The Medmastery Show - Episode #14 | Samuel Shem on failure, creativity and life as a clinician

Have you read the novel “The House of God” by psychiatrist Samuel Shem? I read it when I was in medical school and it deeply influenced me. The book tells a captivating story of what it’s like to be a Harvard resident with lots of humor, drama and wisdom. I’ve had the great pleasure to interview Samuel Shem for you.

In this conversation we cover lots of ground like:

• The best advice he ever got
• What his creative process looks like
• How he came up with the idea for The House of God
• How failure has set him up for success
• The quote he lives by
• And much, much more

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2. You can download the audio file
3. You can listen to it on the bottom of this page

Shem as he likes to be called is an American psychiatrist, his real name is Stephen Joseph Bergman. He was a Rhodes Scholar at Oxford in 1966.

He completed his internship at Beth Israel Hospital, which was the inspiration for House of God.

Shem is Professor of Medical Humanities at NYU Medical School.He lives in Newton, Massachusetts with his wife Janet Surrey and a daughter.

Other books by Dr. Shem are Mount Misery, the sequel of House of God, Fine and others. His most recent book At the Heart of the Universe has been published in June 2016 and he’ll talk more about it in the interview.

Franz:

So, Hi Shem. Thank you so much for taking the time for this interview.

Shem:

You're welcome.

Franz:

You know, your work has been very influential to me. I read your book The House of God when I was in medical school and it's deeply, deeply influenced me and it has become part of the physician culture, really. How did you do that? How did you ... Did you plan that or was that by accident?

Shem:

The reason I right is I have realized over the years is the motivation is one thing and then the purpose of the writing is the other. The motivation is what I've come to call, "Hey, wait a second moments." These are moments that you have everyday, you may have already had them before this interview in Austria where you ... Something happens during the day like you walk past somebody who's asking for some money on the street and the person looks okay but you just keep walking on by and later you say, "Hey, wait a second why didn't I give that guys something?" He didn't look so bad, you know. Or something that you did in the day that you say, "Hey, wait a second why did I do that?"

So, The House of God which is based on my internship in the Beth Israel Hospital in 1973, 74. There were so many of these, "Hey, wait a second," moments. What is this all, you know? What's going on here? That at the end of it, I felt that, "Well, you know what? Someone has to write about this thing and I guess that someone is me." So that was the motivation. It was really kind of cathartic because it was such a miserable year. I mean, the book isn't really as bad as what happened there because nobody would want to read it.

That I just started ... Well, I got the guys together in the core group, many of whom are really closely written to the characters, like Chuck, the African American and eat my dust, Eddie who the motorcycle jacket guy, and hyper Hooper and the runt. They were all based on real characters, my dear friends. So we used to get together and get drunk and talk about all this stuff. We were all still in the area in Boston afterwards. Sometimes we ran a tape recorder which was useful at the end. And I just started writing.

So, that was the motivation that gets me going on all the novels. I mean your listeners may be interested, publisher seems to have kept the other novels I have written hidden but there are, you know, I don't know, six, seven novels that have come out since.

But what I found out recently actually fairly recently in an interview that somebody did for a paper here. The purpose, I am in a very strange group of authors, very few of whom are left today who believe that writing a novel can have a purpose. The novel serves a purpose. And what became obvious to me after this interview, this woman asked me, "Why do you write?" And I forgot what I said until I read it. And I said, "I write for two reasons. One to draw attention and resistant justice and number two to describe the danger of isolation and the healing power of good connection." That's not a conscious thing that's just something I've always done and I think it came out of the fact that I grew up in the '60s.

What we realized when I was in college in the '60s and then later at Oxford for three years as a road scholar in the '60s was that if you see an injustice and you get together and take action, you can actually change things for the better. And guess what? We helped put the civil rights laws on the books here in America and we stopped the Vietnam war. That's pretty good. So when we got into the internship at The House of God we were very idealistic young doctors and when we saw injustices that are described in The House of God, we weren't going to just take it. We resisted it. And in fact I realized that you can look at the ... No one's done this kind of analysis but it would be a useful project for someone 'cause it wasn't conscious on my part but The House of God can be read as a manual of nonviolent resistance to an in-just system.

Franz:

What exactly do you mean by that?

Shem:

I don't want to get too sociological here because it's a very passionate, and humorous, and sexy book but what I came to realize is The House of God was like any major medical hierarchy, that is it's a power over system. Where somebody has power over you and you often have power over somebody else. But in this system, the interns, we were at the bottom. In that kind of system the pressure comes down. There's a conflict between the received wisdom of the medical system and the call of the human heart which is what we're going through as idealistic young doctors. And the pressure comes down on the group of interns and what happens is they get isolated. They get isolated in three ways.

One, they get isolated from each other as you notice as the book goes on they scatter. One person kills himself. Another goes crazy. The second thing is that each of us got isolated from our authentic experience of the system itself. Which means that you start thinking, "I'm crazy for thinking this is crazy." And then the third thing in those days we all got isolated in the hospital. We didn't have time for relationships. People got divorced. People had affairs. All that stuff. And so, the only thing in a power over system that helps change it or at least resist it is the quality of connections among the subordinate group.

