The house of God

by Samuel Shem

  ROY G. BASCH, M.D. OUTPATIENT CLINIC, HOUSE OF GOD.

  Bolstered by pride, pretending to know what I was doing, I waded through my first Clinic. Too poor to afford a House Private, Clinic patients would turn out to be of two types: fifty?two?year?old husbandless black mothers with high blood pressure, and seventy?two year?old husbandless Jewish LOLs in NAD with high blood pressure. I would hardly ever see a male, and to see someone below the age of fifty?two, except for "mental disturbance" or venereal disease, would be publishable. My first very own patient was a LOL in NAD in need of a checkup and a prescription for a new artificial breast and padded bra with fillable pockets. Who knew how to write a prescription? Not me. She wrote it, I signed it, and, grateful, she left. Next was a Portuguese woman who wanted me to do something about her corns. Who knew about corns? I toyed with the idea of writing her a prescription for an artificial foot and a padded shoe with finable socks, but then I remembered the Fat Man and TURFED her to Podiatry. The next LOL in NAD was seventy?five, Jewish, and came in with her upper eyelids, Scotchtaped to her forehead. Reading her old chart, I found out that this was a case of "drooping lids of unknown etiology" and that her previous Clinic tern had TURFED her to Ophthalmology, where the resident had told her to "tape them up or I operate" and she'd chosen the tape and had been TURFED back to Medicine. This was a BOUNCE.

  "Oh, I love meeting all you nice young doctors," she said.

  "How long have you had this tape on your lids?"

  "Eight years. How much longer do I have to wear it?"

  "What happens if you take it off?"

  "My eyelids fall down."

  I wrote her a prescription for more tape. She grasped my hand and began to chatter about how glad she was to have me as her doctor. It was hard for me to listen because her taped?up lids made her eyes bulge out like a monster of the deep, and the only thing that stopped her life story from pouring out was that the nurse brought in my next patient, the last of the afternoon. This was a hypertensive black woman of fiftyfour named Mae, with no chief complaint except "my joints hurt when I play basketball with my kids" and a request for a pelvic exam. When she was up in the stirrups Mae started spouting Jehovah's Witness gospel, and after she got dressed, chattering all the while a mixture of religion, family history, and history of her previous terns at the House Clinic, she spewed out some Witness pamphlets and left. These women loved coining to the doctor. I walked into Chuck's office and found him with a LOL in NAD too. He was doing something I'd never seen done before in medicine, something with a tape measure and a breast.

  "Well, you see, man, this lady says her breast is growing."

  "Just one of them?"

  "Right. So I thought I'd better measure and see if it gets any bigger in the next two weeks."

  Back on the ward, I felt grand. I was excited, thrilled at being a doctor. Having been a red?hot in my academic career, there was no reason not to be a House red?hot too. Hadn't the Pearl himself, earlier in the day, congratulated me on the way I'd cleaned out his patient for the bowel run? Feeling Dr. Kildarish, I sat in the warm sunlight of the nursing station. Looking into the room across the hallway, I saw Molly, perky transparent Molly, bending over the bed, fiddling with the sheet. She kept her legs straight, so her miniskirt rode up her thighs, and with a final reach over to the far side of the bed, she hiked the hem up over her ass, showering me with the rainbow?and?flower pattern of her little?girl panties, snug against the firm full gluteal folds that formed an awning over the juicy female thing that grew up there. I could feel a half?chub mumbling and squirming in my whites.

  "That's the straight bendover." It was the Fat Man. He sat down beside me, unrolling the Journal.

  "Huh?"

  "That nursing maneuver, where they bend from the waist and flash their ass. Called the Straight Bendover Nursing Maneuver. Learn it in nursing school. What are you going to do about TURFING Sophie? She's settling in, and I'm warning you, she's really getting Putzeled this time. She could be here for months."

  "Putzeled?"

  "Bob Putzel, her Private, remember? He uses the standard method: admit the LOL in NAD, do a test, produce a complication, do another test to diagnose the complication, get another complication, and so on until they're gomertose and non?TURFABLE. Do you want that nice LOL in NAD to become an Ina Goober? Nip it in the bud. Do something now. You gotta get her to leave."

  "How?"

