The House of God

“And I knew now that the sex in the House of God had been sad and sick and cynical and sick, for like all our doings in the House, it had been done without love, for all of us had become deaf to the murmurs of love.”

This quote, from the flash-forward scene at the end of Roy’s internship year, shows how isolated the hospital is from the outside world and that having sex there is a coping mechanism. Roy has also come to view his work at the House of God as being done “without love,” the opposite of what he intended or believed it should be.

“These fingers do not touch bodies unless they have to. You want to see bodies, go see bodies. I’ve seen enough bodies, and especially bodies of gomers, to last me the rest of my life.”

This quote, spoken by the Fat Man, summarizes his non-interfering philosophy of medicine. It also upends the expectation that a medical professional doesn’t get tired of examining patients or doesn’t experience disgust when doing so. As the Fat Man’s character does throughout the book, this statement undermines and implicitly questions expectations.

“Why didn’t they want you to meet me, your first day as a doctor? Because I tell things as they are—no bullshitology—and the Fish and the Leggo don’t want you to get discouraged too soon. They’re right—if you start to get as depressed now as you’ll be in February, in February you’ll jump off a bridge like Jo’s pop. The Leggo and the Fish want you to cuddle with your illusions, so you don’t give in to your panic.”

The Fat Man acknowledges that the higher-ups do not want the interns to understand or suspect the difficulties they’ll be up against during their internship year. Roy loves that the Fat Man acknowledges the interns’ fear (“panic”) and that he wants to be honest with them despite the dark nature of what they may undergo.

“I shut up. [Berry] got mad. She couldn’t have known that all I wanted then was to be taken care of. Things had moved fast. Two days, and already, like swimming in a strong current, I’d looked up and found my life an eternity farther downstream, the near bank far gone. A rift had opened. Up until then, Berry and I had been in the same world, outside the House of God. Now, for me, the world was inside the House, with the Yellow Man my age and the Runt both about to crump, with the dead father my age who’d popped an aneurysm playing baseball, with the Privates, the Slurpers, and the gomers. And with Molly. Molly knew what a gomer was, and why we’d laughed. With Molly, so far, there had been no talk, there’d been only the straight bendovers, the clefts and the round full hollows, the red nails and blue lids and panties splashed with flowers and rainbows, and the laughter amidst the gomers and the dead. Molly was the promise of a breast against an arm. Molly was recess.

Yet Molly was recess from much that I loved. I didn’t want to laugh at patients.”

This quote underscores several important threads of the narrative. Roy wants “to be taken care of”—a childlike desire that reflects his feelings of confusion and hopelessness about his work. The references to a “current” and “downstream” imply a force beyond Roy’s control that has taken a hold on him. His use of the word “rift” is a foreshadowing of the long-term rift that will open between him and Berry, despite the fact that he loves her. He acknowledges that he is attracted to Molly partially because she understands and inhabits the world of the hospital and he doesn’t have to explain anything to her. Finally, the end of the quote indicates that he feels guilty about cheating on Berry and about his callous treatment of the patients.

“The disintegration of [Jo’s] family had intensified her medical achievement, as if by learning how to do a stellar rectal exam she could detect her family’s psychological cancer. And so Jo had come to the House of God, and had become its most ruthless and competitive resident.”

Roy observes that Jo has psychological scars that she’s trying to overcome by becoming a “ruthless and competitive” doctor. The comparison of these issues to a cancer underlines the similarity of mental to physical disease, suggesting the body-mind connection, one of the book’s major themes. It also shows that, despite Jo’s characterization as a one-dimensional character, there are emotional motivations behind her wholehearted pursuit of her career.  

“‘I see every patient every day. There’s no excuse for not seeing every patient every day. You’ll soon find out that the more you do in medicine, the better care you give. I do as much as possible. It takes a little longer, but it’s worth it.’”

This quote by Jo shows that her medical philosophy is almost the exact opposite of the Fat Man’s. Her aggressive, oftentimes overly invasive treatment borders on desperation and prevents her from making sound medical decisions. Her avowal to “do as much as possible” and her comment about it being “worth it” reveal her lack of understanding about what constitutes true patient care as advocated by the Fat Man and eventually by Roy.