There's a dominant group who ran the place and there's a subordinate group. In life these are general ideas whether you're subordinate in race, sexuality, culture, religion, ethos, whatever. The only resistance to a dominant group is the quality of connections among the subordinate group. So that's why I say what I write about is the danger of isolation and the healing power of good connections because the only way that doctors can get through something like this is to stick together.

Franz:

Yeah, that's very insightful.

Shem:

You know, there's a slight little thing that Chuck, the black character in The House of God, says, which is a simple example of this nonviolent resistance. They tell him, "Why don't you wear a tie when you come to the [inaudible 00:07:03]?" He was like, "Fine, fine." Or you know, "When are you gonna write those orders for that patients that I asked you to?" "Fine, fine." He never does it.

Franz:

Mm-hmm (affirmative). And what does that tell us?

Shem:

Well, if you ... This is a lesson, there are two lessons if anybody wants to resist their in-just system, which still exists. One of them is that you don't resist alone, certainly. Number two is you have to be deft. D-E-F-T. Meaning you don't use a fist against a fist. You use a palm against a fist. It's like martial arts or something like that. You use the force of someone else's madness to retaliate. So you have to be deft.

Franz:

Yeah, I understand. Can you tell us a little bit about the day you had the idea for The House of God? Can you still remember?

Shem:

An interesting question. I had started to be a writer, I had wanted to be a writer before medical school. When I was at Oxford I started writing but then I had a very simple choice to make which was between Vietnam or Harvard Med. I decided, "Well, maybe it would be better to save people than get killed myself." So I went to medical school just basically to get a meal ticket. I liked pre-med and all that but I wanted to be a writer. Then I decided I'd find a way to do that and have medicine as my money making livelihood. So I was prepared ... I was always writing and then I didn't really think of writing a novel about what happened. I wasn't interested in novels. I had never written a novel. I was interested in plays and stuff like that. Poetry.

Actually, it's a funny story, I was looking for a play agent and someone said, "Oh, there's this woman in New York who does plays." So, I wrote here and said, "I want a play agent." What I had been doing was writing down these things that we were talking about with my friends just for their fond of reading it. I would just, I wrote out stuff about the House of God about what had happened and never thought to publish it at all. She wrote me back and she said, "I don't do plays but you said at the bottom that you had a piece of a doctor novel. Why don't you send me that? What you have?" What I had was, I didn't even know you were supposed to double space things at the time. It was just this mess of beer rings and whiskey on the paper. I was smoking then and drinking, cigars ash burned holes in the thing. So I just packed it up and sent it off. Forgot about it.

Then a couple weeks later I'm there, I'd started my psych training in a big mental hospital called McClean which I wrote a novel about called Mount Misery which is the sequel to The House of God.

Franz:

Yeah, absolutely fantastic. I just loved that book just as much as House of God.

Shem:

Thank you. Needs a little help. My wife just said she's here and she said, "Yeah." She loves it too.

Janet:

I like it.

Franz:

Oh yeah. Absolutely. It's just a great book.

Shem:

I'm a little amazed at that book. When I look at it now I think it's every bit as good as House of God-

Franz:

Absolutely, yeah.

Shem:

Okay, go buy it audience.

Janet:

[crosstalk 00:10:42] can't laugh it.

Shem:

Yeah, Janet said ... You want ... Janet should be on this. She said [crosstalk 00:10:47] can't laugh at themselves. That's true. In fact, you know the audiences that are the worst audiences for me to talk to ... You know, I give a lot of talks. I vowed I would never talk to a group of psychiatrists again because you say something that's funny and they're analyzing it before, you know, instead of laughing. It's crazy. Well, you know if you've read the book [inaudible 00:11:07].

So, anyways, I sent it off to her, two weeks later I'm standing in Mclean Hospital, this big mental hospital, doing my residency and the phone rings. I get on the phone with her and she said, "You know, I don't know if you're a madman or a genius but I really love what you sent me." And I actually had the presence of mind to say, "Well, I can't help you there but you should know I'm speaking to you from within a big mental institution at this time."

So, I started that. She showed interest. If she hadn't done that there'd be no House of God. I wouldn't have written it.

Franz:

Wow. One thing that strikes me is you said you were hanging out with your friends drinking and talking about The House of God or your training and the internship and you said you recorded you conversation. It seems a little odd to record the conversations you have with your friends. Why did you that? Did you have foresight that this might be helpful one day? Why did you do that?

Shem:

I don't remember the chronology exactly but I think I had an idea. I think I had an idea after the internship. So I think ... I didn't record often. I think I just recorded one long session. Which I still have the tape. It's one of those spooled reel tapes and I decided, "Gee, why don't I get that transcribed if it's still okay before it decays some more?" But, yeah, I think I had it ... The experience was so vital, I think I had kind of a novel in mind but I would've dropped it if she hadn't said, "Oh, send it to me."

