46 pages • 1 hour read
Samuel ShemThe House of God
Fiction | Novel | Adult | Published in 1978A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Introduction-Chapter 4 Chapter Summaries & Analyses
Introduction Summary
American writer John Updike praises The House of God, comparing it to the military satire Catch-22. Updike says that the novel dispels the idea that medical professionals do not experience the same human emotions and reactions as non-medical people when faced with the serious and unpleasant parts of their work. Updike states that Shem portrays sex in the novel between nurses and doctors as “mutual relief, as a refuge for both classes of caregiver from the circumambient illness and death, from everything distasteful and pathetic and futile and repulsive about the flesh” (xvi). Updike also identifies the time period of the novel as 1973-74, during the Watergate scandal in America.
Chapter 1 Summary
It’s August 1974, and Roy Basch is a 30-year-old doctor who has just finished his first year as a medical intern at the House of God hospital. This chapter is a flash-forward, as the rest of the book recounts his internship year from 1973-74. Roy and his girlfriend, Berry, are on vacation in France. Roy is traumatized by his experiences over the past year, and Berry reminds him to pay attention to the present moment rather than reminiscing about his work in the House of God. He drinks heavily on their trip and struggles to relax and focus on Berry. The chapter ends with Roy’s erotic fantasy about having sex with a nurse while she tries to revive a patient having a heart attack. The patient dies, and the medical staff in the room all have sex to console themselves.
Chapter 2 Summary
It’s July 1973. Roy is apprehensive about his internship. Berry, a clinical psychologist, tells him to deny the existence of his fear and anxiety. The day before he starts, Roy attends an orientation with his fellow interns led by senior doctors, including one Roy calls “the Fish” and the Chief of Medicine, whom Roy calls “the Leggo.” A psychiatrist at the orientation warns the interns that some doctors commit suicide following their internships, but he’s quickly shushed up by other doctors there. At the end of the day, the interns are told to go meet some of their patients. Roy and another intern, Chuck, become disgusted when they see the first two patients and leave to go drink together. Roy learns that Chuck, a black man, received offers for college, medical school, and the internship through postcards in the mail, without any kind of testing to get into the schools. Roy and Chuck discover that they’ll be working their first rotation together. After Roy and Chuck go out and drink together, Berry picks up Roy, puts him to bed at his house, and leaves. Roy falls into uneasy dreams that night.
Chapter 3 Summary
It’s Roy’s first day at the House of God. He meets his resident supervisor, called the Fat Man. The Fat Man is filling in for the first few weeks for another doctor, a woman named Jo, whose father unexpectedly committed suicide. The Fat Man openly acknowledges the interns’ fears about practicing medicine, making Roy admire and respect him. The Fat Man is a proponent of not performing any procedures unless medically necessary, a philosophy that goes against the practice of the hospital. Expensive, unnecessary procedures are regularly ordered for patients to raise the hospital’s profits. The Fat Man is also seemingly obsessed with his idea for a mirror that would allow people to examine their own anal areas.
The Fat Man teaches the interns the difference between what he calls a “gomer”—an elderly “Get-Out-of-My-Emergency-Room” patient who isn’t seriously ill, many of whom linger for years—and patients who truly need medical intervention. The Fat Man says that in the year he’s worked at the House of God, he hasn’t seen a single gomer die. Roy struggles with his work, overwhelmed by the transition from learning about medicine in a textbook to working with real patients. He envies Chuck, who is confident even on the first day and attributes his intuitive medical decisions to the fact that he hasn’t been exposed to as much theoretical medical information as Roy. An attractive nurse named Molly introduces herself to Chuck and Roy. Roy goes home, exhausted, at the end of his first day.
Chapter 4 Summary
It’s Roy’s second day at the House of God. Potts, the intern who was on call the first night, is exhausted and traumatized after his harrowing night admitting and caring for patients. The Fat Man explains that the interns’ goal should be to TURF the gomers (have them transferred to other departments in the hospital) and demonstrates how to raise the hospital beds in order to cause patients to break hips or receive head injuries so that they will be TURFed away. The interns debate among themselves whether the Fat Man is that cruel or if he’s joking. Later that day, the on-call intern from another ward says that he took Valium all night to combat his nerves and that he’ll be prescribing it to all his patients. Roy tries to perform a spinal procedure on a patient to get her TURFed but makes a mistake that puts her at risk of infection. He then mans the outpatient clinic of the hospital and treats patients for minor problems.
The chapter also relates how patients get worse because of decisions the interns make, and a young man dies from a brain aneurysm. Roy goes home and tries to articulate his experience to Berry, but he already senses a rift between them because she doesn’t understand what he’s been through in the last two days.
Introduction-Chapter 4 Analysis
These chapters lay the groundwork for the rest of the book: Many of the major characters are introduced and main conflicts foreshadowed. Already, Roy is sensing the difficulties of being a doctor within the medical culture depicted in the book, and he and Berry are beginning to drift apart because of his work. These conflicts will be heightened as the book progresses. Roy is also trying to decipher the Fat Man’s techniques, which run counter to what he’s learned in medical school. He’s faced with the challenge of trying to determine whether to follow prevailing medical practice or adopt the Fat Man’s philosophies.
The fact that Roy and the other interns immediately start to adopt the Fat Man’s terminology—referring to gomers, TURFing, and so forth—signals that they’re open to his influence and recognize that such terms will be a shorthand that binds them together as they progress through their internship year. What the interns don’t yet realize is that despite the Fat Man’s seeming nonchalance about many aspects of practicing medicine, he cares deeply about the patients and the interns.
Additionally, although he never explicitly recognizes it, Roy is desperate for guidance from more experienced medical practitioners to help him normalize and cope with his feelings about caring for patients. The interns’ feelings of confusion, disgust, and fatigue as they go about their duties are never acknowledged or legitimized by the more senior doctors, and it takes time for Roy to realize what emotional lessons the Fat Man is trying to teach him and the other interns. At this point in the novel, Roy feels without an authority figure who can help him navigate the challenges he faces, and the predictable, superficial letters Roy receives from his father throughout the book reveal that he also doesn’t have an authority figure in his personal life. Roy and the other interns turn to sex, both imagined and real, alcohol, and drugs to cope with the stresses of their work. These methods will prove inadequate as the book progresses.