“I soon found out that the more tests I ordered, the more complications there were, the longer the House kept the patients, and the more money the Privates collected.”

This quote reveals the relationship between patient care and profit at the House of God. Patients are treated not necessarily with their best interests in mind but with the goal of maximizing the hospital’s profit. Shem decries this system in the book’s Afterword. 

“[…] over the past ten years whenever I’d estimated what was fantasy in America […] I’d been wrong, dead wrong, and had always underestimated, falling far short of the absurd, which had inevitably turned out to be the real.”

This quote articulates the larger sense of disbelief that Roy and some other young Americans felt at the time the book is set, as they grappled with the implications of such events as the Vietnam War and Watergate and systematic flaws in institutions such as religion, education, medicine, and economics.

“Like an overeager [medical student] trying to make an A, Jo would stay up the whole night writing obscure referenced discussions of the ‘fascinating cases’ in the charts, each BLEEP and shriek and nurse’s question echoing off the lonely tile walls making Jo feel real full and needed as she never felt full and needed outside the House of God.”

This quote again identifies the larger emotional issues that drive Jo to workaholism. The comparison of Jo to an “overeager” medical student suggests that her misguided ideals are somewhat juvenile. Her pleasure at the normally dissonant noises such as “BLEEP[s] and shriek[s]” also suggests that her sense of fulfillment in such environs is unnatural and somewhat pathetic.

“At times in pickup games […] the elbows [were] in fact thrown at Jo and the Fish and the Leggo and the deaths and diseases and wasted healthy moments cooped up in the House of God.”

This quote, which describes Roy and Chuck’s behavior in basketball games, shows that their aggression is directed at their supervisors and the forces that bring patients into the hospital. The phrase “wasted healthy moments” also acknowledges their frustration with being asked to spend their own young, healthy lives around the ill and dying. The players who stand on the court with them are just stand-ins for the supervising doctors and those abstract forces. The fact that those physical players are opponents also suggests the sense of being in a battle or war.

“Something had happened when I was with Saul and Jimmy and Lazarus and Dr. Sanders, and I didn’t know for sure what, but I knew that from taking the risks and learning and remembering Fats, I had pinned down my terror and exploded it to bits. From that night on, I might be everything else, but I’d never again be panicked in the House of God. It was a thrilling thought […] until I realized with alarm that I hadn’t learned how to save anyone at all, not Dr. Sanders or Lazarus or Jimmy or Saul or Anna O., and that what I was thrilled about was learning to save myself.”

Roy recognizes that the Fat Man’s guidance has made him a better doctor and relieved some of the distress he felt when he started his internship. This progression lessens some of his troubles, although his emotional issues continue through the rest of the book. The idea of saving oneself versus saving patients is brought up at various points in the book, with Roy finally deciding that psychiatry will give him the tools to help himself even as he helps other people. 

“Everything had happened. Most of us had learned enough medicine to worry less about saving patients and more about saving ourselves. Although some of our ways of saving ourselves were beginning to seem bizarre, they weren’t so far-out, yet, as to be dangerous or intolerable. Looking around the room, hearing the simmering jokes and laughter and chatter that from time to time popped its lid and boiled over into a happy roar, I realized how much we’d grown to care about each other. We were developing a code of caring, helping each other leave early, not fucking each other over, tolerating each other’s nuttiness, and listening to each other’s groans. Each life was being twisted, branded. We were sharing something big and murderous and grand. Sensing that, I felt close to tears. We were becoming doctors.”

Roy experiences this moment of camaraderie after the initial shock and challenges of the internship have worn off and as he realizes how much the young doctors have bonded through their experience. As the book progresses, this sense of bonding proves to be short-lived and unable to protect the interns from the struggles that befall them. However, Roy still recognizes that they are growing and learning as medical professionals, even though some of them will ultimately leave the practice. 

“Her apartment was motel-cool. The stereo was still not unpacked. There were no plants. The dining-room table had had to be cleared of journals and texts.”

These details describe Jo’s apartment when she invites Roy to dinner. The use of the word “motel” suggests a place where no one stays very long, a reinforcement of Jo’s workaholic nature. Areas that are meant to be used for activities like eating (the dining room table) must be cleared of medical literature to perform their function, suggesting that Jo would have to do similar “clearing” before she could function in other ways.