  "Do a painful procedure. She doesn't like painful procedures."

  "I can't think of anything that's indicated."

  "Oh. Well, she has a headache, and her noon temp is a degree high. No matter that it's almost a hundred Fahrenheit up here and all the temps are a degree high, no matter, 'cause the chart is BUFFED with a recorded noon temp a degree high. Oh, and she has a stiff neck too. So: headache, fever, stiff neck; diagnosis?"

  "Meningitis."

  "Procedure?"

  "Lumbar puncture, LP. But she doesn't really have meningitis."

  "She might. If you don't LP her, you might miss it, like Potts missed with Mellow Yellow. And don't worry about hurting Sophie, she's tough. A Gray Panther. Get Molly to help." Looking in the paper, Fats mumbled, "The Dow Jones is up, baby, up. Good. Good climate for the Invention now, for sure."

  "For what?"

  "The Invention, the Invention! The Great American Medical Invention!"

  With the Dow Jones rising up over America's colorful ass, how could I not enjoy doing an LP on Sophie? Molly had never before assisted at an LP and was glad to help. Together we walked into Sophie's room. Levy the Lost, my BMS, was sitting on Sophie's bed Putzeling her hand, "taking a history." He was still at the beginning, asking her "What brought you to the hospital?"

  "What brought me? Dr. Putzel, in his white Continental."

  I stopped Levy, and instructed Molly in how to hold Sophie curled up in a fetal position on her side, exposing her back to me. As Molly bent down over Sophie, grabbing her behind the knees and neck, arms spread apart like Christ on the Cross, I noticed that the two top buttons of her ruffled blouse were undone, and I was staring into an enticing cleft between Molly's breasts, bubbling up out of lacy bra cups. She noticed me noticing, and said, smiling, "Go ahead." How bizarre, ' the contrast between these two women. I had an urge to slip my penis into Molly's cleft. Potts popped his head in, and asked us if we knew where a Bible could be found.

  "A Bible? What on earth for?" asked Molly.

  "For pronouncing a patient dead," said Potts, vanishing again.

  I tried to recall how to do an LP. At BMS I had been particularly bad at these, and to do an LP on an old person was more difficult, for the ligaments in between the vertebrae are calcified, like guano on an old rock. And then there was the fat. Fat is death to a tern. All the anatomical landmarks get obliterated in fat, and as I tried to locate Sophie's midline, with my ill?fitting rubber gloves and the rolling fat, it was impossible. I thought I had it, and as I put the needle in, Sophie screamed and leaped, and as I advanced the needle further, she yelped and leaped again. Molly's hair came loose, a blond cascade over Sophie's old and sweaty torso. Every time I looked into Molly's cleavage I got aroused, and every time Levy said something I got mad and wanted to slug him, and every time I advanced the needle Sophie leaped up in pain. I began to sweat. I tried another spot on Sophie's fat back. No luck. Another. Nothing. I noticed that blood was coming out of the spinal needle, so I knew it wasn't where it was supposed to be. Where was it? Lubricated by the sweat, my glasses fell off and contaminated the sterile field. Molly let go at the same time, Sophie uncoiled and looked like she was about to GO TO GROUND from just below the Orthopedic Height but we caught her in time. Embarrassed, my cockiness splattered in sweat all over Sophie, I told Levy to stop smirking and get the Fat Man. Fats came in, in two shakes had Molly expose herself and Sophie's porcine back, and, humming a TV commercial that sounded like "I Wish I were an Oscar Weiner weiner," with a smooth and effortless Sam Snead stroke sliced through the fat and popped into the subarach
noid space. I was amazed at his virtuosity. We watched the clear spinal fluid drip out. Fats took me aside, and like a coach put his arm around my shoulders and whispered:

  "You were way off the midline. You hit either kidney or gut. Pray kidney, 'cause if it's gut, it's Infection City, and she may suffer the ultimate TURF, to Pathology."

  "Pathology?"

  "The morgue. No BOUNCE. But I think it worked. Listen."

  "I WANT TO GO HOME I WANT TO GO HOME I WANT TO . . ."

