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In this episode, we welcome Samuel Shem, a renowned novelist, playwright, and activist. As a Rhodes Scholar and a professor of medical humanities at NYU School of Medicine, Samuel brings a unique perspective to his work.

Today, we’ll be discussing Samuel’s latest novel, Our Hospital, the fourth and likely final installment of The Healing Quartet, which spans fifty years of American medicine. Beginning with The House of God, followed by Mount Misery and Man’s 4th Best Hospital, Samuel’s quartet offers a poignant exploration of the human experience within the health care system.

Join us as we delve into Samuel’s insights on storytelling, medicine, and the evolving landscape of health care in America.

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, 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, and professor in medical humanities at NYU School of Medicine. He is of course the author of The House of God, but also Mount Misery and Man’s 4th Best Hospital, and his latest is titled Our Hospital. Samuel, welcome back to the show.

Samuel Shem: Hello, thanks.

Kevin Pho: So your latest book is titled Our Hospital. It is what could be your final book in the proverbial healing quartet. Now tell us a little bit about this book and what led you to it.

Samuel Shem: Yeah, let me just set it up first of all. So it goes in a healing quartet. The first was The House of God, the second Mount Misery, Man’s 4th Best Hospital, and now this one, Our Hospital. And I’ll go back to that in a minute.

But I just want to say, for those who want to write, don’t listen to people. Don’t listen to people. You may be brilliant.

I don’t know why I’m looking back, I’m 80. At Harvard I really wanted to write, and everybody has to do a thing with a woman who is supposed to know about writing. So I went to her and I wrote a thing for her, and then it came back and there was not a thing on it. And I’m looking, I said, oh, it must be perfect. And then I looked down in the bottom, it says, see me. Oh no, I said, what does she want to see me for? But I thought she wanted to be kind, you know, to say a good thing.

And I go to her, this is the first time to hear something done at Harvard, this great Harvard. And she said, yours is so bad I couldn’t write anything on it. It’s below F. Oh, below F, that’s pretty low. And so she said, what should I do? I don’t know.

And basically I flunked the course, but they let people go out anyway, and so many people wanted to be writers in the thousand that were in that group. And they really took all the things that you could do in writing in Harvard, and I didn’t. I just went my way, and then I got a Rhodes scholarship and all that stuff, but I was a scientist basically. And so I never tried to write, I thought, well, they’re true.

So when I got to Oxford, four years later, I said, she can’t get me. And so I really, and I was in this Rhodes scholar group of all of these things, and it was ’66, everything was going off, and it was crazy. It was crazy there, and you could be drafted.

And so I started to write. That’s it. And I read everything, I wrote everything, I met all these people from all over the country. And then finally there was a mix up and I was slated to go to the war, and so I said, I better get into medical school. And so I slipped into medical school. I loved medical school and all that stuff.

But the point is that those years were doing things that were just letting people come in, in this incredible pace of people getting killed, and war, and all this stuff. And we were starting Harvard Medical School.

Kevin Pho: Your books have certainly touched a nerve and have been iconic novels to read for anyone going into medicine, of course. Your latest is Our Hospital, part of the healing quartet. So talk about the healing quartet in general, about those books, and just some of the messages that you want readers to come away with after reading your quartet of books.

Samuel Shem: Yeah, right, get something that would keep you awake, I guess.

No, The House of God just came, bang. We were treated so difficult, that when we stopped that one year, I went on to being a psychiatrist. But it was so horrible, as in the book, we were just so out of it.

And about four people, Eat My Dust, Hyper Hooper, the Runt, all of those things, and I brought them over to my house and we started just talking, talking and drinking and puffing. And it was just the funniest stuff that anybody had ever made about medicine.

And all of a sudden I think, gee, maybe I should tape it. Maybe I should tape it. So I start taping them, and we got drunk and all this stuff.

And then I was trying to write plays, but then I was looking for someone who did plays, and I wrote to her. I had started writing this stuff up, just taking it off right off this, cigars and all, it was all a mess.

And she said, I don’t do plays, why don’t you send me what you got? And then it came back. I was standing in the hospital, the what is it called, McLean Hospital, it’s a psychiatric hospital. I’m standing there, and she says, this is whatever, coming back, the first time anybody ever said anything about it. And I didn’t want to write prose, but she said, well, I think you’re a madman or a genius, but I really loved what you said.

