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Join Samuel Shem, a renowned novelist, playwright, activist, Rhodes Scholar, and professor in medical humanities at NYU School of Medicine. We’ll dive into his latest novel, Our Hospital, which marks the culmination of The Healing Quartet, spanning fifty years of American medicine.

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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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Samuel Shem. He is a novelist, playwright, activist, Rhodes Scholar, professor in medical humanities at NYU School of Medicine and, of course, the author of The House of God. His latest book, which we’ll talk about today, is called Our Hospital. Sam, welcome back to the show.

Samuel Shem: I’m doing well. I always love talking to you.

Kevin Pho: All right, appreciate you coming on. Now, for those who don’t know who you are, just briefly share your story and journey to where you are today.

Samuel Shem: Well, I’m overeducated. I went to Harvard, I was a Rhodes Scholar, and I came back to Harvard Medical School because I didn’t want to fight in Vietnam. But I always wanted to be a writer, and I wrote a lot. When I came back, it was to The House of God, and at first I didn’t want to write novels; I wanted to do other stuff. But after my guys and I finished at the House of God, we were so down. The ones who were at the core, Eat My Dust Eddie, Fats, not Fats exactly, but all of those people, we just talked about it. We just unloaded. We drank, we smoked stuff and we laughed so hard. Then I thought, “Gee, this is so funny. I’ll just write it down,” with my pen. I happened to send something to someone who handles that in New York, and she said, “Hey, I really like this.” That was the first time I wanted to write it. So anyway, eight drafts later, I had a book.

Next I did a very small but smart thing. I thought real writers don’t go out and talk to people, like we’re doing now; I was a purist. So for two years the book ran on without my showing my face. I just went on with my life, until one day I got a letter. I opened it up, and it said, “I’m on call in Tulsa, Oklahoma, all night long, and if I didn’t have your book, I’d kill myself.” And I thought, “Oh, yeah.” From that day on, whenever anybody wanted me to go someplace or do something, I did it. So I’ve been all over.

That made me think about why the book is good, and the answer was the danger of isolation in medicine and the healing power of good connection. If it’s not with another person, it doesn’t work. That’s the one thing I really write about: good, mutual connection. That’s what it is, all of it. So I wrote The House of God, then Mount Misery, and then the last one, Man’s 4th Best Hospital.

The other wonderful thing that just happened, out of the blue: I was no longer at Harvard, and out of the blue, NYU Medical School said, “Hey, do you want to come as a professor?” “Why would I want to do that?” They said, “Well, we want you to teach.” I said, “What do you want me to teach?” They said, “We want you to teach The House of God.” I said, “Oh my God, are you crazy?” Because Harvard hated me. And for the past nine years, I think it’s been, I’ve been incredibly happy. It’s an amazing place, everything that Harvard isn’t.

And it’s really interesting: I was down at Montefiore touting my book Man’s 4th Best Hospital, and this was March 2020. We’d heard about COVID; it was right at the beginning of COVID. Then I came home and I got COVID. I got pretty bad COVID, and I gave it to my wife, of course. Nobody knew what to do. We weren’t going to die, but it was very bad. So then I said, “Well, somebody’s got to write about this, and it has to be me.” So here I am, after the last three years, almost three, of dedicated writing. I wrote the new novel, and I can’t tell you how happy I am, because what a story: the story of COVID, the story of us, the story of a long line, whoever the president was. It’s a very simple book, in three parts. It’s my shortest book, and a lot of people like to see that.

It’s dedicated to NYU, and this is the epigraph: “My house shall be called a house of prayer, but you have made it a den of thieves,” Matthew 21:13. Those are the things it’s about: the money. What I did in this book is very simple. I had help from someone who was going through it, a lot of help, and it’s just the first three COVID waves. They’re called “Flying Blind,” “False Sense” and “Wave of Suffering,” and it ends when Trump is done. The thing that was so remarkable about it was that it was such a strange thing, and we didn’t know how to handle it. It was just full of drama, all the time, every time. And as I said, I wasn’t in it firsthand; I wrote about it. I don’t think any book, fiction or nonfiction, can take this up as much as I did.

Kevin Pho: Let me just ask you here. Your book is Our Hospital, the latest book in what you call The Healing Quartet, which started with The House of God. It obviously takes place during the time of COVID. Tell us some of the major themes that run through this particular book.

