Forty-one years after the publication of Shem’s cult medical novel, The House of God, the doctor has written a sequel, Man’s 4th Best Hospital (Berkley, Nov.; reviewed on p. 85).
Why a sequel now?
I start to write when I live through an unjust, inhuman situation full of “Hey, wait a second” moments. I say to myself, “Someone’s got to write about this, I guess it’s up to me.” This was true of The House of God, about medical training. I always wanted to write a sequel, but I had drifted out of medicine. Five years ago, I chanced to get back into medicine. I was thrilled to see the miracles that medicine can do—but I was also appalled at two things: money and screens, electronic medical records. Which, since the screens are billing machines—means money and money. “Hey, wait a second,” I thought. “Someone’s got to write about this, it’s up to me.”
Was it difficult to reconnect with characters you originally created in the 1970s?
It was very easy. Six of us—the real-life versions of the characters called Roy, Berry, Chuck, Eat My Dust Eddie, Hyper Hooper, and the Runt—have been pals all along. The Fat Man—the hero of The House, and now of Man’s 4th—was imagined. It was pure joy to watch him write himself again.
How have your characters changed since the original?
In real life, all have become great, brilliant doctors. In 1973, the real House of God was ranked as the #1 medical internship in the U.S. We were not chopped liver. Over the years, life happened, but we kept living our core of integrity and kindness. As products of the ’60s, we have lived with a certain creative activism—the faith that medicine, and life, can be better. I started with the changes in the real people and kept them in character, but put them in a wholly imagined story.
Have you always wanted to be a writer?
Yes, but I failed the Harvard writing course, and wrote nothing for four years until I was a Rhodes Scholar at Oxford. After three years there, I faced an easy choice: Vietnam or Harvard Med. I went to med school to learn a day job, so I wouldn’t have to write for money. I had never tried writing a novel until life insisted, in The House of God.
Were you surprised at how influential The House of God was and continues to be?
I knew that I had told the truth, one step off real, riding on humor and sex, and I knew my generation of docs would read it. Years ago, NYU Medical School brought me in to teach it—its human core still resonates, down three generations.
Will there be a sequel to Man’s 4th Best Hospital?
If I get another “Hey wait a second” moment, you bet.