Notes on craft: Characters in a novel have to move


My first novel, The House of God, after being turned down by a number of publishers, was sold to one.  I had sent in 50 pages of first draft.  It was single spaced (I didn’t know you had to double space!), and covered with cigar pipe ashes, burns, rings of coffee, beers and scotches etc.

After working on it for a while with the editor, the great Joyce Engelson who was in the running for “toughest editor in the world,” told me I wasn’t writing a novel.

“How do I write a novel?” I asked.

“These characters are great, but they don’t move.

“What does that mean?”

“A good novel is where characters move through an experience and change.”

I never forgot that.  It is at the core of what I believe we novelists do.


The bad news is that it’s hard to do well—without copping out into melodrama (more of that later).  The good news is that when you do this, you really create something fine.

Except for crap writing to make money, and a current literary trend to work as hard as you can  to make sure nothing much happens, and totally nothing changes in character, all good novels all do this.

Characters in a novel have to move



In writing change/movement, the easiest thing is to start with a character, and then destroy him or her.  It’s easy to destroy, there are a million ways to bring people down. It’s hard to write fully-rounded characters, and then take them through often hellish experiences, and then bring them through better. (without melodrama).

Deep down I believe there is hope, that going through suffering—especially with others—can bring understanding, awareness, and even awakening.


In my new novel, At the Heart of the Universe, I do this.  As one person told me: “It’s Heart of Darkness with a happy ending.  (Conrad’s novella, and Marquez’ Of Love and Other Demons, are favorites of mine, textbooks of the perfect novellas).

At the Heart of the Universe started in a real incident in China when we went back with our 10-year-old adopted daughter to the orphanage and police station where she was abandoned as a  baby. The four main characters—the three American adopted family members and the bio—the Chinese birth mom—don’t meet for the first half of the novel.  They all are going through hard times and changes, and the writing of all of them went well.

Halfway through the book I came to a dilemma: the four meet in the midst of the wild Mount Emei, one of the four sacred mountains of China, where we had been.  But Clio, Pep, and Katie, the Americans, only knew maybe three words of Chinese, and Xiao Lu, the Chinese birth mom, knew no English.  The only others on the mountain were a small group of Buddhist monks and nuns.

How in the world was I going to write the second half of the novel?

And then, letting it brew, something else happened.  I myself didn’t find the answer of how they spoke to each other, something else came in that was real, and right, and kept them moving through the experience, down to a horrific place, and then through it to a happy ending.

So in order to do the right hard thing in a novel, you need some outside help. The self, the I can’t think it, or plan it, or read it in a book or look on a screen for it.

If you are truly in it, in the reality you have started to create, and which the characters are moving through, eventually they will move on their own, and you will just have to write it down.  It is, in the words of Wallace Stevens, “a thing beyond us, yet ourselves.”  It is whatever each of us calls the spirit.

That’s the joy of writing novels, that’s the great feeling I have of getting it right, right to the heart, of At the Heart of the Universe.



Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.


It might just cure the world


 An Excerpt from “Lust in Medicine”:

Finally, a grand and good medical and personal lust, simply because it expands from self-centeredness to our patients and to others—i.e., it is not self-serving.  This urge includes that of having children, described in my new novel, At the Heart of the Universe, set in China, about adopting our daughter at four months of age, and then returning to China with her when she was ten—and the amazing things that happened to make it a novel.  A love poem to our love, our daughter.

The urge is broad enough to encompass the world of patients, and maybe even the world. The expense of spirit is for the sake of inspiring, and is an investment, not a debt.  I recently heard a story about a woman doctor working in a leper hospital in Asia.  A doctor friend came to visit her, and seeing the conditions and the hardship, said to her, “I couldn’t do what you do for a million dollars!”

She replied, “Neither could I.”  One of the greatest things about the newer generation of doctors is this lust for making the world better—it’s astonishing what they have done before they get to med school, during med school, and what they go on to do after.

If that’s lust, give us more!  Selfless lust for doing good?  Saintly lust?  It might just cure the world.

Image: Caroline Gamon


Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.



I’ve been away all week at a 50th reunion of Rhodes Scholars in Oxford England, and time is tight, and I don’t feel too serious, so how about some fun: 5 LAWS OF THE NOVELIST. Like the arcane process of film developing in a darkroom tray, they have appeared, and are offered as a guide to those so inclined. Adapted from The Boston Globe.

