The House of God

The House of God is a novel written by American author and doctor Samuel Bergman under the pseudonym Samuel Shem and originally published in 1978. The book is heavily based on Bergman’s own experiences as a medical intern in the early 1970s, and the fictional hospital “the House of God” is a thinly veiled fictional version of the Beth Israel teaching hospital associated with Harvard Medical School. The novel is a satire in the vein of Catch-22 that parodies aspects of the medical profession in 1970s America. As of 2020, The House of God has several sequels that follow the character Roy Basch through his career. This guide refers to the 2010 Berkley paperback edition, which includes an introduction by John Updike and an afterword by the author. 

Plot Summary

The House of God follows medical intern Roy Basch and his fellow interns as they enter their medical career. They spend a year at a hospital called the House of God under the supervision of more experienced resident doctors, most notably a man called the Fat Man and a woman named Jo. During that time, their assumptions about practicing medicine are challenged as they battle fear, disgust, exhaustion, bureaucratic inanity, despair, and grief. One intern commits suicide because of the strain of the internship year. 

Roy rotates through four different wards in the hospital, spending approximately three months in each. He faces his own fears, disillusionment, and sorrows even as he gains medical confidence, but for much of the book he struggles to acknowledge and process these emotions. To cope with these feelings, he and the other interns, all men, turn to drinking, prescribing themselves medications, and sex with the hospital’s female staff. Over time, Roy begins to drift from his serious girlfriend, Berry, who is a clinical psychologist. Although she becomes frustrated with Roy’s inability to articulate and cope with his emotions—and also learns of his dalliances—she stays with him and eventually helps him overcome those challenges. At the end of the book, Roy proposes to Berry. 

The Fat Man serves as a crucial character for Roy as he progresses through the year, helping him understand how to deliver good medical care within the confines of the American health care system. Despite everything he has learned about being a medical doctor, Roy decides to take a year off after his internship and then to become a psychiatrist. Throughout The House of God, Shem uses satire to call attention to deficits in the medical training system and what he sees as American health care’s immoral reliance on capitalist principles to provide care for patients.