Franz:

You said it created controversy, the book, and what was the controversy about and did some people be offended? Did they recognize themselves? How did all that play out?

Shem:

Yeah. Well, it was about a Harvard teaching hospital. It was right there on the quadrangle of Harvard Medical School. The way it played out, I was very naïve. I thought, "Oh, you know." I remember thinking, "Oh, people are gonna love this book because it tells the truth." It was interesting because I felt totally impervious to any reviews. There weren't very many reviews, first of all. But I didn't worry about reviews because I knew I told the truth. Then I remember the night before it was gonna come out, I realized what it was about and all and I said, "Oh, shit. What have I done?" I kind of had a little hit of fear but I don't run on fear. I run on guilt. So, it didn't bother me very much.

When it came out the people at the Beth Israel, of course, they all read it and they started to spread rumors about me that I didn't really like. One was weird. I was, "Yeah, it's all true but he shouldn't have told people about it." That's sort of a ... That ain't good. I didn't care about that. The only one I cared about, they spread another rumor that, "Oh, he wasn't really a very good intern at the time." I may not have been the best but I always took care of patients because if I didn't take good care of patients, I never could have written what I wrote. They would have killed me. They would have gotten rid of me or something. Those rumors persisted.

I was asked to be the speaker at some, I started to get asked to be a speaker at a medical school commencement by the students then I'd get a letter from the dean saying, "Oh, we decided to have a speaker from within the medical school this year." Meaning they didn't want me. So, people really didn't ... I heard a lot of stuff. Didn't bother me really because I had a ...

In fact one time I actually did two tours of Germany, book tours for the House of God and then for Misery, and the one question I remember in Hamburg, it was really wonderful event. Well, all of them they were packed. I had no idea people were really reading it. And the one question they asked at the end was really interesting because I had never been to Germany before even though I had been all over. And one of the students said, "How could you possibly, you know, given the hierarchy and the people above, how could you possibly write that? Weren't you scared?" It was very interesting. And I think the American medical system is hierarchical and vicious but I think the German is even more so. But that was the thing they ... It was nice for me to feel because they thought I was being brave but you know. I didn't feel particularly brave.

Franz:

One thing that would interest me because it sounds like the book is clearly autobiographical and you're a psychiatrist and ...

Shem:

Wait, wait, wait, wait, wait. I'm in recovery from being a psychiatrist. I haven't done it for 20 years.

Franz:

I'd like to hear your thoughts about ... It seems like these days journaling is becoming more and more popular again and it's clearly a way of clearing your mind and ordering your thoughts. How much was writing the book a journaling exercise in a way and how much of it was actually therapeutic to kind of like ... What are your thoughts on journaling in general? I know it's kind of like multifaceted question but yeah.

Shem:

Well, you're a multifaceted guy.

Franz:

Thanks.

Shem:

There's a big difference between- Is that me or you? I'm sorry. That's my phone. I've got a flip phone. Let me turn it off here. For various reasons I had been at Harvard but for various reason I got a call from NYU medical school about two or three years ago and they said, "Do you want to be a professor in medicine in medical humanities literature and bioethics?" So, I said, "Yes." And it's a great school. It's really amazing school. It's the best, kindest, and smartest medical school I've ever ... It puts Harvard to shame really. One of the things I got ...

So, I had been back on the wards and the system and there are two big problems with medicine now, huge problems with medicine now. One is particular to the states which is money. It's all about money. And doctors are way down the pole on that. But the other thing is screens. The electronic medical record, iPhones, iPads, and all that stuff is a huge problem in America.

I don't know if you know this but interns have shifts now where they have to have a 10 hour shift and then they have to leave the hospital. So in a 10 hour shift, I did a study. The minimum amount of time that an intern in a hospital is in front of a screen of some kind, guess what it would be. The minimum percentage.

Franz:

During a day?

Shem:

Yeah, that they're in front of a screen.

Franz:

I mean they probably have electronic patient records, right?

Shem:

Well, that's right.

Franz:

Yeah, so they must be in it for the largest part of the day, right? I don't know. Are they four hours minimum, like five hours? I don't know.

Shem:

Well, they're on a 12 hour shift, so four hours out of 12. A third.

Franz:

A twelve hour shift, okay.

Shem:

So it's 30% maybe. You know what it is? It's 80%. Some said 90 minimum, 80 minimum. So this is a huge problem. That's a whole other story. Maybe I'll write about it, we'll see. Okay, so I'm sorry I forgot your original question.

Franz:

So, it was all about how much was that a journaling exercise to write the book and how much was that therapeutic and did it help you? What are your thoughts about doing like journaling in general to clear your mind and write about problems and then kind of get rid of them?