 1.) Don’t Believe Teachers:

The son of a dentist, I always wanted to be a writer.  At college I worked like hell on the first essay of the freshman writing course, and got it back with one comment, in red letters, “See me.” Her feedback: “This is too terrible to mark, it’s below F.”  Devastated, I tried again, and again, and always: “See me.  Still below F.”  Later that year I was on the golf team with a blond Adonis named Ray.  He said he was getting  straight A’s.  Ray was a great golfer, but could barely talk, much less write.  “What, you an A?”  “Yeah.  I’ve been sleeping with her all year.” Could this be the meaning of “See me”?”   I didn’t believe her, and kept on.

 2.) Editors Are Ephemeral and Don’t Edit:

The editor of my first novel moved to another publishing house for my second.  In the middle of my third, at another publishing house, she was fired, and my new editor, after sending me terrific edits, was fired the next day.  The editor on my fourth novel, at still another publishing house, said, “I love this novel.  I won’t change a word.” But when I got the manuscript back she had marked it up with so much red pencil that each page was pink. We struggled.  I took few of her suggestions.  In our final conversation she said, “You’ve ruined this book.  It will get bad reviews”—and then she was fired.

As one editor told me: “We no longer edit, we acquire and market.”

 3.) Publishers Don’t Publish:

When my first novel was about to come out, I asked my publisher if it would sell.  “No, your novel won’t sell.”  This startled me.  “It’s about medicine, and that’s good, and it’s funny and sexy, and that’s good.”  Why won’t it sell? “Because it’s a good book.  Good books don’t sell.”  Bookstores can return any book for a full refund, a business model that spells doom for publishing. Only about 5% of books pay back their advance. Those hardcover remainders piled up in stores mean that the publishers overpaid, overprinted, and undersold.

 4.) There Is No Humiliation Beneath Which a Writer Cannot Go:

My second novel had come out in paperback, and my wife and I were on a hiking trip in New Hampshire. We stopped in a mom-and-pop store for lunch.  There, in a spindle book-rack, were two copies of my novel.  I immediately suspected my wife had placed them there, to make me feel good.  Nope.  I took both books out of the rack and went up to the little old lady at the counter, and announced, “I wrote this book.”  “Oh, You wrote that book!”  I averred yes.  I asked if she would like me to sign the copies.  “Oh no, our folks would never buy a book that was writ in.”  Another standard humiliation: at an author signing in a bookstore, sitting at a desk in the window, facing a wall of Grishams, watching people hurrying past as if you are an escaped convict. Not fun, especially if your publisher has overlooked advertising the event.

  5.) There Is Only One Reason To Write:

During a post-second-novel depression, I spent six months, more or less, in the bathtub, trying to give up being a writer. Finally I realized that while I disliked publishing, I still loved writing.  But if you want to respect what you write (rather than write for cash), you need a day job. Luckily, decades previously I faced a choice: between Vietnam or Harvard Med.  I became a psychiatrist because I might learn about character and story, and could leave mornings free to write. Not as good a day job as my first, working the graveyard shift as a toll collector on the Rip Van Winkle Bridge—you can learn pretty much everything from what goes on at night in cars—but still.

 Only write if you can’t not


Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.

Gratitude every day for our good fortune: The story of a family


Having battled infertility—the expert medical diagnosis was “we don’t know why, except that you’re older”—when in 1991 China opened up for adoption, we felt it was right.  The cultural pressure in China, with the one-child-per-family policy, valued sons.   Virtually all the babies abandoned for adoption were girls.  In 2015 China rescinded this policy, and the window of adoption, except for special needs children, closed.  That twenty-five-year opportunity for adoption had profound effects in both countries: in China, the families’ suffering, the skewed population of boys, the “Little Emperors”, with concomitant problems; in the USA, 120,000 adopted girls, with concomitant joy, and the building of bridges with Chinese culture.

China required that eight adoptive couples at a time go to the orphanage in Changsha, together.  Back home, Janet and I asked several of our friends to be “Godmothers”. Soon Janet organized a “Women’s Welcoming Ritual,” with fifty women and one man, me: song, prayer, testimony, tears of joy—and a good deal of talk about the “birth mother,” or, in the lingo, “the bio”.  At home we bought a 21-year candle, and on each of our daughter’s birthdays we would sit together in the meditation room of our house, light the candle, and I would read our story out loud, the last part of which was to remember the birth mother, sure that she was remembering her baby on that day as well.

