by Samuel Shem
"But she's dead. Just look at her."
"Oh, she looks dead, sure. I'll give you that."
"She is dead. I called to her and felt for a pulse and listened for a heartbeat and looked for a breath. Nothing. Dead."
"With Anna, you need the reverse stethoscope technique. Watch."
The Fat Man took off his stethoscope, plugged the earpiece into Anna O.'s ears, and then, using the bell like a megaphone, shouted into it: "Cochlea come in, cochlea come in, do you read me, cochlea come . . :"
Suddenly the room exploded. Anna O. was rocketing up and down on the stretcher, shrieking at great pitch and intensity: ROODLE ROODLE ROOOOOO . . . DLE!
The Fat Man plucked his stethoscope from her ears, snatched my hand, and pulled me out of the room. The shrieks echoed through the E.W., and Howard, at the nursing station, stared at us. Seeing him, Fats yelled: "Cardiac arrest! Room 116!" and as Howard jumped up and came running, the Fat Man, laughing, pulled me into the elevator and punched the cafeteria button. Beaming, he said, "Repeat after me: GOMERS DON'T DIE."
"GOMERS DON'T DIE."
"You betcha. Let's eat."
Few things could have been more disgusting than watching the Fat Man shovel day?old blintzes into his mouth, talking all the time about things as different as the porno motif in Oz, the virtues of the foul food we were eating, and finally, when he and I were left alone, his prospects in what he still would refer to only as the Great American Medical Invention. I drifted off, and was soon with Berry on a June beach, filled with love's excitement, of possibility shared. Capability Brown. English landscapes. Eye within eye, sea salt on our caressing lips?
"Basch, cut it out. You stay there much longer, and when you come back to this shithole, you'll snap."
How had he known? What had they done to me, putting me with this madman?
"I'm not crazy," said Fats, "it's just that I spell out what every other doc feels, but most squash down and let eat away at their guts. Last year I lost weight. Me! So I said to myself, 'Not your gastric mucosa, Fats baby, not for what they're paying you. No ulcer for you.' And here I am." Sated, he mellowed, and went on, "Look, Roy, these gomers have a terrific talent: they teach us medicine. You and I are going down there and, with my help, Anna O. is going to teach you more useful medical procedures in one hour than you could learn from a fragile young patient in a 'week. LAW NUMBER SIX: THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A NUMBER?FOURTEEN NEEDLE AND A GOOD STRONG ARM. You learn on the gomers, so that when some young person comes into the House of God dying . . "
My heart skipped a beat.
". . . you know what to do, you do good, and you save them. That part of it's exciting. Wait'll you feel the thrill of sticking a needle blindly into a chest to make a diagnosis, to save someone young. I'm telling you, it's fantastic. Let's go."
We did. With the Fat Man's guidance, I learned how to tap a chest, tap a knee, put in lines, do an LP properly, and many other invasive procedures. He was right. As I got better with the needle, I began to feel good, more confident, and the possibility that I might become a competent doc glowed inside me. Fear began to leave me, and when I realized what was happening, I felt, deep inside, a blush, a rush, a thrill.
"All right," said Fats, "so much for diagnosis. Now, treatment. What do we do for her heart failure? How much Lasix?"
Who knew? BMS had taught me nothing about the empirics of treatment.
"LAW NUMBER SEVEN: AGE + BUN = LASIX DOSE."
This was nonsense. Although the BUN Blood Urea Nitrogen?was an indirect measure of heart failure, it was clear that Fats was playing another joke, and I said, "That equation is nonsense."
"Of course it is. And it works every time. Anna is ninety?five and her BUN is eighty. A hundred and seventy?five milligrams. Twenty?five to grow on, and it's an even two hundred. Do what you like, but she'll start to piss only when you get to two hundred. Oh, and remember, Basch, BUFF her chart. Litigation is nasty, so put a good shiny BUFF on Anna O's chart." "OK," I said, "but do I have to get her out of heart failure before I start her bowel run?"
"Bowel run? Are you nuts? She's not a private patient, she's your patient. There's no bowel run on her."
Feeling grateful, feeling glad that this medical wizard was with me, I said, "You know what you are, Fats?"
"What?"
"You're a great American."
"And with luck, soon a rich one. Bedtime for Fats. Remember, Roy, primum non nocere, and hasta la vista muthafucka."