Shem:

What I was gonna say there is a big difference between journaling and fiction. I am of the opinion that people have either fiction or nonfiction brains and I have a fiction brain and I don't like writing nonfiction but I love writing fiction. Journaling is a little bit in between because a journal is personal but you're also writing about your experience in medicine most of it, I think, is what you're talking about. And there's a huge movement in narrative medicinal that stuff. I think it's, sure, it's always useful. It's always useful. In fact, I've kept ... I've changed it from journals, well, I kept journals or notes. I still do. They're very different from what you do in fiction. I think it's a good idea.

I think that's one of the reason there's more writing about The House of God now because people are ... Almost every medical school around here has something about journaling. It certainly helps explore your self and all that in a way that is good.

Franz:

What does your writing process look like? From the moment you have a idea? Also, from a day to day basis, when do you write? When are you most prolific? Can you tell us a little bit about that?

Shem:

Yeah, sure. If anybody's interested in becoming a writer you just gotta try what works for yourself. I tried everything, you know? Of course metal ... As I said I'm 103. I have a regular process. I write in the mornings and what I used to do and this is why I chose psychiatry partly is because I could have the mornings to write. I wouldn't schedule patients till the afternoon. And that worked for twenty five years. I used to do that everyday.

I used to get up early and write and then get some exercise and then go in and see patients all afternoon and that just about washed me out to do whatever else I might want to do. That's the way and I've done that except I gave up seeing patients probably twenty years ago or something like that. So now it's a lot ... It was a lot easier because I wouldn't have to shift gears very much. It was very hard ... The newest novel which I'd like to talk about, just came out here is called At the Heart of the Universe and it's set entirely in China. So I'd be there, I'd be in China and then I gotta go see patients and clear my mind of that.

So I still do that. The nice thing now except for my NYU appointment where I have to commute to New York from Boston fairly often, one of the things I do ... They wanted me to teach The House of God which is really interesting. No other medical school is really ... The last thing Harvard would do.

Franz:

What do you mean by that? Teach The House of God?

Shem:

They called me up and said, "Do you want to be a professor?" And I said, "Yeah, what do I have to do?" They said, "Well, we want you to teach?" And I said, "What do you want me to teach? I don't know. I haven't taught in a while." Said, "Dummy, we want you teach The House of God." They want me to do that for med ... I have a first year seminar, a seminar that's open actually no the first year but a seminar, a six week seminar. Hour and a half session and we go through The House of God and mostly it's for, it's aimed toward medical students who are interested in humanities in addition but I get everybody.

The nice thing is like last year, this is the third year, I think or the fourth. Last year it had this wonderful mix which you never see in medicine really of first year medical students, and second year and then third and fourth years and even doctors came. You know, if there was enough room. It was absolutely wonderful. I had a funny experience because I had never taught The House of God in all these years. We're talking about like two years ago that I started or three at NYU.

I remember I said, "I don't know how to do this." And on the train down to New York, four hour trip. I'm cramming for the first session. I'm reading this book which I had not read for years and although I give a lot of lectures and stuff at medical schools and other places, I've never, I hadn't read it. And I'm reading this book and I'm saying, "Hey, this is a pretty good book. Who wrote this?" I had so many years that it kind of wasn't, I wasn't the writer. It was very interesting and the thing that is so wonderful which you addressed is it's absolutely important today as ever. The only difference ... You know, there are differences especially in the USA in medicine now, in it's training. It's all kind of easier and shift work and all that.

All of these kids and they're kids. You know, the first year of students are 23 year olds. They're sitting there with their mouths open and when we get to the part where Potts jumps off the roof, suicide, you know. Well, there are suicides in medical schools, a lot. You know, there are a lot of suicides in medical students. Well the thing they appreciate is I realized the situation was so bad that in order to write something that people would want to read it had to ride on humor. So the first part of the book especially, people are laughing a lot as we did and then it gets pretty dark.

They're laughing but the other thing that carries these students 35, 37 years later, the same feelings. The same feelings, the feeling of being scared. The feeling of having doubts. The feeling of horror. The feeling of losing your friends 'cause you don't have time. And Tolstoy who was the most remarkable novelist said something that I've always remembered, it's ... Because he spent 25 years trying to figure out what is art. He wrote a book, a little book. What Is Art? It's a terrible book. But he comes down to basically one sentence, it's something like, "Art," meaning writing too of course for him, "Is," yeah he was talking about writing. "Art is when having experienced something in a feeling way in the world, you transmit the feelings or you transmit in a feeling way to the reader and the reader has the same sense of feeling that you did." Which really is an empathic connection across and through the words.

This is why sort of new post modern fiction that often gets the noble prize is so unreadable and dry because there's been sort of campaign in literary circles against real feeling in fiction. In moving the writer, it's more about technique and stuff except for Bob Dylan. Except for Bob Dylan. What a wonderful thing, what a wonderful thing. That guy is, I mean, his lyrics are absolutely remarkable and you know, I grew up with him. You should look at ...

