Samuel Shem

Shem’s darkly comic sequel to The House of God starts out at rock-bottom (literally!) and segues into flashback, reuniting most of the characters from his first novel. Unfortunately, that flashback format means that several major events have been revealed up front – a technique that tends to vitiate their emotional impact for the reader.

The backbone of the novel has the House of God crew reuniting to do battle against the corporate forces sweeping through modern medicine, emphasizing profit over all else and creating “doctor as adversary [whose] ‘work’ was the computer.” There’s a kind of ‘Catch-22’ flavor here as narrator Roy Basch, the Fat Man, the Irish cops Gilheeny and Quick (possibly the most interesting and certainly the most enjoyable characters in the book), and assorted other subversive teammates do battle against the hated computerized records system, bean-counters who want them to monetize medicine, and an egomaniacal surgeon who’s out to defeat Death, no matter how many test subjects he has to kill to do it.

Along the way, Shem takes healthy swipes at the general screen culture that has overtaken virtually all modern life. In his words, the iPhone (iPad, iMac, etc.) becomes the “I”-phone. What seems at first to just be a snarky swipe, or perhaps a mere authorial affectation becomes a way to make a deeper point about the shift away from community in our personal and professional lives. He also has his narrator (who, in this universe, “wrote” The House of God) ‘fess up to having edited reality in a few of the cases he cited in his book, explaining that at first he felt guilty about it, but ultimately decided that, since it was his universe, he could “edit” reality for a more satisfying outcome.

Which brings us to the pie-in-the-sky conclusion of the characters’ rage-against-the-machine odyssey. In Shem’s “edited” reality, common sense, dedication, and teamwork do bring about the fall of Big Med, Big Pharma, and Big Insurance, and everybody (well, almost everybody) gets to live happily ever after.

As poet e.e. cummings told us, “…there's a hell of a good universe next door; let's go”. Shem has definitely gone there, and this sudden about-face from blackest of black humor to unicorns and rainbows is a jarring resolution that not all readers will find satisfying.… (more)

Abandoned this on my first attempt and finally picked this up again after close to 20 years (gosh!). Not sure why I couldn't finish it then, as I found it quite readable. Dr Roy Basch is a first-year resident at Mount Misery. As he rotates through the different disciplines, getting mired in the technicalities of psychiatry and mental health, he loses touch with his patients and became depressed himself. Only by remembering that he just needs to be human and to connect with them, did he regain himself and his love. The story is good and Shem can write. It could be trimmed though as Basch's experiences in the different disciplines became something like a movie on repeat.… (more)

If you have never read The House of God, funniest book ever penned by a doctor for a general audience, please do so before picking up this 42-years-later-sequel. Boston readers will immediately recognize Mass General and Brigham and Women's (the former Partners consortium, unsuccessful and now abandoned) as the fictional BUDDIES, a messy medical morass of profit-driven excess. The hero attending physician of the prior book's setting (Boston's Beth Israel Hospital, now also part of a pustular profit pile including Lahey Clinic), Fats, has made a fortune in biotech curing dementia and is bringing back his old team to make doctoring fun and humane again. Dr. Roy Basch, the fictitious doc using Samuel Shem as a non de plume, who is really a doctor and really Stephen Joseph Bergman - stay with me - begins to have hope again for his profession when the electronic records system's billing component OUTGOING is disabled and the medical staff gets to spend their time learning from patients instead of hiding behind screens. This is a complex novel that scurries off in multiple directions simultaneously, the most surprising being recognition of the harm of gender imbalance and the value of working cooperatively. A worthy sequel to a true classic.

Quotes: "The new model was health care only for the healthy, the Fewer-Better-Patient Model."… (more)