Of course he was right. As I wrote up my admissions from the day, BUFFING the charts, I tried lower doses of Lasix on Anna, and nothing happened. I sat at the nursing station listening to the cooings of the gomers punctuated by the BLEEP BLEEP of the cardiac monitors. It had a soothing lullaby quality:
BLEEP BLEEP, FIX THE LUMP: BLEEP BLEEP, ROODLE ROODLE.
GO AVAY, ROODLE ROODLE: FIX THE LUMP, BLEEP BLEEP:
BLEEP BLEEP . . .
Les Brown and his gomer band of renown serenading me as I awaited Anna O.'s pee. At 175 she trickled, and at 200 she gushed. It was crazy. Nevertheless, seeing the urine, like a new father, my chest puffed with pride. I announced the event to Molly.
"Golly, Roy, that's terrific. You're going to get that nice old lady back on her feet. Great. Have a good night's sleep. I'll be here. We'll take care of things together. I've got a lot of confidence in you. Happy Fourth of July."
I looked at my watch. It was two A.M. on the magnificent Fourth. Feeling good, feeling proud and competent, I walked down the empty corridor to the on-call room. Power trip. I was in charge of all this. I felt a chill go through me, like the intern in the book. Far?out.
The bed was unmade, and I couldn't find any surgical pajamas and Levy the Lost BMS was snoring in the top bunk, but I was so tired, who cared? As I headed toward my dreams, listening to the BLEEP BLEEP, I mused on cardiac arrests, and as my mind covered all I knew about cardiac arrests, I was soon left with all I didn't know. I started to worry. I couldn't sleep, because any minute I might be called to an arrest, and what would I do? I felt a nudge, and there was Molly. She put a finger to her lips to signal silence. She sat on the bottom bunk and took off her white nursing shoes and pulled down her white pantyhose and bikini panties. She lifted the covers and said something about not wanting to get her uniform wrinkled and sat cross?legged on top of me. She unbuttoned her front and bent over and kissed me full on the, lips, and as I put my palm round her glassy ass her perfume?
There was a tap on my shoulder. Perfume. I turned my head toward the tap and found myself looking straight up into Molly's thighs as she squatted down to awaken me. Damn, it had been a dream, but this was not. It really was going to happen. She put her hand on my shoulder. Jesus, but wasn't she going to leap into the sack with me after all.
I was wrong. It was about a patient, one of Little Otto's cardiac cases. who refused to lie quietly in her restraints. Trying to hide the stiff screaming crowd living it up in my . white pants, I stumbled out into the corridor, blinking in the glare, and followed that pert bouncing ass to the patient's room. There was an explosion. We ran in to find the woman, having GONE TO GROUND, standing naked in the middle of her room, screaming obscenities at her own reflection in the mirror. She picked up an IV bottle, screamed, "There! There! That old woman in the mirror!" and hurled the bottle at her refection, smashing , the mirror to bits. When she saw me she knelt in the broken glass, grabbed my knees, and said, "Please, mister, please don't send me home." It was pathetic. She smelled stale. We tried to cool her off. We roped her back into restraints.
This was the first of a series of explosions, to mark the Fourth. When I called Little Otto to tell him that his patient was living it up, Otto exploded, accusing me of "worrying my patient with your inept attention. She's a nice woman and you must have upset her. Leave her alone." Next, the elevator door opened, and exploding out of yet another ring of Hell, out rolled Eat My Dust and his BMS, wheeling yet another human carcass to the far end of the hall. Th
is one was a bony mollusk of a man, with a red knobby protuberance popping out of his skull, sitting as rigid as a corpse, chanting:
RUGGALA RUGGALA RUGGALA RUGG,
RUGGALA RUGGALA RUGGALA GUGG . . .
"This is my fourth admission." said Eddie, "and it means that you're next up. You should see what they're cooking up in the E.W. now."
Next up? Inconceivable. I went back to bed, and I fell asleep, until my finger, celebrating the Fourth on its own, exploded in pain. I screamed at the top of my voice, bringing Levy down from the top bunk and Molly in from the ward, pushing those fun thighs into my puss.
"Something bit me!" I shrieked.
"Honest, Dr. Basch," said Levy, "I swear it wasn't me."
My finger started to swell. The pain was excruciating.
"I was going to call you anyway." said Molly. "There's another admission for you in the E.W."
"Oh, no. I can't stand another gomer tonight."
"Not a gomer. Fifty, and sick. He's a doctor himself."
Fighting panic,.I went to the E.W. I read the chart: Dr. Sanders. Fifty?one. Black. On the House of God Staff. Previous history of parotid and pituitary tumors with horrible complications. Came in this time with chest pain, increasing weight loss, lethargy; difficulty breathing. Should I call the Fat Man? No. I'd see him myself first. I walked into the room.
