His first novel, House of God, began as an act of catharsis, Stephen Bergman, M.D., Ph.D., told an audience at internal medicine grand rounds in January. It was also, he said, an act of “resistance to [the] inhumanity and injustice” that he saw during his intern year at Beth Israel Hospital in Boston.
Although Bergman’s novel, published under the pen name of Samuel Shem, resonated with medical students and residents, it infuriated Harvard faculty when it appeared in 1978. Nevertheless, Bergman himself got a faculty post at Harvard, where he remained for 35 years. “When House of God first came out the people that hated it and me most were at Harvard Medical School,” Bergman said. “A year and a half ago, guess who was the commencement speaker at Harvard? Samuel Shem.”
Bergman’s January visit to Yale was sponsored by the Department of Internal Medicine Writers’ Workshop. Each year the workshop publishes Capsules, a collection of stories and essays by residents, and invites a distinguished writer to speak and meet with the residents. At grand rounds that morning Bergman used his novels The House of God and the award-winning The Spirit of the Place—about a young doctor going home to join his aging mentor in primary care—to intertwine the topics of writing and staying human in medicine.
“The motor that starts me writing is the ‘Hey, wait a second’ moment when we see things or think of things that we do or don’t do, and say, ‘There’s something wrong here.’ In House of God there were so many ‘wait a second’ moments that I couldn’t pass them by,” he said. “We really were interested in treating the patient humanely. We were told to treat people in ways that we didn’t think we should. You can read [the book] as a moment of nonviolent resistance to an authority that we didn’t respect.”
To maintain humanity in medicine, Bergman offered four pieces of advice.
“Stay connected. Isolation is deadly.”
“Speak out. If you see an injustice in the medical system you have to speak out. Speaking out is essential for your survival as a human being.”
“Learn empathy. If you have suffered it is easier to understand the suffering of others.”
“Learn your trade in the world. The good news is that you current medical students are different from my generation. You have been all over the world and come from all over the world. You don’t see foreign people as foreign. You are able to identify with all kinds of people. The bad news is that you are entering a health care system that is beyond broken. It is a disaster and you are going to have to do something about it.”
Summing up, he said, “We all suffer—it’s how we move through it, and with whom, that matters. We doctors have a great opportunity to be there with others and care for them through their suffering.”
At noon in a conference room at Yale-New Haven Hospital, residents read their stories, which were published in the seventh edition of Capsules.
Deena Adimoolam, M.D., described a hectic day on the wards interrupted by a call from her mother. Initially annoyed, the young doctor tried to end the call quickly, only to learn of her grandfather’s death. Nancy Dodson, M.D., wrote of her frustration with a teenager crestfallen that her pregnancy test was negative. Dodson’s efforts to discuss the perils of teen pregnancy had no effect. “Instead,” Dodson wrote, “I turned her out into the world with a jumbled message of doom and gloom: diapers are expensive and your baby will have a heart defect and your boyfriend will leave you.”
Susan Gamble, M.D., offered a humorous account of her misdiagnosis of her boyfriend’s pulmonary ailment. (He married her anyway.) Lily Horng, M.D. ’08, described her return to Mulago Hospital in Uganda as a resident three years after her first visit there as a medical student. Steven Wang, M.D., a resident in radiology, wrote about a conversation with his girlfriend that served as a reflection on aging. Boback Ziaeian, M.D., described his relationship with an elderly patient who repeatedly pulled out her IVs unless restrained.
Links to selected stories and essays from previous editions ofCapsules can be found athttp://residency.med.yale.edu/writershop/stories.aspx.