“I’m straight with ’em and I make ’em laugh at themselves. Instead of the Leggo’s grim self-righteousness or Putzel’s whimpering hand-holding that makes them feel like they’re about to die, I make them feel like they’re still part of life, part of some grand nutty scheme instead of alone with their diseases, which, most of the time and especially in the Clinic, don’t hardly exist at all. With me, they feel they’re still part of the human race.”

The Fat Man’s approach empowers patients despite their hospitalization, unlike that of other doctors who treat them as though they were already impaired beyond the point of being themselves. The quote also includes the suggestion of isolation (“alone with their diseases”), which is central to the narrative. Shem also employs irony with the idea that diseases exist less in the clinic than in the outer world. 

“‘You’re telling me again that the cure is worse than the disease?’

‘Nope. I’m telling you that the cure is the disease. The main source of illness in this world is the doctor’s own illness: his compulsion to try to cure and his fraudulent belief that he can. It ain’t easy to do nothing, now that society is telling everyone that the body is fundamentally flawed and about to self-destruct. People are afraid they’re on the verge of death all the time […].’”

The complexities of physicians trying to treat patients, especially without realizing their own shortcomings and human needs, are at the root of what is being discussed in this exchange between the Fat Man and Roy. The Fat Man also identifies what he believes is a culturally embedded (and damaging) idea: that the body’s default state is disease rather than health. Such fearful thinking prevents effective treatment by doctors and creates unnecessary work for them. The Fat Man clearly does not subscribe to these beliefs, and his hands-off approach can be understood as his stepping back to let a natural equilibrium of health restore itself.

“This was no live thing, no hope. This was death. This was despair, that rare look into the mirror at first twinkle, at first graying, at gray. This was the bottomless panic at the lost smooth cheek of childhood, at no longer being young. I was angry at this woman because this, the beginning of her end, meant work for me.”

This quote expresses the revulsion Roy feels when he is forced to confront death in his patients. It also conveys his frustration that he must toil against the inevitable process—dying—that he knows he can’t prevent. These emotions are not part of the socially acceptable narrative about medicine and caregiving.

“Each of us was becoming more isolated. The more we needed support, the more shallow were our friendships; the more we needed sincerity, the more sarcastic we became. It had become an unwritten law among the terns: don’t tell what you feel, ’cause if you show a crack, you’ll shatter. We imagined that our feelings could ruin us, like the great silent film stars had been ruined by sound.”

This quote articulates the disintegration of the interns’ social bonds with each other and any bond they might have felt with their patients. It also articulates their inability to express or acknowledge any emotional vulnerability. Like silent film actors who could not adapt to films with sound, the interns can’t adapt to their new circumstances (in which they must own and process their feelings or be owned by them), and this inability threatens to result in their being left behind. 

“Pinkus, it was said, rarely left the House. I myself had seen him, night after night, prowling the corridors, in the guise of following up consults on cardiac patients. Whatever the hour, I had found him patient, helpful, courteous, ready to produce an article, ready to put in a pacemaker, ready to chat. Such was his dedication to being in the House that an apocrypha had arisen about his home life: married, with three daughters, it was rumored that the only way his wife or daughters knew he’d been home was to notice the toilet seat flipped to the UP mode.”

Like Jo, Pinkus is a workaholic who lacks meaningful emotional ties. The use of the word “prowl” in describing his rounds suggests that the patients and other interns are prey and Pinkus the predator. They fulfill a need for him as much as he fulfills needs in others. Despite his pleasant demeanor, it’s clear that there is dysfunction in his relationship to his work.

“Having recognized the doctor’s disease, I wasn’t sure that I could escape. Oh yes, I had work to do, on compassion, on love. Like a park attendant with a steel-tipped stick, I had to patrol the darkening seaside summer park, browsing around the bandstand in the wake of the wedding, stabbing, collecting the shredded scraps of self scattered among the rainbow of confetti, ruffled in the breezes from the bay.”

Roy acknowledges that he must confront his emotions, and the images used to describe his inner state describe vigilance amidst a turbulent landscape. The park attendant must “patrol,” the intense and almost violent activity has passed (“the wake of the wedding”), and violence is further suggested by “stabbing.” The end of the quote turns more toward a sense of hope, with “collect the shredded scraps of self,” “rainbow,” and “confetti” indicating a process that is ultimately worthwhile. “[R]uffled in the breezes from the bay” is a gentle image.