And I was standing in the crazy hospital. I said, well, I can only tell you that I’m in a mental hospital where we’re talking. So that was it.

And I hadn’t ever written a, but I happened to sell it for nothing really. No one else wanted it, some crazy woman got it. And then it was six, seven revisions, so that I could actually say it. My brain isn’t there now, but I knew every single word in it.

And then it goes on, but it was the 60s and people went off at me very, very hard. But I don’t react to that.

I’ll tell you one other thing about The House of God that really crystallized this. I decided something weird, I took a pen name, and I didn’t want to go out for the book. I was very pure, pure like this.

And so for two years, Kevin, I refused everything that they wanted me to talk about all over America. In those days you could only go through the publisher, and they’d put it in an envelope. And for two years I didn’t say anything, I just went on with my life.

And one day, nice sunny day, he hands me an envelope. We used to have envelopes, I think you know what they are, right?

Kevin Pho: Sure.

Samuel Shem: I open it up and he says, I’m in Tulsa, Oklahoma, and if I didn’t have your book I’d kill myself. Overnight, kill myself.

And I mean, God, I could almost cry. God, he meant it. You could tell he meant it. And I said, well, maybe people would have a way to want to hear about my experience.

And so from that time I went really the other way, anyone who wanted me, because I had my money, I didn’t need to do it, from doctoring. From that day on, there I was, I did it. I have been everywhere in the United States, and almost all the old youth.

So the one thing I would say is, we grew up in my time to do things with other people, by and large. You really try to make things better.

Kevin Pho: So The House of God was written decades ago. Do you think that the themes in The House of God are still relevant today?

Samuel Shem: It’s not quite like it, but it’s really, really hard. And what’s the reason? Money. Yeah, it’s money.

I cry sometimes about what’s being done to us doctors, what’s happening to us. They’re leaving, they’re cursing. I mean, I’m at NYU, that’s a great, great place for me, I’ve never seen a hospital like that. I’m easing out of it because I’m old.

But what has happened, and what’s in the new book Our Hospital, is the first part of COVID. And I sort of thought I was done with that series, but all of a sudden, well, I’ll tell you how it went.

I was going out to talk, and I was in one of the hospitals in March of COVID time, and I caught it, right in the first times. We were right up there in that March, right at the beginning, beginning of March, nobody knew anything.

And then I got back with Janet, my wife, and me, and all of a sudden I felt, just after it, nobody knew, nobody did anything with it. And one of the things that happens, you stand up and then you sort of fall over, because it can’t pump the blood up. And I almost hit my head right on the head, but who knew?

And then one of the guys I was with died three days later. And I’m sitting there and I’m just scared as hell. And luckily I gave it to Janet, and we had a hard time. We weren’t going to die, but it was sort of close, it was going into the inside, into the breath, into the lungs.

And then, what do I do? And one of the ones that I was there with died a day, two days after, I don’t know if I told you that.

But then, I’m an addict, I’m an addict to writing. And then that time I say, well, this is what always gets me, somebody’s got to write this and it’s going to be me.

And so I did three years, and I almost was not going out of the house and stuff, because we didn’t get to go out of the house after a while.

And then I did something I never did in writing. I just used to write in the morning and then go do doctor things, and then I didn’t have to do that anymore. And so this time I really got through this, because I was sick and I didn’t know how sick I was going to get. I really wanted to write. I mean, COVID, the plague, I could be in, this time, what is that like? It’s been all the way through the world.

And so usually what I do when I write, I only work in the morning, because I’ll get worn out if I do more, and I used to go and see patients after that. Just the morning. Well, this time I got so wrapped up in it, and I didn’t have anything to do in the afternoon, so I went again for another four hours. It was crazy. I mean, crazy, crazy stuff.

And I just loved writing this book, because I knew I was getting it all right.

Once somebody asked me and said, well, how long do you work in the morning? And I say, when your head goes into atrial fib, and I stop. That’s true, I can hear it stopping, and I said, OK, bye. And sometimes this time I went through it. Writing really keeps me going, you know, it really does.

