The house of God

by Samuel Shem

  It still wasn't clear how Jo's orthodox medical approach would work on those who the Fat Man had said could die, the non-gomers, the young. As the sweaty green and smelly summer months wore us out, as America frolicked in the news given it by a smalltime White House bureaucrat named Butterfield who revealed that Nixon had gotten so excited about being President that he'd installed a tape system to record every single immortal presidential word, which?immortal words he was trying like hell via some ruse called "executive privilege" to keep from Sirica and Cox, Chuck and I gave ourselves up, during the day, to Jo's fanaticism about the dying young, letting her show us how to do everything to these non-gomertose patients, always. During the day we'd slog along with her, using her as a live textbook, and also, since she found it impossible to let us do things on our own, by feigning incompetence, using her to do anything distasteful, like disimpactions. I'd told Chuck and Potts about the Fat Man's analysis of Jo, and so at first we held ourselves in check, walking around her as if she were a fragile house of cards. We hid our contempt of her from her, and Chuck and I hid our doing nothing on the gomers from her. I slogged through the long, dull, duplicitous days with Jo, keeping Fats alive inside me until, every third night, he and I were together again on call. Remembering his saying about himself, "I spell out what every other doc feels, but most squash down and let eat away at their guts." I studied Jo to detect the symptoms of her ulcer, and studied the Fish for his big ulcer and the Leggo for his giant ulcer. Looming more and more clearly so as almost to be touchable, with me was always that comforting fat presence, just past the edges of my sight.

  While I had Fats, and Chuck had himself?which seemed, given his having endured worse than the gomers, to have been enough?Potts didn't have much, and was having a helluva time. Having been burned by not telling Fats about the liver functions of the Yellow Man, Potts was reluctant to hide data from Jo. Jo was always on call with Potts, and so every night for Potts was the same as every day, with Jo niggling at him to "feed the cat," to do everything for all forty?five patients, always. Even if he'd wanted to try doing nothing on a gomer or two, Potts would not have been able to conceal it, for Jo, in her inability to trust anyone else, more or less took over Potts's service, running it for him. Like an overeager BMS trying to make an A, Jo would stay up the whole night writing obscure referenced discussions of the "fascinating cases" in the charts, each BLEEP and shriek and nurse's question echoing off the lonely tile walls making Jo feel real full and needed as she never felt full and needed outside the House of God.

  And so Potts was in rough shape. Thanks to Jo's aggressive treatment of the gomers, they got worse and never got TURFED, and the dying young took longer to die, and Potts's service swelled, so that out of the forty?five patients, he had twenty?five. Jo's increasing his work meant that on his nights on call he didn't sleep, and that he had to work harder and longer to stay afloat during the days. While Chuck and I, often being off duty the same night, got to be better and better friends, Potts never could do things with us outside the House, and he became more and more quiet and withdrawn. His wife, titillated on the rack of her surgical internship at Man's Best Hospital, MBH, where she was on call at least every other night, had virtually disappeared from his life. We watched Potts sink, and the deeper he sank, the more out of our reach he became. His dog began to pine.

  During a late?August thunderstorm, the Yellow Man began to scream, and from the look on Potts's face when he heard the screams, it was as if his own liver was screaming in pain and affront. Coincidentally, another liver disease had presented itself to Potts: Lazarus was a middle?aged janitor who'd had the bad sense and good fortune to hold night jobs all his life, which allowed him to sit and destroy his liver with cheap booze. Lazarus' liver disease was not classy, it was just the standard sure?death brand of cirrhosis seen sucking the end of bottles wrapped in paper bags on every street corner of the world. Lazarus was going to die and was trying hard to do so. Jo and Potts stood in his way. Their efforts began on the plane of the heroic, and soon became, even in the House of God, legendary. From time to time Chuck and I would try to make Potts feel better about Lazarus, talking about how sad it was that he had cirrhosis and was dying.

  "Yeah," said Potts, "the fuckin' liver gets me every time."

  "Why don't you just let him die?" I asked.

  "Jo says he's gonna make it."

  "Make what, man, a new liver?" asked Chuck.

  "Jo says I have to go all?out on him, do everything."

  "Is that what you want to do?" I asked.