“And that, Basch, is what you’ve learned this year in the House of God: when you feel like vomiting, you don’t.”

The idea that the doctors can overcome feelings of disgust and control their behavior around patients is introduced here. This larger message relates to the themes of the book, since medical care would be more positive for the patients and for the doctor if such an outcome were possible. Irony is expressed here as the quote undermines the expectation for the intern to have learned something more complex than “don’t vomit.”   

“And who were we, anyway, to imagine we knew what these gomers felt, to be so hot on saving them? Wasn’t it ridiculous for us to imagine that they felt as we did? As ridiculous as it would be for us to try to imagine what a child felt? We were putting into these gomers our fear of death, but who knew if they feared death? Perhaps they welcomed death like a dear long-lost cousin, grown old but still known, coming to visit, relieving the loneliness, the failing of the senses, the fury of the half-blind looking into the mirror and not recognizing who is looking back, a dear friend, a dear reliever, a healer who would be with them for an eternity, the same eternity as the long ago, before birth. Wouldn’t that be death, for them?”

The feelings about death expressed here undermine the prevailing cultural belief about the end of life. Roy understands that for some people, death could be welcome or a relief, and that delaying it at all costs may not make sense or meet the needs of the patient in every case. The passage lists some commonly expressed ailments of age (“loneliness” and “failing of the senses”) as well as some less commonly expressed ones (“fury”), further contributing to the passage’s complex presentation of death.

“I felt his fat pinky hugging mine. Suddenly I knew what he meant. It was perfect, a magical moment. A tingling current of feeling zinged through me. He’d sensed my emptiness, and he’d responded. His touch meant I wasn’t alone. He and I were connected. I squeezed back. It was love. No matter what, Fats and I would be friends.”

Roy finally feels and recognizes a sense of connection, something he has so desperately longed for, with the Fat Man. He understands that they have progressed beyond the professional into a friendship. He feels that the Fat Man has adequately addressed the emotional issues (connotated by “emptiness”) Roy has experienced over the course of the internship.  

“‘You’re saying that psychiatry really offers something to patients? That it’s different from medicine in that you can cure?’

‘Sometimes. If you catch a life early, yes.’

‘So the big thing is that you can offer something to patients?’

‘No. You can offer something to yourself.’

Stunned, I asked her: ‘What can you offer to yourself?’

‘Growth. Instead of forgetting, you’d try to remember. Instead of defensive, obsessive superficiality, you’d try to become open, looser, deep. You’d create. Your only tool as a therapist is who you are and who you might become.’”

This exchange between Roy and Berry is an example of the text’s growing consideration of psychiatry as possibly superior to medicine. Rather than focusing only on the patient and not tending to himself, as a therapist Roy would be cultivating himself as much as the patient, to the benefit of both. This idea appeals to him after his struggles over the course of his internship year.

“So that was it: the reality of his inventions was only that they involved us with him, showing us that someone could stand outside the drudgery of the Hierarchies and create. He’d given us his inventions as a way of helping us through. How I would miss him! More than anyone else, he knew how to be with patients, how to be with us. Finally I understood why he stayed in medicine: only medicine could take him. Burdened by his precocity, all his life Fats had hurt people by being too much. From his puzzled parents through his grade-school teachers and chums to his college and med-school classmates who’d gather at dinner, where he’d scribble notes and equations with such prodigal brilliance that as he rose to leave there’d be a mad dash for the napkins, the Fat Man had found himself separated from others by his power and his genius. All his life, he’d had to hold himself back. Finally, after two years of testing it at the House, he knew that here at last was something even he couldn’t dent, that would not, in awe, in jealous anger, reject him and play with somebody else. He could dish out anything and not hurt anyone. He was safe. He would flourish. He would bloom.”

This passage calls attention to the Fat Man’s intensity and how it makes him a good fit for medicine. Rather than being a psychological coping mechanism, as it is for Jo, his intensity is an innate part of him and can be expressed in his work as a physician. The comparison of the Fat Man to a flower that can “bloom” in this environment adds to the positivity of the passage.