effective second-year resident; wishes to obtain a GI fellowship.

Dr. Chuck Johnston, a black first-year resident from Chicago; Basch's best friend.

Dr. Jeff Cohen, the psychiatry resident.

"Eat My Dust" Eddie, a first-year resident fixated on winning the Black Crow Award (awarded for most consents for postmortems/postmortems); wishes to pursue oncology.

Elihu, "a tall beak-nosed Sephardic Jew with a frizzy Isro-Afro, rumored to be the worst surgical intern in the history of the House".

Harry, another first-year resident fixated on winning the Black Crow Award.

"Hyper Hooper", a first-year resident who wins the Black Crow Award.

Dr. Howard Runtsky (Runt), a first-year resident (intern) who takes Valium for his nerves. Runtsky is a friend of Basch's, having been a classmate of his at BMS. He is described as a "short, stocky product of two red-hot psychoanalysts". Runtsky has sex with one of the nurses and breaks out of his shell; he "[goes] west for a "classic Eastern" psychiatric training program on the "mountain campus" of the University of Wyoming.

Dr. Wayne Potts, a first-year resident (intern) from Charleston, South Carolina who is insecure and uncertain. Married to an MBH surgical intern, Potts is described as "a nice guy but depressed, repressed, and kind of compressed, dressed in crisp white, pockets bulging with instruments".

Other doctors

Dr. Leggo, the Chief of Medicine who believes in doing everything to save patients.

Dr. Gath, a surgeon.

Dr. Otto Kreinberg, one of the attending physicians.

Dr. Pinkus, a "tall, emaciated-looking staff cardiologist, heading toward forty".

Dr. Putzel, a private doctor who has admitting rights.