In the nine years that we had been adopted parents, I don’t recall hearing much about “the birth-dad.” Was there a mention at the first ritual?  Or from the adoption agency, or at our yearly reunions of China 2?   Rare.  One day in the car with four-year-old Katie in the back seat,  she asked ‘The Big Adoption  Question’: “Mom, in the story-book dad reads on my birthday it says a daddy plants a seed  in another mummy’s tummy and I came from her, not you right?”  Janet and I stiffened, and she explained it, carefully, delicately.  Pause.  “Mom?”  “Yes.”  “Can I have French Fries for dinner.

For sure there were mentions of “birth-dad” in our Families of Children from China organization.  All of us did try to include him, yes.  But he just didn’t have the same punch as the mom, it didn’t seem to land, and sink in.

Why not?  Maybe it’s merely a symptom of women being more valued than men as caretakers, builders of community and continuity, relationships?  Or seeing the “birth-dad” as part of the oppressive governmental policy?  Or we men, as “non-bio dads,” feeling lesser, imagining the much younger birth-dad being easily fertile, a robust perhaps poor farmer.  A caring man, yes, but who, sensibly, could not afford a girl as first child, needing a boy—not only to work the farm or in the city, but to marry, bring home a girl to provide grandchildren and help with old age.  If the first child is a girl, and he and his wife want the historical-cultural Chinese ideal of one girl and one boy, would he risk the financial ruin if the second child is again a girl?  A huge sacrifice.

The birth mom is always present our minds.  Her “oppression” and suffering, her core loss, is immense, as described in a recent study and book by the China scholar Kay Johnson.

But on this day let’s think of the birth dad.  Let’s imagine that his suffering and core loss is immense as well—not the same, but just as bad.  Let’s imagine that at his daughter’s birth, and the one whole month he and his wife nursed and nurtured this gorgeous little baby, tormented by the choice of whether to keep her or abandon her to another mother—and dad—that he too was sad and mad at the system and maybe felt it as severely as his wife but, being a man, crunched it down to “do the right thing” for the family. Let’s imagine his heartbreak as he puts his young wife on the train with their baby to go to the immense city and find a busy market down an alley and, hiding her baby under her dress, go to a vegetable stall and quickly part the celery and put her dear one in it and run away and turn and watch as the woman vegetable-seller discovers her and picks her up and cries out: “Whose baby?  Whose baby?” and she, staring, puts her fist in her mouth so she won’t scream “Mine!” and runs away?

Janet, Katie, and I are allies with both of them, mother and father, and with all the other “bios” who entrusted us “adoptives” with their children.  Both are invisible, except in our daughter, and in our imagination, awareness, and sense of gratitude every day for our good fortune.  But today I am with him especially, and fatherly—for he is of an age that our bio son would have been.  Today, let’s remember him.  Happy Father’s Day, birth-dad.

Note: Our trip back to China when our daughter was ten is the basis for the new novel, set in China: At the Heart of the Universe.


Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.


Best-selling author Samuel Shem will discuss his latest novel, At The Heart of the Universe


Best-selling author Samuel Shem will discuss his latest novel, At The Heart of the Universe (Seven Stories Press), from 7 to 8:45 p.m.  on Nov. 14 at the SoHo Playhouse, New York City. Joining Shem for this deeply personal evening of story-telling and dialogue with the audience will be his wife, the author Janet Surrey, and their daughter, Katie Surrey Bergman.

Together, the family will share their own experiences about adoption from China, which led Shem to write At the Heart of the Universe. The book, set in 1991, is the story of two mothers and a father in love with the same daughter. It is an epic novel set deep in rural China, against the backdrop of an ancient mountain monastery, and under the cloud of Mao’s one-child policy.

The moderator for the evening will be Adam Pertman, one of our country’s leading experts on adoption. Pertman is President of the National Center on Adoption and Permanency and author of the seminal book Adoption Nation, among other publications. He has received numerous awards for his work, and his frequent interviews in the media include appearances on Oprah and Nightline.

Samuel Shem is the pen name of Dr. Stephen Bergman, Professor of Medical Humanities at NYU Medical School, and author of the classic medical novel The House of God, which recently was named #2 on Publishers Weekly’s list of “Best Satires of All Time.” He and Janet Surrey co-wrote The Buddha’s Wife and We Have to Talk, as well as the Off Broadway play Bill W and Dr. Bob.