Samuel Shem: It’s based on where I grew up, in Hudson, New York. I’ll read you this: “In 2020, May, BushCare Hospital in Columbia, New York, was the flagship of BushCare, a private equity, for-profit chain of hospitals across America, a for-profit that was listed on a lot of lucrative trading routes. Clearly, its workings were murky, maybe not equity at all, a clever goulash of nonprofit and big-time profit. It was on the same site as the very first hospital of Columbia, called Whale City Infirmary, founded just after the Civil War with a grand charitable mission to care for each and every wounded soldier, even the rare Confederate soldier who wound up there, and it was totally free.”

So that’s the story: the first three waves, till Biden gets in. And here’s the wonderful thing I was able to do. One of the three main characters is a woman. I’ve never done that before. She’s a woman who grew up in this little town, and they rush her over to do this, and she is an absolutely marvelous person. There are three generations, and she’s the most recent. They get Roy Basch, Eat My Dust Eddie and Hyper Hooper to come out of retirement and join in at the end. And I’ll give you a hint: There’s not the Fat Man exactly, but there is, so you can find out how they get the Fat Man back, because when the Fat Man died at the end of the other one, I was crying. And then there’s the old guy who lives there, who was with the city for a long time.

So this completes the thing I called the quartet. What is it called? The Healing Quartet. I always forget that, but that’s what it is. If somebody wants to know what American medicine was for 50 years, and I started writing it 50 years ago, this is it. And frankly, I wanted to come on with you because this is it: Get on this, because I don’t think I’m going on anymore. And the nice thing is that it has a happy ending, not just about COVID, but in all the ways they get back at these horrible money men. They figure out what nobody’s ever figured out before.

Kevin Pho: Let me ask: How did you get the stories for this particular book? You mentioned things like COVID and private equity, and some of the unsavory business evolution that’s been pervading medicine today. How did you do your research to weave these realistic themes into your narrative?

Samuel Shem: Well, I read everything. It’s so amazing, Trump and all that stuff too, but I read everything, and I especially read about money. My last hospital book was about money and screens, which were coming in, and which are linked, of course. But this one, if you look at it, is about how much money the insurance people made through the whole thing. Something has to change. We can’t go on like this. What we have to do is stick together, doctors, et cetera.

And I’ll tell you a little story. I always bring my new book to NYU. We have a big auditorium, and this wonderful guy, Bob Grossman, introduces me: “Here he is,” blah, blah, blah. I get up there and talk for 45 minutes, and then there are questions. This time, because it’s about nurses, and the nurses are the heroes in this book, with other people of course, what I decided was that instead of just getting up at the podium and talking, I wanted two chairs on the stage: me and the head nurse of NYU. And it was incredible. It’s the first time I have really put nurses at the center. I didn’t put them at the center before, because that’s where they were for me. Now, if I could just say, “Hey, this is you.”

The big thing we have to do is to piggyback, if they let us, on a way of threatening: “Or else we’re not going to do our job.” It’s a classic thing. I think it will get better. I think it will get better; lots of people are working on it. But you know this. You’re writing all these wonderful things about what’s terrible, about what doctors are going through. You’ve got it. You’re raw about all of it. Thank you, thank you.

Kevin Pho: So through your novels, you weave in 50 years of themes in American medicine. You expose some of the ugly sides of what’s been going on in American health care. Now, what does success look like to you? Through your novels, you clearly want to reform and improve our health care system, and you want to bring doctors and patients closer together. In your mind, what would success in changing medicine look like?

Samuel Shem: It has to be equality. I mean, it has to be equality. But the thing is, it’s really bad now for people like me to find a doctor, and you have to read my books to see why it’s bad. The money is the main thing. But we’ve got the VA; that’s a good model. It works. People are pretty happy with the VA. And look at NYU. I don’t know exactly what their thing is, but it works for them. It really works for them, and they’re buying hospitals all over Long Island and so on. You have to get the insurance companies to tone it down. You have to make their profits not worth really doing these things. And I think the first thing to do is for the nurses and the doctors to start talking, because doctors are walking out. I read something this week, didn’t I, about doctors walking out, just quitting. So I think you do what other good hospitals do when they have to. You have models, and it has to reach a fever pitch in order to do that, and then maybe it will. Maybe it will. But it’s a great big, good thing at NYU Medical School. I’ve never seen anything like it. Imagine Harvard doing a course on this. Never, never.

Kevin Pho: We’re talking to Samuel Shem. He’s the author of The House of God, Mount Misery and Man’s 4th Best Hospital, and his latest is titled Our Hospital. In your description, you said this is the fourth and probable last novel of The Healing Quartet. So is there a slight possibility that there may be another one after this, or is this really the last?