Dr. Sanders lay flat on the stretcher, a black man looking twenty years older than he was. He tried to shake my hand, but he was too weak. I took his hand and told him my name.
"Glad to have you as my doctor." he said.
Moved by his helplessness, his weak hand still lying trustfully in mine, I felt sad for him. "Tell me what happened."
He did. At first I was so nervous I could barely listen. Sensing this, he said, "Don't worry, you'll do all right. Just forget I'm a doctor. I'm putting myself in your hands. I was where you are once, right here, years ago. I was the first Negro intern in the House. They called us 'Nigroes' then."
Gradually, thinking of what the Fat Man had taught me, I began to feel more confident, more wide?awake, nervous, but excited. I liked this man. He was asking me to take care of him, and I would do my best. I went to work, and when the X ray showed fluid in the chest cavity, and I knew I'd better tap it to see what it was, I decided I'd page the Fat Man. Just as he arrived, I put together the findings and realized that the most likely diagnosis was malignancy. I got a sick feeling in my gut. The Fat Man, a jolly green blimp in his surgical pajamas, floated in, and with a few words with Dr. Sanders established a marvelous rapport. A warmth filled the room, a trust, a plea to help, a promise to try. It was what medicine might be. I tapped the chest. Since I'd practiced on Anna O., it was easy. The Fat Man was right: with the gomers you risked and learned, so when you had to perform, you did. And I realized that the reason the House Slurpers tolerated the Fat Man's bizarre ways was that he was a terrific doc. The mirror image of Putzel. I finished the tap, and Dr. Sanders, breathing more easily, said, "You be sure to tell me what the cytology of that fluid is, all right? No matter what it shows."
"Nothing will be definite for a few days," I said.
"Well, you tell me in a few days. If it's malignant, I've got to make some plans. I've got a brother in West Virginia; our father left us some land. I've been putting off a fishing trip with him much too long."
Outside the room; chills running up and down my spine as I thought of what might be in the test tubes of fluid in my pocket. I listened to the Fat Man ask, "Did you see his face?"
"What about it?"
"Remember it. It's the face of a dying man. Good night."
"Hey, wait. I figured it out?the reason they let you screw around the way you do is that you're good."
"Good? Nah, not just good. Very good. Even great. Night?night."
I wheeled Dr. Sanders back up to the ward and went back to bed just as the dawn was exploding the hot nasty night. The frenetic surgeons were just beginning their morning rounds, getting ready for a day of doing nice civic things like sewing people's hands back on people's arms, and the first shifts of Housekeeping were boogeying along in the House bowels. I pulled on my socks to go to the Fat Man's cardflip, and realized that I felt like socks: sweaty, stale, smelly, stiff, worn a day longer than I should have been. From the cardflip on, things began to melt, meld, and blur, and by lunchtime I?was so woozy that Chuck and Potts had to lead me through the cafeteria line to the table and the only thing I'd put on my tray was 'a big glass of iced coffee. I was so ataxic that when I tried to sit I banged my shin on the table leg, stumbled, and spilled the iced coffee all over my whites. It felt cool dripping through my crotch. It felt far off, somewhere else. That afternoon the Leggo was holding Chief's Rounds with our team. He came down the hallway wearing his usual butcher?length white coat with that long stethoscope wending its way across his chest and down and tucked into his pants, and he was whistling "Daisy, Daisy, give me your answer troooo." As he examined the patient, I had an urge to shove Levy into the Leggo so that both would tumble into bed with the gomer who was being saved at all costs, and I fantasized that "Leggo" was somehow cryptographic for "Let my gomers go," and I pictured the Leggo leading the gomers out of the peaceful land of death into the bondage of prolonged pitiful suffering life, legging it through the Sinai wolfing down the unleavened bread and singing "Daisy, Daisy, give me your answer troooo."