I was in Australia giving a bunch of talks for The House of God when that was announced in October and I was so happy about that because he was our person. He was our resistor in music to what was going on in the same way I felt that I have been a resistor in medicine. So he was very meaningful to me and there's a wonderful song. I went on Australian radio and I read the lyrics to a wonderful song called Up To Me which is not a very well known song and he basically said, "I was always too stubborn to ever be governed by enforced insanity. Somebody had to reach for the rising star, I guess it was up to me." And that just hit because that's what I tried to do. That's why I started to ask people to call me Shem instead of Bergman. So anyway that's long digression.

Franz:

Yeah, beautiful.

Shem:

You can edit it.

Franz:

Oh yeah, yeah, sure. I won't edit. It's precious. Your new book. It's tell us a little bit about it please.

Shem:

Yeah, I should just to encouragement to people who write. My writing pattern is what I do but seven drafts later it's a book and ironically enough Tolstoy had to write War and Peace seven times to get it done.

Franz:

Just to interject, the quality of a book. A lot of people are all about editing and what's the first version and what's the edited version and how often do you have to edit it to get it to the point and to the quality where you want it to be? So what's the role of editing versus the first epiphany and production?

Shem:

Yeah, well. Well, you know, you have to have a spark. As I said you have to have something, "Hey wait a second I gotta write about this." If it's a bright enough spark you have the first line usually. Like with The House of God, "Except for her sunglasses Barry is naked." And I knew I was gonna set that first chapter in France. I think I started it in France.

This is why no psychiatrist have ever written a good novel as far as I can tell. Because they're too obsessive, they're too analytic. Writing a novel really is a funny thing because it's a kind of a back and forth between the spark and this tremendous vision that you really can not ... I got depressed at one point and I decided I wasn't, you know, "Why am I writing? This is hard." I think after my second novel or something. And I got to the point where I write because I can't not. I love it. I can't not.

It's a balance between this incredible being in this remarkable, wonderful, and terrible situation you are inspired by and then shaping so it works for other people. So, The House of God, I think I worked ... There were seven drafts, all of my novels take about seven drafts even now, but ... Even after the sixth draft which I worked with this editor on was gonna be published. She said, "Okay, now you have to cut 50 pages out of it." What? You know. Believe it or not I did it. It was probably a 500 page manuscript so I'm cutting fair amount out.

It's this balance. You have to learn, it's fine to let, you have to learn to let yourself ... Well, I let myself go too much on The House of God because I knew nothing about writing a novel and I had a lot of work to do. I remember she had told me because she had bought it on only those message pages, about 40 pages or something. Then she came back to me after I started working on it and sent her a new bunch of pages, she said, "Okay." I'll never forget this, she said, "A novel is something where you bring characters through something important or difficult and they change." I had the characters all set and all that but I hadn't thought about bringing them through something that changes. That gets back to what I said. Change brings suffering and feelings and that's what I said about ...

Happens often in post modern novels now is the easiest thing to do in a novel is you start with somebody in a pretty good place and you tear him down or her down all the way through the book and they end dying or miserable, more miserable. I think it's hard to ... Each of my books because I'm sort of an optimist. I mean wouldn't be a doctor if I wasn't. Every book of mine has some sense of a lessening of suffering or even redemption or awareness at the end. That's the way I am. A lot of bad things may happen but something good is in there as an example of the purpose of living.

Franz:

Mm-hmm (affirmative). It's kind of like the hero's journey. Is that something that you?

Shem:

Yeah, hero, heroine.

Franz:

Yeah.

Shem:

Anybody's journey. You can trace every person in every book I've written. They don't stay still. I mean some of them don't do well as you know there are deaths and all that.

Franz:

Yeah, sure. Sure.

Shem:

That's part of the journey. One book that is, I don't know if you've read, I would strongly suggest called, it's sort of a book end to The House of God, it's called The Spirit of The Place.

Franz:

No, I haven't.

Shem:

It hadn't published much in Europe. It didn't get much attention except it won two best novel of the year awards in the United States which was nice. It's about a guy going back to his hometown to be a doctor with the old doctor who got him in to it in the first place. At the end of that book, the narrator, the doctor because this is a book about how you're a doctor in the community. One of the reviews said, "The House of God was about learning to be a doctor." This is a doctor about how you can be a doctor in your community which I think is an important topic.

At the end, he has an important choice to make, this guy, this young doctor. Middle aged doctor. He here's a kind of voice, it's not a crazy voice, it's just a spirit maybe or something how I like to think of it. And the voice says about this choice, it says, "Don't spread more suffering around. Whatever you do don't spread more suffering around." And then he makes the choice on that basis. That's a big part of what I've come to believe. How you do that.

And it gets back to the theme of isolation and connection because what we men often are taught when we suffer and the Buddha's first noble truth, of course is there is suffering. Big suffering, little suffering. Everybody suffers. The issue isn't the suffering, it's how we walk through it and if we try to stand tall and draw a line in the sand and walk through it alone, we're gonna suffer more and we're gonna spread more suffering around. If we walk through it with others, with caring others that's what we doctors are there for. That's our job. That's why we went into this. These remarkable moments in human suffering. If we walk through it with caring others we won't suffer as much and we won't spread as much suffering around.