  I began to feel scared that I had started an infection that would send Sophie home for good. As if in confirmation, from the next bed, behind the curtain, Potts was dealing with his first death. His patient, the young father who'd dropped on the first?base line the day before, had died. Potts had been called to pronounce the patient dead, as required by law. We peeked through the curtain: Potts was standing at the foot of the bed, his BMS beside him holding a Bible, on which rested Potts's hand. His other hand was raised toward the body, which was lying there as white as a corpse, which was what it was. As we watched, Potts intoned:

  "By the power vested in me by this great state and nation I hereby pronounce you, Elliot Reginald Needleman, dead."

  Molly, snuggling up to me so that her left breast brushed my arm, asked, "Is that really necessary?" and I said I didn't know, and I asked Fats, who said, "Of course not. The only federal regulation is that you take the two pennies out of your loafers and put them over the dead man's eyes."

  Potts, decimated, sat with us at the nursing station. Slurring his words, his eyes bloodshot, he said, "He's dead. Maybe I shoulda shipped him to surgery sooner. I shoulda done something. But I was so tired when he came in, I couldn't even think."

  "You did all you could," I said. "He popped an aneurysm, nothing would have helped. The surgeons refused to operate."

  "Yeah, they said it was too late. If I had moved faster, maybe?"

  "Enough of that," said the Fat Man. "Potts, you listen to me. There's a LAW you've gotta learn, LAW NUMBER FOUR: THE PATIENT IS THE ONE WITH THE DISEASE. Understand?"

  Before he had a chance to understand, we were interrupted by the Chief Resident, the Fish. He had a concerned look on his face. It turned out that both Needleman and the Yellow Man were not Private patients, but House patients, and the Fish was partially responsible.

  "Liver disease is a special interest of mine," said the Fish, "I've recently had the opportunity to review the world literature on fulminant necrotic hepatitis. Why, the case of Lazlow would make a very interesting research project. Perhaps the House Staff would wish at some point to undertake such a project?"

  No one said he wanted to undertake such a project.

  "However, both the Leggo and I feel, Dr. Potts, that you waited too long without giving steroids. Do you understand?"

  Stabbed, Potts said, "Yes, you're right. I understand."

  "I'm on my way to an impromptu colloquium on Lazlow. We've brought in the Australian, the world's expert on this disease. It does not look good. You waited too long. Oh, and one more thing," said the Fish, looking at Chuck's dirty whites and unbuttoned shirt without a tie, "the way you dress, Chuck. Not professional. Not enough for the House. Clean whites here, and a tie. Understand?"

  "Fine, fine," said Chuck.

  "And you, Roy," said the Fish, pointing to the cigarette I'd just lit up, "enjoy that, because it will prove to be three minutes off your life."

  I saw red. The Fish slid off down the corridor to the colloquium. A morbid silence coated us. The Fat Man broke it, spitting out, "Jerk! Now, just remember this, Potts, if you want to end up like that jerk, you'll believe him. If not, you'll listen to me: THE PATIENT IS THE ONE WITH THE DISEASE."

  "Are you really going to dress better?" I asked Chuck.

  "'Course not, man, 'course not. In Memphis, we don't even wear neckties to funerals. Man, these gomers are sumpthin' else. None of my four admissions so far believes I'm really their doctor. They all think am the hep."

  "Hep?"

  "H?e?1?p. Hep. The colored hep. See you later."

  Staring out the window, Potts muttered to himself something about how he should have given the Yellow Man the roids, but the Fat Man stopped him, saying, "Potts, go home."

  "Home? Charleston? You know, right now my brother?he's in construction?he's probably lying out in a hammock on Pawley's Island, sipping a fizz. Or maybe upcountry, where it's all green and cool. I never should have left. The Fish is right in what he said, but if this was the South, he never would have said it. Not like that. My mother has a word for him: 'common.' Guess I made my choice, though, didn't I? Well, I will go home. Thank God Otis is at home."

  "Where's your wife?"

  "She's on call tonight at the MBH. It'll be just Otis and me. That's just fine, 'cause he loves me, too. He'll be lying there on the bed with his balls up in the air, snoring. It'll be good to go home to him. See you tomorrow."

  We watched Potts stumble on down the hallway. He came to the colloquium, outside the room containing the Yellow Man. Without looking in, as if ashamed, Potts slunk past them and out the door.