The SoHo Playhouse: 14 Vandam Street. New York, NY 10013

For more information, please contact Soho Playhouse at 212-691-1555 or

For further information about the book and/or to arrange an interview with Samuel Shem, please contact Ruth Weiner,

Follow Samuel Shem on Facebook, and read about his upcoming events here.

The coming together of American and Chinese cultures


Advance Praise for At The Heart of the Universe:


“A fascinating, very moving novel—I couldn’t put it down. An imaginative and truly creative exploration of the amazing ways that adoption affects the many people touched by it. It should be read by all Chinese adopted families—and will be read by most of them—and anyone intrigued by the coming together of American and Chinese cultures. If I saw it in a bookstore I would pick up right away, no question.”

At the Heart of the Universe:

Set in 1991 in Changsha, capital of Hunan province, where a Chinese daughter is given up; then, again in Changsha ten years later, when the same daughter returns with her adopted American parents; then roaming across southern China until, high atop Emei San, one of only four Chinese “sacred mountains” that still has an active Buddhist monastery, something happens that does not reverse—but fundamentally changes—the irrevocable losses that have accumulated in these lives.


Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.

Spring comes early to the gardens: #HeartoftheUniverse



Spring comes early to the gardens

Of the South, with dancing flowers.


The willow leaves are long

And really are curved like a girl’s eyebrow.

–Ou Yang Hsiu, “Green Jade Plum Trees in Spring.”

Song Dynasty, 10-12th century


Sleep comes fitfully to her now. It is her hellish time of year. Her first thought upon awakening? Five days ago was Chun’s tenth birthday and in less than a month it will be the tenth anniversary of taking her to Changsha and abandoning her.

Dawn is a relief. Her favorite time of day. The first sunlight  hits the tops of the high white spruce and transforms to a russet glow. Clearing the eastern peaks, the dawn pours down through the tree trunks on a million splinters of hazy light. The forest is still, crisp, the air metallic, like the taste of a cold metal coin.

To read more, click here.


Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.



Notes on Craft (4): POV & Tense


Point of view

In a novel, you have a grand choice in choosing a point of view, or several points of view, or even no points of view (which will default in the reader to the view by the name of the author on the book). For me, this is sometimes easy, sometimes hard.  You can  have a third-person omniscient narrator, who knows everything and tells some things, or you can have partially omniscient, which I’ve done in a couple of novels, who is inside he heads of selected main characters—I did this happily with my novel The Spirit of the Place, being in the heads of only the two people who fell in love, and out of love, and then…(read the book)!


Present or past (I don’t do future, although future fantasy and sci fi is a big seller).

Two examples:

1.) At the Heart of the Universe

POV:  Set in China, I knew that it would be centered around the experience of four main characters: the Chinese birth mom, Xiao Lu, and the three adopted parents, Clio, Pep and their daughter Katie.  It was clear that the POV would be me the writer, telling the story, but we would be in each of those four heads.  Warning: this is quite difficult to do—if you want lessons, read Tolstoy, who was the expert (in War and Peace, he’s even inside the head of a dog).  Some writers including Faulkner make it easy, sometimes (As I lay Dying) having separate chapters when each person talks or thinks.  

The hard one is when you have all four of these people in a scene—which I do a lot in this novel—and have to make the narrator’s voice and each individual voice transition clearly and easily. I probably could not have done this until I’d written my six previous novels—and experimented a lot.  But, getting it wrong, and then revising until its right, is fun. Nobody ever gets it right the first time.  Tolstoy revised War and Peace seven times!

TENSE: This is a matter of feel.  I fiddled with past, and it didn’t seem to work.  I tried present tense, and it did.  Sometimes, depending on what you’re writing, present tense does not seem as immediate as past—which is strange.  In this case, when I tried present. it totally worked—everything came alive. But for a long novel, to do present tense, and in the heads of major characters is a challenging job.

So let’s look at what, for many writers, including me, was the least challenging job for POV and Tense, and why a lot of first novels are written in this mode:

author and his typewriter

Nobody gets it right the first time!

2.) The House of God

POV:  Since it was my novelization of my year of medical internship, one iteration from real, it had to be an “I” narrative.

TENSE:  It starts in present tense, from France after the year ends. The rest is in the past tense, except coming back to the present tense in France, to end.