Franz:

Yeah, that's so true. That's so true.

Shem:

And as the ... Yeah, go ahead.

Franz:

Because I want to be respectful of your time and ... Why don't we talk ... Why don't you give us a little bit of an intro of your newest book and then I would like to ask you a couple of rapid fire questions if that's okay.

Shem:

Yeah, sure. Sure as you know, I talk too much.

Franz:

No, it's very interesting.

Shem:

Yeah, the new novel is ... Well, once again it was one of those, "Hey, wait a second moments that I talked about." And this was a big one. This was a really big one. Maybe the biggest one. Janet and I adopted a baby, a four month old baby from China in 1992. She's wonderful. Her name is Katie and she's 25 now. What usually people suggest with Chinese adoptions and foreign adoptions is that you go back to China with the child when they're 10, teenage, whatever to give them some sense of where they came from.

So we did. We went back to China when she was 10. At first we toured all over the country then we went back to the city in which she was adopted from and what happens in Chinese adoption because of the one family, one child per family policy which is recently only been abolished. Almost all of the adopted children are China because boys are wanted and girls are not. What people know to do is they take, these women take their babies into, usually they're rural women from rural farms. They can't afford it. So they take the baby into this big city and there are places that are known that you can put the baby so they'll be found right away and then they're taken to a police station nearby. The police station is associated with an orphanage. That's where we got our baby when she was four months. She was left when she was a month old.

So we went back and one of the places we went back to was the police station. Wondered if there were any records. While we were there, we were standing in the courtyard, Janet and I, Katie was asleep in the van. Both Janet and I saw this woman walk across the courtyard who of all the thousands of faces we had seen in China previously on the trip, she really looked like Katie and she had the same kind of russet glow of her hair. Katie, and she seed quite elegant and she looked at us and then walked into the police station. Both of us independently said, "Did you see that woman?" "Yeah." And both of us said, "Hey, she looks just like Katie."

Then something else happened and we kind of lost track of her because we wanted to meet her. We were there with a guide who spoke English and a van driver because nobody speaks english. Then we couldn't find her when it was time to leave. This is how real it was. We got into the van. We said, "Try to find her. Let's ride around." We rode around for about 15, 20 minutes in all the alleys and stuff and streets. Didn't find her. But that was the, "Hey, wait a second," moment kernel of the novel.

I said, "Well, would it be possible to find the birth mother. Would it have been possible to find the birth mother?" So that's what the novel's about. It's a very simple novel set all in China. Quite autobiographical in some ways. Three Americans ... the Americans are not like us, well the daughter is sort of like our daughter. But these are rather waspy people, sort of white Anglo-Saxon protestants who are kind of stiff, all of that. They're not like us. He's an insurance salesman, etc.

It's a story about basically what happens after that. What happens next. It's sort of big adventure story where they do finally find the birth mother partly because of their wish and partly because of her determination. Things have not gone well in her life and there's this ... A lot of it is set up on this sacred mountain in the middle of China where she has become a recluse and has a job in a Buddhist monastery and stuff. Anyway, somebody called it, one of the critics called it, "Heart of darkness with a happy ending." It's a very, very nice kind of book.

Franz:

And what-

Shem:

Go ahead.

Franz:

What's the book you're most proud of?

Shem:

Well, let me just say I didn't even tell people the title of this. It's called At the Heart of the Universe. I should tell you. You should tell people this. I have a new website. I finally got somebody to do social media ... And actually it's kind of a treasure trove because she wanted me to write stuff for it. It's www.samuelshem.wordpress.com and actually if people are interested in ... It's mostly about At the Heart of the Universe, well not mostly but a lot of it's there. She got me to write for some reason, said, "People are interested in you as a writer." So I wrote I think 10 or 15 blogs on how to write and all that stuff. There's a lot of really interesting stuff on there now including videos.

Franz:

Nice, nice. We're gonna link to it in the show notes. Absolutely make sure to check it out.

Shem:

Have you looked at that website?

Franz:

Yeah, I have. I actually found it because you had the links to it at the end of your emails. I checked it out. It's absolutely, it's a treasure trove. Absolutely.

Shem:

Yeah, and there's a whole video on ... We launched the book in New York City in November. Janet, Katie, and I are on stage at this Broadway theater where we had our play Bill W. and Dr. Bob done for a year about the founding of Alcoholics Anonymous which is another treasure that actually doctors should know about. That's one of my other big things is alcoholism and it's treatment. But there's a really good video in three parts of me reading and us three answering questions. It's a wonderful thing.

Franz:

Yeah, amazing. So what book are you most proud of?

Shem:

The six of them or the eight of them. I don't know. That's a hard question. I think a writer ... You know I've been at this a long time. I think I have the satisfaction that on each book I've done the best that I can. Which do I which ...

Franz:

Which have you gifted the most?

Shem:

You mean given to people?

Franz:

Yeah.

