The House of God

Since all the interns are struggling with what to do at the end of the year, the Fat Man gives them a talk on how to choose a specialty to proceed with. He chooses six that don’t involve as much patient bodily care, which seems to be the root of most of the interns’ issues. The six areas are radiology, gastroenterology, pathology, dermatology, ophthalmology, and psychiatry, and after the Fat Man’s talk, Roy is thinking even more seriously about becoming a psychiatrist. The interns go on a picnic with Berry and Gilheeny and Quick, and after talking with Berry all the interns become enamored with the field. The Leggo is alarmed that he might be losing all his interns when he counted on them staying for another year.

The Leggo has a lunch for all the interns to talk about their future and the coming year. Hooper wins the Black Crow award for performing the most autopsies, and Roy wins the “Most Valuable Intern” award. All the interns tell Leggo they’re thinking about going into psychiatry and angrily confront him about the lack of support for interns to help process and understand their emotions about their work. Even Gilheeny and Quick, who attend the meeting to keep the peace, reveal that they’re quitting their jobs to become lay analysts, psychoanalysts who are not M.D.s. Roy treats a wealthy patron of the hospital who is so impressed with his hands-off style that he invites Roy, Berry, and Chuck out to his mansion, where Roy continues to feel as though he has turned a corner past the misery he felt during the internship year.

Roy ends his internship year. He and the Runt are both leaving to pursue psychiatry, although Roy is planning to take a year off first. Hooper and Eddie are staying on at the House of God, and Chuck decides to go home to Memphis to practice medicine and regain his fitness. Roy goes to say goodbye to the Fat Man and finds him talking to the new interns about the anal mirror invention, which makes Roy realize the whole invention is a way of engaging each new group of interns. On his way out of the hospital for the last time, Roy goes to see Leggo, whom he has begun to pity. Leggo insists that the year has been good and is still baffled why so many of the interns struggled, despite Roy’s repeated attempts to explain that the interns don’t get enough emotional guidance and support. 

When he leaves the hospital, Roy throws his black doctor’s bag up into the air, letting the medical instruments fly out of it and shatter on the concrete. Gilheeny and Quick drive him and Berry to the airport in a police car for the vacation to France first described in Chapter 1. In France, Roy decompresses after his time in the House of God and continues to open up to Berry, although he’s still traumatized when he sees elderly people or a cemetery. A stream-of-consciousness passage at the end of the chapter represents Roy’s acknowledgement of his diverse emotions. It’s implied that he will propose to Berry. The chapter is followed by the Fat Man’s “rules” of the House of God and a glossary of medical terms. 

Shem reflects on the history of The House of God. The book caused an uproar among elite medical institutions and professionals in the 1970s because of its depictions of inhumane, ineffective treatment of both young doctors and patients. The book became a bestseller and helped spur reform in medical education and practice. Shem relates his recommendations for “staying human in medicine” (376): Stay connected to other medical caregivers to normalize what would otherwise be a devastating emotional experience, speak up in the face of medical injustice, learn empathy for the patient, and become as competent and holistic in medical care as possible. Shem also decries the for-profit medical model currently used in America and calls for a “universal coverage federal system” (378).