Like all the things I’ve written so far, you just have to live with what you’re writing, holding your vision no matter what—hunger, thirst, fever, sweat– from time to time if you notice her (for me it’s a her) YOUR CRITIC sitting on your shoulder telling you this is shit, and you better not let go of your day job, and you take your dominant hand and smash her in the face and she explodes in gaseous cloud and is gone— until POV and TENSE and all the rest of your vision, that day at least, becomes clear.


Follow Samuel Shem on Goodreads and Facebook

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.


Raw and Utterly Honest: Reviews from Goodreads


Steven  C. on At The Heart of the Universe

A big change from the author’s first book, The House of God which was a Swiftian send-up of the pretensions and puffery of graduate medical education, a fierce confrontation with the narcissistic injury. It was funnier than Swift, BTW, and supplied an entire argot of interns. This book is much more mellow, wiser, kinder. It is from the heart.

Patrick H. on House of God:

I read this in college, then again my first year of medical school, then again my last year of medical school, then again during my internship, and I’m reading it once more now as a senior resident. Along with the television show Scrubs, it’s the most accurate portrayal of American medicine that I’m familiar with. I gave it to my father and he called me saying that he wanted to go medical school. I gave it to my mother and she called me crying, asking if my job really is as bad as Shem makes it out to be.

Ivan C. on Mount Misery:

Fans of The House Of God should not expect the same kind of hilarious exuberance from the author in this sequel; there is too much real human pain and suffering here. But this novel feels more mature and is much more likely to stay with readers, I think. (It has been a decade since I read this book and I’m STILL affected by it.)

Rosemary B. on The House of God:

I thoroughly enjoyed the beginning of the novel, cherishing (and identifying with) the interns’ horrors at their introduction to hospital wards and the stereotypes of their patients and the care they receive. The descriptions of the emotions that an overburdened, under supported intern can feel are things I can imagine or have experienced in some way. These depictions were raw and utterly honest.

Follow Samuel Shem on Goodreads!

And please join us @ the book launch for At the Heart of the Universe:

Samuel Shem in conversation with Adam Pertman, Adoption Nationand with Katie Surrey-Bergman and Janet Surrey. At Soho Playhouse, 14 Vandam Street, NYC. November 14, Monday at from 7 to 8:45.  Free.


“House of God” in New York Times: Still a seminal, groundbreaking satire on medicine


Howard Markel  writes for The New York Times:

“It was a raunchy, troubling and hilarious novel that turned into a cult phenomenon devoured by a legion of medical students, interns, residents and doctors. It introduced characters like “Fat Man” — the all-knowing but crude senior resident — and medical slang like Gomer, for Get Out of My Emergency Room.

Called The House of God, the book was drawn from real life, and 30 years after its initial publication, it is still part of the medical conversation.

SHEM631-1Written by a psychiatrist, Stephen Bergman, under the pseudonym Samuel Shem, M.D., the novel is based on his grueling, often dehumanizing experiences as an intern at Harvard Medical School’s Beth Israel Hospital in 1974. More than two million copies have been sold, and the book has been continuously in print since its 1978 publication. A recent edition (Delta Trade Paperbacks, 2003) features an introduction by John Updike, who ranks the book alongside Joseph Heller’s famed military satire, “Catch-22.”

Over the years, it has served as a required guidebook for medical neophytes and a clarion call for the old guard to make striking changes in the way we train young physicians.

When the novel first appeared, many doctors were hesitant to admit they had heard of it, let alone were willing to discuss it. Several prominent physicians denigrated it as scandalous and without merit. And based on such scabrous reviews, hundreds of thousands of medical students eagerly read it, first laughing at how the protagonist, Dr. Roy Basch, and his fellow interns survive a year of being on call every third night and working 100-plus-hour weeks, and then shuddering when thinking about their coming internships.

“I got a lot of flak for this book,” Dr. Bergman recalled in a telephone interview. “Older doctors attacked it and me, students would ask me to speak and deans would cancel me.”

Stories of doctors learning the ropes have been a theme in American popular culture for decades.

What makes “The House of God” singularly compelling is its brutally honest portrayal of the absurd tragedies and occasional triumphs of hospital life; the once-common abuse of young physicians by their superiors; and the anger and frustration these interns directed at themselves and patients.”

Click here for the whole article