What I did was, there’s a book called The Spirit of the Place, which won all kinds of national things. The Spirit of the Place, which is probably my best book. But what I did was, I took the doctors that I always wrote on in The House of God, and that one was in Hudson, New York. I wanted really to be with these people. They’re crazy, I’m crazy, they’re real for me.

What I wanted to do was, I went like with these hands of mine, and I said, I want to bring these together as a last book. But I really want to, this is going to be in the COVID, in this small town, Hudson, New York, that’s where I grew up.

So that’s a lot to tell you of what I’ve been doing. And I gave it to Janet, and I think it took a lot out of me. So it’s hard, but I love writing.

Some people say, well, they don’t know. But what I did, I have put the COVID on history. Put it this way: I was sad, because the Fat Man couldn’t be in it, he was dead in the previous one. But I found a way to make him come back. I found a way to make him come back. So he’s there.

Kevin Pho: Let me ask you how your writing has evolved since The House of God, and decades later to your most recent book Our Hospital. How have the themes and your writing evolved from your first book to your most recent one?

Samuel Shem: Well, it’s a wiser person writing them, I think. I can go deeper, I think. I really could take in all different kinds of things that went up.

I think you get wise if you really write, and you learn everything. You have to learn everything through writing. You get wiser, for me. You get wiser, you let yourself talk to people. Hopefully you and your spouse do better. She loves me writing. She’s about to kick me out, OK, because I’ve been like six, seven, I haven’t written anything. But I think I’ve got it now. I think I’m going to do something, maybe. Well, anyway, that’s the answer.

Kevin Pho: We’re talking to Samuel Shem. He’s a novelist, playwright, activist, and author of, of course, The House of God, and his most recent, Our Hospital. Samuel, as always, just share some take-home messages that you want to leave with the KevinMD audience.

Samuel Shem: Don’t go down things alone. If you’re having anything difficult, don’t go down and keep it to yourself.

We are really in a hard time now. First it was the machines, and now it’s the money. I have never seen the greed around these hospitals that are getting bought and sold.

Don’t do things alone. It’s harder now, because it’s more diverse and stuff. The most important thing is, have people with you, have people with you that are good people. And just always remember that you’re not alone.

What we’re doing now is not going with people. I mean, I think it’s very hard to have good friends. Even I’m at friends, partly because of the COVID and all of that. But everything is in chaos.

I never thought it would get worse. I really didn’t, after a couple of these books. But this is worse. This is worse, as you know. All these places are falling down.

One of the things in this book, Our Hospital, it’s to the tee what is true. I talked to lots of people, if I wasn’t there. It was true, the way that we are paid by the big companies, that’s it. And doctors have to take more and more to do, they have to take it on.

But I think, you know the issues probably, that people are going, are they still leaving medicine?

Kevin Pho: Are you asking me?

Samuel Shem: Yeah.

Kevin Pho: Yeah, I talk to a lot of doctors who are, yes.

Samuel Shem: Yeah, I notice on what you put up there that a lot of people are running and trying to do different things.

I mean, it’s so sad that these young people are having to do what they do. They don’t do what they need to do. I mean, you know what I mean. It’s money, money is killing us. That’s what it is, it’s really killing us. And I think we’re near the bottom in terms of, why would we stay with this thing? Why would we stay?

Could I read one page? One page, it’s very short. This is the end of the book of Our Hospital, just the last one, with Roy and Berry, and they’ve won all the things, they won, it’s a very happy book. They’re sitting outside their house.

[Samuel Shem reads the closing passage of Our Hospital: Roy, speaking to Berry, turns to address the next generation of doctors and nurses directly, telling them that although the fight is no longer his, he and his contemporaries have their backs, urging them to stick together and to lean on those who came before. He tells them that things can change like lightning, and that in such a moment they may glimpse a beloved person, a teacher, a family member, or, as he did, the Fat Man. He closes on the idea that their job is to reveal and to heal, that together they have the power to lift one another, and that it is a rising time. Berry takes his hand, and he ends by wishing them all well.]

Writing is wonderful, really.

Kevin Pho: Samuel, thank you again for sharing your perspective and insight. Thanks for coming back on the show.

Samuel Shem: Thank you very, very much. I really appreciate it. You’re doing God’s will.