Shem:

Well, I give it. That's not gonna get us anywhere because I give it ... I usually give the new book to people and people write me for The House of God. I don't know. I'm thrilled with ... I don't know if you knew and this is something wonderful, you might want to tell your listeners. You know, I've gotten so much recognition lately that it's kind of embarrassing. One of the things that happened was Publishers Weekly which is the major publishing magazine here in the Us and in the world, I guess, had a list of the 10 best satires of all time. And House of God was number two.

Franz:

Wow.

Shem:

Which is kind of interesting. So of course my first question is who's number one? And Don Quixote was number one. So my ego, of course, got all-

Franz:

That's impressive.

Shem:

Yeah, my ego got all inflamed and I said, "Well, what's so great about Don Quixote?" Catch 22 was number three.

Franz:

Oh wow. That's impressive.

Shem:

Yeah, it was lovely for someone who's been abused for the book.

Franz:

Can I ask you a couple of rapid fire questions because I know you are pressed on time?

Shem:

That's all right. Let's go ten more minutes, okay?

Franz:

Yeah, yeah. So what traits impress you the most in a physician?

Shem:

What traits, plural or what trait?

Franz:

Yeah, let's stick with one. What trait?

Shem:

It's not fair because you gotta ... I'll give you two. One is competence. You have to be competent. And the other is the ability to make good connection.

Franz:

What career related skill do you wish you had learned in medical school? Or skill in general?

Shem:

What skill in general?

Franz:

What other skill you wished you had learned in medical school or even later? Let's say medical school.

Shem:

Well, you know what. I don't think I have a wish because I think I learned what I really needed to learn while holding the establishment part of medicine at bay.

Franz:

Mm-hmm (affirmative)

Shem:

You know? I mean, [inaudible 00:46:16] so that I could learn what I needed to learn. I don't know what skill.

Franz:

That's a good answer. It's fine.

Shem:

Look, skills. The skills that I looking back wished I had learned and wished I could learn even better are what I said is how do you make ... How do you live your life from the central focus of relationships not self?

Franz:

THat's cool. What would your advice be to your 30 year old self?

Shem:

To my 30 year old self?

Franz:

Yeah.

Shem:

Don't drink so much.

Franz:

And what's the best piece of advice you've received from a mentor or whoever?

Shem:

The best piece of advice I have to tell a little story. Well, you've got time.

Franz:

I have time, yeah.

Shem:

Yeah, okay. So believe it or not I was at Oxford and my PHD thesis was going to be about the biochemical basis of learning and memory which boiled down to teaching cockroaches and grasshoppers how to lift their legs. I started to write then as well. I was getting more to really want to write and less to want to be a scientist. So, what I couldn't ... I had this wonderful supervisor there named Dr. Dennis Noble who's alive and well and kicking and just a wonderful writer. He's transforming the idea of the selfish gene to the gene that basically doesn't do anything unless it's regulated in a certain way by feedback from the environment IE. that Lamarck was right basically in a lot of ways. Which Darwin said of Lamarck.

Anyway Dennis Noble was my supervisor. A wonderful man. I was dear friends with him and after ... In the middle of my third year, I had to figure out a way to tell him I didn't really want to do anymore lab work. I made up the excuse really, I was a little sociopathic, I said to him, "Dennis, you know, I can't keep doing this work unless I have a computer." Well, this was 1969, there were no computers. There were things that were primitive computers. He said, "Well, I'll see what I can do."

Then I went off to one of these crazy road trips to Morocco. Driving from Oxford to the Sahara. Having all kinds of adventures. I came back and I really decided I was through, I wanted to be a writer. I walked up to the lab and there were boxes in front of my door. The computer had arrived. He'd actually gotten a computer. I had been gone six weeks.

So I said, "Oh shit. I gotta face this." So I went and bought two lamb chops and a bottle of wine, went over to his house, and knocked and stood there in the door with my djellaba, this hooded garment from Morocco and a beard and these lamb chops. He said, "Oh, come on in. Come in, come in." Very proper Englishman. And I said, "Dennis, I got to tell you something. I don't want to be a scientist. I want to be a writer." And my heart is in my throat and he said, "Well, then Bergman have a sherry." And he knew. We knew it wasn't right for me. He knew as well as I knew and he supported that. That's the advice I ever got. Have a sherry.

Franz:

Yeah, I think that's on your Wikipedia page also.

Shem:

It is.

Franz:

That story. Yeah.

Shem:

I know I've looked at it.

Franz:

Do you have a quote that you live by or think of often?

Shem:

Yeah, actually. As I've already said it. It's, "Don't spread more suffering around." When I think of being nasty, I say, "Well, you know. Don't spread it around."

Franz:

How has failure or apparent failure set you up for later success or another words do you have a favorite failure of yours?

Shem:

Yeah. I can only tell these in brief stories if you don't mind. And I can swear on this, right?

Franz:

Sure. Yeah, if you want. It's totally fine. We don't have kids listening, I think.

