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46 pages 1 hour read

Samuel Shem

The House of God

Fiction | Novel | Adult | Published in 1978

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Chapters 18-22Chapter Summaries & Analyses

Chapter 18 Summary

Roy starts a new rotation in the House of God’s ICU. He’s working with Jo and another doctor named Pinkus. He meets the ward’s nurses and patients, already depressed at the seriousness of the patients’ conditions. An exception, however, is the healthy woman whom Jo and Pinkus are keeping in the hospital against her will just to try out new medications on her. Another of the patients is a young medical student who caught a cold that has morphed into a deadly and mysterious ailment. Roy is afraid of catching whatever it is and distracts himself with his sexual excitement over the fact that the nurses change clothes in front of him in the staff room when they’re coming in for a shift. 

When Roy goes home, Berry asks him how he’s doing after Potts’s suicide a few weeks earlier. He brushes off her concern, saying he hasn’t had time to think about Potts, and Berry says, “That’s what’s so wrong. It isn’t the medical skills you learn, it’s the ability to wake up the next day as if nothing had happened the day before, even if what happened is a friend killing himself” (283).

Chapter 19 Summary

Roy gets a sore throat after being in the same room as the dying medical student and fears for his life, having tests run on himself to make sure he’s healthy. The medical student dies after a long and invasive effort to try and save him, including opening his chest and pumping his heart by hand. Pinkus praises Roy after his first night on call, and his praise encourages Roy and makes him proud of his work. After discussing cardiac health with Pinkus, a marathon runner, Roy decides to take up running and goes for his first run after his shift. He comes back with chest pain, again panicking about dying before realizing he’s just out of shape.  

Chapter 20 Summary

Roy starts running to and from the hospital and has erotic fantasies about having sex with the ICU nurses. During the week of Passover, patients begin dying of heart attacks, and the staff, especially Jo, is frantic to stop them. Roy, who is Jewish, calls a rabbi and has him swab red paint over the ICU doorways to stop the deaths, as the ancient Israelites did in Egypt according to the biblical story. It works for a night, but then a patient quickly dies even after regaining a normal heart rhythm. Berry continues to be frustrated by Roy’s unwillingness to confront the traumas he’s experienced over his internship year and tells him that if, when he finishes his final rotation, he won’t engage with her to work on his emotional problems, she’ll leave him.

Chapter 21 Summary

Roy treats a young woman whose prognosis is so bad that her husband asks him repeatedly not to intervene anymore. Roy keeps trying to “save” her, however, because he thinks he needs to. Another patient dies and the nurse refuses to pull the plug on the woman’s respirator, revealing the deep discomfort of some staff members about prematurely ending a life. 

The hospital discovers a ploy by Chuck of putting dead patients’ names into his appointment schedule to give himself free time. After work, Roy goes to cheer on Pinkus as he runs in the city’s marathon, amazed by Pinkus’s calm demeanor during the race. He runs into an ICU nurse at the gym and invites her out for a drink. The two have sex later.

Chapter 22 Summary

Roy’s rotation in the ICU ends, but he finds it hard to let go of his work there. He makes plans to go to a mime show—put on by the famous French mime Marcel Marceau—with Berry but then finds himself back in the ICU ward. Berry tracks him down there, and she has recruited Gilheeny and Quick to go with her and Roy to the show so the policemen can physically drag Roy there. At the show, Roy has an emotional breakthrough about his work and the harm he has done by suppressing his feelings of despair and grief. He and Berry begin repairing their relationship, and he’s now open to her insights on his psychological state.

Chapters 18-22 Analysis

The conflicts running throughout the book intensify even more in these chapters, leading up to the moment when Roy finally lets down his emotional guard in Chapter 22. Berry becomes increasingly frustrated with Roy, and he is distant with her. The Fat Man is angry at him for not treating Berry as he thinks she should be treated. Chuck is so desperate for a reprieve from the demands of the job that he puts the name of dead patients into his appointment roster. This section of the book ramps up the emotional intensity, culminating in the scene at the Marceau show when Roy finally expresses and understands his feelings. 

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