Samuel Shem: I’ll give you something that should help you with that. My best book is wedged in among these four novels. It’s The Spirit of the Place, and it takes place before all this happens, in this little town. It’s my best book; everybody loves it. It’s about a younger guy who’s here, but it’s an old one. It’s a love story, and it’s wonderful, so you should read that. Let’s not forget it.

As for the ending, how do you keep going? I would love to keep going, but it’s very hard to write at this age. This is funny: People ask me how I write, and I say I only write in the morning. They say, “Well, when do you quit?” And I say, “When the atrial fib starts in.” That’s true. That’s true. Usually I get four hours alone, but what I did this time was really bad for my body. I had nothing else to do when I was writing. I wasn’t going anywhere; I wasn’t talking very much. Because of the A-fib, I had never written in two shifts. So this time, smart me, I’d take a nap, meet with my wife, daughter, et cetera, and then I’d slip over and do two or three hours, and then that might become four hours. That’s when I really started to get into a real wave of hard stuff, and I had to stop, because it got so crazy. So when you get older, physical things make it hard to be a writer in that way. It was very dramatic, but I’m fine now. The main thing I think about now is that I think there will be some kind of joint doctor-nurse work, lots more of it, I hope. I hope this book will do that, just a little piece: to talk about it and get them closer. They’re close at NYU; they’re amazing.

Kevin Pho: All right, my last question, where you can share some of your thoughts and take-home messages with the KevinMD audience.

Samuel Shem: All right. This book, there it is. It’s the shortest book of the four, the very shortest. You can read it in two days, maybe one if you read faster. And things come out well. You have to know this: Everybody you want to be happy is happy. They earn it. So this is Roy and Berry at the very end, after they’ve, shall we say, done what they wanted to do. I won’t say, but it works out happily. They’re just looking out at night over their house and so on. This is Roy talking to Berry:

“After 50 years of this, almost everyone in medicine is hurting, doctors, nurses, all the others working in the money-driven hell realms of American medicine. We’re all suffering terribly. COVID has lit it up for all to see. The risks to our bodies, minds and spirits are profound: killing ourselves, acting normal, the poor and people of color dying in droves.”

Then there’s the question, “So when you go out there and do what Fats suggested,” because there’s a way Fats has already taught us. Let me go back. “Roy paused, scanning the trees for Fats. He went on: ‘We do miracles every single day, but we haven’t been able to get a place safe to work in, in body and spirit. One in five health care workers have quit. Many of us died at the start of COVID. We did the most important thing for us and our patients: We stuck together. But it became a very hard thing to do. We ran into the big American self, killing off the American dream, because it was only a solo dream, in darkness, not really with others, not lasting into the day. Hatred and money killed it.’ He smiled at Berry.” Because she’s a Buddhist teacher now. “‘As the Buddha said, it’s the three defilements, greed, hatred and delusion, the roots of suffering. Right?’ ‘Yes,’ she said. ‘So when you go out there and do what Fats suggested,'” which is to go to people and try to help, “‘what would you say to the next generations?'”

This is it. After all these years, I’m coming right back to the beginning. “She smiled. ‘I’ll pretend I’m one of them.’ He looked down over the deck, to the flat land before the river, and then he said, ‘Now we turn our sights to you, the next generations. This isn’t our fight anymore, at least not on the front line, but it breaks our hearts to see you this way. It’s the fight, and we have your backs. We have faith in you. Stick together. Lean on us, count on us, call on us, and we’ll be there with you, with you, with you.’ He went on, as if he were reading from writing in the sky: ‘All of you have made it as doctors and nurses. All you need from us now is inspiration. We promise we will help with that. It will be hell, but listen. Take this in deeply: These things can change like lightning, and with lightning, sometime, maybe when you are down, your dark sky may lighten, and in that moment you may glimpse a beloved person, a lover or a wild, kind teacher or family member, or, as I did, a fat man. And in that sudden, strange awareness, you can count on one thing above all else, for sure.’ He smiled at Berry. ‘Our job is to reveal and heal. We all together have the power to lift you and your caring. It is a rising time.’ He paused. Berry reached out, took his hand gently and smiled. He finished: ‘We wish you all well.'”

That’s why I write it. That’s why I write. I hope they get to that.

Kevin Pho: The book is Our Hospital, the probable last novel of The Healing Quartet. Thank you again for sharing your time, insight and perspective, and thanks again for coming on the show.

Samuel Shem: Thank you. Thank you. You’re a genius at this. Thank you.