Shem:

Okay. My second novel Fine about a psychoanalyst. I was working with that same editor and she was really tough. She was a tough New York woman editor. She was known for how tough she was but she was good. She was the one who said, "People move through the experience and change." So I wrote about 50 pages toward the back of this novel and I sent it off to her and she was gonna call me on it. And she was so tough I said to Janet, my wife, "I'm really afraid of what she's gonna do to me. I don't know what to do when she calls. She's always so nasty." Janet being the psychologist that she is said, "Look, before she starts yelling at you say to her, you know Joyce I'm feeling a little vulnerable about what you might say and so could you please take it easy." Something like that.

So she calls and she starts and try to, "Okay, Joyce wait a second." And a voice like this, you know? A New Yorker voice. She says ... I said, "Joyce, you know I'm feeling a little vulnerable about this and ..." She interrupts me. And she says quote, "Well, fuck your vulnerability." And I just plummeted but said, "Well, fuck your vulnerability, dash dash. We've got work to do." And the interesting thing about that is the, "We," which has become the important thing for me. The we not the I. Not I or you but we. Not either or but and. Which is connection.

And she said, "We're gonna work on this together." And it was really a mess and it wasn't very right but the thing I learned from that is if you can find somebody who will help you, if you can ask for help, then you can move. I mean the only way you learn from failure. I mean that's what a rewrite is. Once again it's walking through the suffering of failure and realizing when you're a writer of novels, it's not about how great you are, it's about the situation you're in. You're really in it. I'm in that book. I'm in every book. I'm in with Roy when Potts jumps off the ... I feel it. You know? That kind of ... So that's yeah.

Franz:

Just last question. Who comes to mind when you think of the word success and why?

Shem:

Well, Janet and I have a Buddhist practice and actually Janet is a teacher. We wrote a book, the next to most recent book is called The Buddha's Wife: The Path of Awakening Together which somebody might want to read and one of our teachers, a woman named, first teacher actually of meditation and spiritual inquiry was a woman named Vimala Thakar was sort of in the tradition of Christian Ammority some people may know. But she was a first a social activist with the Gandhi Land gift movement where they gave land back to the peasants. And after being a social activist, she became ... She was really an enlightened person. She became a teacher and we used to ... We went to India. We went all over Europe to follow her. We hosted her here in America for retreats, meditation retreats. And she said something once that just came to mind, she gave a marvelous, marvelous lecture. It changed my life. On psychological suffering. What she said basically, she absolutely struck me because I had been on the American self achievement roller coaster towards success becoming someone like Donald Trump is success.

I was on that ladder and I was miserable. I was thinking of giving up writing and all of that stuff. I was very depressed and in one lecture she basically said, "The source of suffering, of psychological suffering is becoming as opposed to being." And that's right. You know, self as opposed to connection or relationship. And she said in one line that just came to mind is, "Success, " she said, "Failure in who's minds. In those who are turning our society's neurotic." It's perfect. It's perfect. And she also said something that has guided me really and it's related to this topic of success. She said over and over she would say, this is what she did. She said, "The purpose of life is to live. There is no other purpose than to live and to live is to be related and success and failure are things of the ego." You know, it's reflection on the self and America's the most self centered country in the world and I was very privileged in America and it took me many, many years to move out of that focus and become someone who values relationship more.

Franz:

Yeah, I think that's a great way to end this interview. Thanks so much. Any parting thoughts? Where can people find you so we already had the blog? Are you also on social media or Twitter or anything?

Shem:

Well, there is, I hate to say it but I don't do it. Because the same reason I don't have an iPhone. If I had an iPhone, I'd never write another novel. My life is so busy with a lot of different things that the biggest problem that's come up for me as a writer and I think this is a lesson for younger writers is that, the edgy, frantic distractions of our culture really make it hard to clear the way for what it takes to write fiction. I'm leaving tomorrow at the crack of dawn for a week. We have a house in Costa Rica. It's a marvelous country. One of the few countries that has not had an army since 1948. So they have healthcare and education and they can't go to war. Stuff like that.

Clearing a way that the business of life is important for anyone who want to ... And the other thing is, I haven't really talked about this explicitly in this interview and I'm embarrassed that I haven't which is for doctors one of the laws that I don't think I put in The House of God but is a law certainly is learn your trade in the world. The patient is never just the patient. The patient is the world and the world really needs doctors to be not just doctors but taking action in the world. Like I have always, always for years and years fought for national health system in America. Which is the only thing that works as you know. There are such big issues now that ... It's a good thing in the United States doctors are in the forefront like of climate change, of positions for social responsibility, anti-nuclear. Doctors have a lot of power and so that's the only other thing I would say to people. Use your power.

Franz:

So true. Thanks so much and that was real pleasure to talk to you.

Shem:

Okay.

• The House of God by Samuel Shem - Find it on Amazon
• Mount Misery by Samuel Shem - Find it on Amazon
• At The Heart Of The Universe by Samuel Shem - Find it on Amazon
• The Spirit of the Place by Samuel Shem - Find it on Amazon
• Heart of Darkness by Joseph Conrad - Find it on Amazon
• Samuel Shem's Website