An excerpt from Man’s 4th Best Hospital.

“Why am I here?” the Fat Man was saying to us, his team gathered for the first time around in his new public clinic leaning up against one of the soaring buildings of Man’s 4th. “And why are you? One day I looked around and asked myself, ‘Self of Fats, what else can you do for medicine?’ I answered: ‘A lot. Medicine has gotten a lean and hungry look, and it’s up to you and your guys, Fats, to fatten it up.’ Why’d I recruit you?” He wrote in chalk, talking:

TO PUT THE HUMAN BACK IN HEALTH CARE WE DO IT TOGETHER

“That sums up who we are: humane docs. And this?” Chalk-talking again:

MONEY KILLS CARE

SCREENS MAKE MONEY SCREENS KILL CARE

“That sums up who they are: profit-seeking drones of inhuman health care. Why did Man’s 4th Best ask Fats to come here? ’Cause we got lucky. They’re on the way down, in cash and prestige. I’m on the way up in both. But they still get a lot of media. So the Krash delegation visits me and makes a sweet offer. And I figure if we can put the human back in here, we can do it anywhere. And if we do do it here, because the spotlight’ll be on us, every- one will know. So I say to myself, ‘Fats, what a chance. Get the guys. And our new gals, Dr. Naidoo and Head Nurse Angel Jones—and Humbo.’” He stood there beaming. “What’s inhuman in medicine? It’s worse for patients, worse for doctors, and better only for insurance and drug companies—for the health-care industry. Why did I choose each of you? ’Cause deep down you each know how bad it’s gotten—all over the country, you’re dissatisfied playing your part in the industry. Some of you are thinking of quitting medicine— one, who shall remain nameless, is even thinking of becoming a lawyer! All of you are pissed to see what’s happened to what we love, and have sacrificed a lot for, including marriages: being good docs, in the world.”

This hit me hard. Yes, I’d thought a lot about quitting medicine, and yes, because of what he had just described. In Berry’s and my travels around the world, we’d seen that some countries have done a helluva lot better getting health care to their people while the docs are a lot happier in their jobs. So it was possible, yes. And we would try to do it here? What was to lose?

“So I chose each of you because you’ve still got that fire inside! In the House we resisted, brought ’em screaming to the wall of fire that is truth—and held their eyes open with red-hot toothpicks making ’em see our agony, the agony of absurdity, right?”

Nods around the table—I felt that fire again, saw fire in those eyes. That hope.

“But, man,” said Chuck, “we didn’t change nuthin’.”

“I know,” Fats said, “but from the inhuman, we learned about being human, right? The seeds were there. Remember my slogan to you back then?”

No one remembered his slogan.

“Thanks a lot. Sheesh.” He seemed to deflate. And then inflate again. “I kept saying we had to learn to be with the patient, remember?” When he mentioned it, most of us nodded. “Make ’em feel that they’re still part of life, part of some grand nutty scheme, instead of alone with their diseases. Even young Basch here said once, ‘What these patients wanted was what anyone wanted: the hand in their hand, the sense that their doctor could care.’”

“And of course,” Naidoo said, “the sense that you knew the science too.” “Yeah. But the science is the easy part. The hard part, the best part, is being with—when they let us in, to do our best doctoring and help ’em heal.

Being with. Empathy.”

“Tell it to my ex,” said Gath, our surgeon, a stocky, blond-haired ex-Marine from Georgia. “The only way to heal is with cold steel.”

“Maybe,” Eddie said, “but we didn’t change anything—and then we scattered.”

“True, because we had no power. When the power came down on us from the top, we got isolated from each other, right? Alone, we started thinking, ‘I’m crazy for thinking this is crazy.’ But in any power-over system—based on race, gender, class, religion, sexual pref, et cetera—the only threat to the dominant group is the quality of the connections of the subordinate group. That’s us. This time, we got leverage. I’ve got ’em over a barrel six ways from Sunday—and they only know about three of ’em. Long as we stick together, we got a chance to create something that’ll shine. The one thing we gotta do?”

STICK TOGETHER, NO MATTER WHAT

“This is new, different. Here we’re not trying to survive, but to humanize!”

Samuel Shem is a novelist, playwright, activist, Rhodes Scholar, professor in medical humanities at NYU School of Medicine, and a visiting artist at the American Academy in Rome. Shem’s new novel, Our Hospital, is the fourth and probable last novel of The Healing Quartet, spanning fifty years of American medicine. It started with The House of God, then Mount Misery, next Man’s 4th Best Hospital, and now Our Hospital.

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