  "This is crazy," I said to the Fat Man, "this internship is nothing like what I thought it would be. What do we do for these patients anyway? They either die or we BUFF and TURF them to some other part of the House."

  "That's not crazy, that's modern medicine."

  "I don't believe it. Not yet." "Of course you don't. You'd be crazy to. It's only

  your second day. Wait till tomorrow, when you and

  me are on call together. Well, I'm going home. Pray

  for the Dow Jones, Basch, pray the fucker stays on up"

  Who cared?

  I finished my work and walked down the corridor toward the elevator. The crowd around the Australian expert was breaking up, and out of it rolled the Runt. He looked a lot worse. I asked him what was going on, and he said, "The Australian said we should do an exchange transfusion, where you take all the old blood out and replace it with new."

  "That never works. The blood still has to go through the liver, and there is no liver. He's going to die."

  "Yeah, that's what they all said too, but since he's young and was walking around yesterday, they think it's worth a try. They said I had to do it, tonight, and I'm scared stiff."

  Screams came from the room. The Yellow Man was flopping up and down on the bed like a hooked tuna, screaming. A member of Housekeeping ambled up, pushing two huge carts laden with linen, gowns, operating?room garb, and large polyethylene bags labeled "Danger?Contaminated." The head nurse told the Runt that the blood would be ready in half an hour and that there was only one nurse to assist, since the others were scared of sticking themselves with a needle and catching the fatal disease. They refused to work in the room. The Runt and I watched the nurse walk away, and watched Housekeeping, whistling, disappear into the down elevator. The Runt looked up at me with terror in his eyes; and then put his head on my shoulder and cried. I didn't know what to do. I would have volunteered to help, but I was scared of catching whatever bad thing it was that had you walking around chatting up the Tit one day and convulsing like a hooked tuna the next.

  "Do one thing for me," said the Runt. "If I die, take the money in my trust fund and donate it to the BMS. Make a prize for the member of the class, who first realizes the insanity of this business and drops out to do something else."

  I helped him on with his sterile operating?room garb, his gloves, face mask, hat. Like an astronaut, he launched himself with an awkward shuffle into the room, up to the bed, and started the procedure. The bags of fresh blood began to arrive. With a lump in my throat I walked out, down the corridor. The cries, smells, bizarre sights riddled my head like bullets in a nightmare war. Even though I hadn't touched the Yellow Man, I went to the bathroom and gave myself a long surgical scrub. I felt terrible. I liked the Runt, and he was going to poke himself with a contaminated needle, catch this liver?ripping hepatitis, turn yellow, flip like a gaffed fish, and die. And for what?

&
nbsp; As if in a tankful of water, I listened to Berry while I read my father's latest letter:

  . . By now you must be in the middle of your work and it will settle down to a routine. I know that there is so much to learn and you will be immersed in it. Medicine is a great profession and it is a wonderful thing to be able to heal the sick. I played eighteen on Saturday in the heat and it was made bearable by a gallon of iced tea and a birdie on number . . .

  Unlike my father, Berry was not as interested in preserving an illusion of medicine as she was in understanding my experience. She asked me what it had been like, and although I tried to tell her, I realized that it had not been like anything, and I could not.

  "But what made it so hard? The fatigue?"

  "Nope. I think what made it hard was the gomers and the Fat Man."

  "Tell me about it, love"

  I told her how I couldn't decide whether or not what the Fat Man taught about medicine was crazy. The more I saw, the more sense the Fat Man made. I had begun to think I was crazy for thinking he was crazy. As an example, I told Berry about the gomers and about how we'd laughed at Ina in her Rams helmet socking Potts with her purse.

  "Calling old people gomers sounds like a defense."

  "Gomers aren't just old people. The Fat Man says he loves old people and I believe him, because he gets tears in his eyes when he talks about his grandmother and her matzoh balls that you eat sitting on ladders scraping them off the ceiling."

  "Laughing at this Ina is sick."

  "It does seem sick right now, but it didn't then."

  "Why did you laugh at her?"

  "I don't know. It was hilarious at the time."

  "I'd like to understand. Try again."

  "Nope. I can't."

  "Try to snap out of it, Roy, please?"

  "No! I don't want to think about it anymore."