Chaos. The blur blurred. I didn't think I would make it through the day. The nurse came up to me and said that my only Italian patient, nicknamed Boom Boom, who had no cardiac disease, was having chest pain. 3 walked into the room, where the family of eight were chattering away in Italian. I took an EKG, which was normal, and then, a showman with an audience of eight, decided to use the Fat Man's reverse stethoscopoe technique. I plugged Boom Boom in, and yelled into the megaphone: "Cochlea come in! Cochlea come in! Do you read me, cochlea . . ." Boom Boom opened her eyes, shrieked, jumped, put her fist to her chest in the classic sign of cardiac pain, stopped breathing, and turned blue. I realized that I and eight Italians were witnessing a cardiac arrest. I thumped Boom Boom on the chest, which produced another shriek, signifying life. Trying to assure the family that this whole thing had been routine, I ushered them out and called an arrest code. The first to arrive was Housekeeping, for some reason carrying a bunch of lilies; next came a Pakistani anesthesiologist. With the ring of the Italian delegation in my ears, I felt like I was at the United Nations. Others arrived, but Boom Boom was now doing OK. Fats looked over the new EKG and said,
"Roy, this is the greatest day of this woman's life, 'cause she's finally had a bona fide heart attack"
I tried to pursuade the intensive?care resident to take her off my service, but taking one look and saying, "Are you for real?" he refused the TURF. Sheepishly, trying to avoid the family, I slunk down the hallway. The Fat Man pointed out a valuable House LAW, NUMBER EIGHT: THEY CAN ALWAYS HURT YOU MORE. I finished my work for the day, and, woozy, paged Potts, to sign out to him for the night. I asked him how it was going.
"Bad. Ina's on some kind of rampage, stealing shoes and pissing in them. I never should have given her the Valium."
"Yeah. To try to control her violence. Worked with the Runt, so I thought I'd try it on her. Made her worse."
Walking to the elevator with the Fat Man, I said, "You know, I think these gomers are trying to hurt me."
"Of course they are. They try to hurt everyone."
"What difference does that make? I never did anything to hurt them, and they're trying to hurt me."
"Exactly, that's modern medicine."
"You're crazy."
"You have to be crazy to do this."
"But if that's all there is, I can't take it. No way."
"Of course you can, Roy. Trash your illusions, and the world will beat a pathway to your door."
"And he was gone. I waited for Berry to pick me up outside the House. When she saw me, her face twisted in disgust.
"Roy! You're green! Phew! Stinky! Green
and stinky! What happened?"
"They got me."
"Got you?"
"Yeah. They killed me."
"Who did?"
"The gomers. But the Fat Man just told me that they hurt everybody and that's modern medicine so I don't know what to think anymore. He said to trash my illusions and the world would beat a pathway to my door."
"That sounds bizarre."
"That's what I said too, but now I'm not so sure."
"I could make you feel better," said Berry.
"Just tuck me in."
"What?"
"Just put me in my bed and tuck me in"
"But today's your birthday. We're going out to dinner, remember?"
"I forgot."
"Your own birthday and you forgot?"
"Yup. I'm green and stinky, and just tuck me in."
She tucked me in, and green and smelly as I was said she loved me all the same and I said I loved her too but it was a lie because they had destroyed something in me and it was some lush thing that had to do with love and I was asleep before she closed the door.
The phone went off, and out of it came two-part harmony: "Happy birthday to you, happy birthday to you, happy birthday dear Roy-oiy, happy birthday to you." My birthday, forgotten, then remembered, then forgotten again. My parents. My father said, "I hope that you're not too tired and it must be great to have patients of your very own at last," and I knew he thought modern medicine was the greatest invention since the high-speed dental drill, and as I hung up I thought of Dr. Sanders, who would die, and of the gomers, who would not, and I tried to figure out what was illusion and what was not. I had expected, just like in the How 1 Saved the World Without Dirtying My Whiter book, to have been rushing in and saving people at the last moments, and here I had been observing a wrecked Southerner being socked in the puss by a gomere wearing a ram-horned football helmet, all the time being told by a fat wizard who was a wonderful doc and also something phantasmagorical like either a madman or a genius that doing nothing except BUFFING and TURFING was the essence of the delivery of medical care. If there had been the feeling of power in the empty corridor at night and in the crowded elevator during the day, there had also been the awesome powerlessness in the face of the gomers and the helpless incurable young. Sure there had been the clean whites, and the clean white of Putzel's Continental, but the clean whites had gotten spewed with vomit and blood and piss and shit, and the dirty sheets had bred bugs that went right for the finger and the eye, and Putzel was a jerk. In months, Dr. Sanders would be dead. If I knew that I were to die in months, would. I spend my time like this? Nope. My mortal healthy body, my ridiculous diseased life. Waiting for the hard screaming line?drive ball, for the aneurysm straining in my brain stem to pop and squirt blood all over my cortex, draining it dry. And now there was no way out. I'd become a tern in the stinky tern in the green house in the House of God.