  "No. There's no cure for cirrhosis, and besides, I'll tell you something: Lazarus told me, the last time he was conscious, that he wanted to be dead. He was in so much agony he begged me to let him die. That last bleed from his esophagus where he was drowning in his own blood, scared him to death. I want to just let him die, but I'm afraid to tell that to Jo."

  "Man, you heard her. She wants to hear our complaints."

  "That's right," said Potts, "she did say 'any complaints, out in the open.' I'm going to tell her about not keeping him alive."

  Thinking that Jo would bring up the Yellow Man, I said, "Don't tell her. She'll blast you to bits."

  "She wants to hear," said Potts, "she said she wanted to hear."

  "She doesn't want to hear," I said. "No way."

  "I want to hear 'em," Jo had said, "out in the open, got it?"

  "She wants to hear 'em, she said she did," said Potts.

  "She doesn't. You tell her, and she'll blast you to bits."

  Potts told her that he didn't think that she was asking him to do the right thing by keeping Lazarus alive, and Jo blasted him to bits. As an example of Potts's failings, Jo cited the Yellow Man.

  7

  Having been pushed around for five steaming weeks with Jo, Chuck and I had learned a lot. One of our main skills was how to put a terrific BUFF on any chart to satisfy Jo, who could thus satisfy the Fish, who could thus satisfy the Leggo, who could thus satisfy whomever he had to satisfy. In addition, Chuck and I had learned to hide what we were actually doing with the gomers from Jo, since what we were actually doing was doing nothing, more intensely than any other terns in the House. Time and again, reading about our prodigious efforts on the gomers in their charts and then seeing how well the actual gomers were doing, Jo would turn to Chuck and me with pride and say, "Good job. By God, that's a damn good job. I told you that the Fat Man was nuts about patient care, didn't I?"

  Without realizing it, Chuck and I were hanging ourselves. On our rounds with Jo, our charts looked so terrifically BUFFED that when Jo on her rounds with 'the Fish displayed them to him, and when the Fish on his rounds with the Leggo displayed them to him, all were amazed. This was it: the delivery of medical care. These footnotes! These cures! And so the Leggo decided that Chuck and I should be rewarded.

  "How will they be rewarded?" the Fish asked the Leggo.

  "We'll give them the greatest reward any intern could wish," said the Leggo. "When I was an intern, we used to fight to get the toughest cases, to show our Chief what we could do. That will be their reward, to let them show me what they can do. We'll give them the toughies. Tell them that."

  "We'll give them the toughies," said the Fish to Jo.

  "They're giving you the toughies," said Jo to us.

  "The toughies?" I asked. "What are they?"

  "The toughest admissions to the House."

  "What? Why?"

  "Yeah, man, what all did we do wrong?"

  "That's just it," said Jo, "Nothing. It's the Leggo's way of saying thanks, to challenge you with the toughies. I think it's great. You should see the cases we're going to get now."

  Soon we saw the cases we were going to get then. They were the worst. They were the House of God disasters, mostly young men and women with horrible diseases just past cure and just our side of death, diseases with rotting names like leukemia, melanoma, hepatoma, lymphoma, carcinoma, and all the other horrendomas for which there was no cure in this world
or in any other. And so Chuck and I hung ourselves, and created, in 6?South, the toughest ward in the House. Without realizing it, without choosing it, and in fact choosing the opposite at every turn, we had to learn to handle the worst disease the House could dish up. We sweated and we cursed and we hated it, but we used each other?him using me for the facts and the numbers and me using him for the nuts and bolts?and we risked, and we learned. Given the increasing concentration of the dying young, the number of bowel runs for headache decreased, and the traffic in gomers went down, with Rokitansky getting sent back to his nursing home and Sophie getting driven back to her house in Putzel's Continental. Ina and Anna, the residua of our mistakenly aggressive approach, were still on the ward, slowly returning to their cradling dementia. Dr. Sanders turned out to have Hodgkin's disease, advanced and incurable, and had been started on chemotherapy and sent home to arrange his last fishing trip with his brother in West Virginia. The Yellow Man lay in his bed, flat and still, as withered as the first yellowing leaf of the fall.

  When Chuck and I found out how much we each loved basketball, we began playing every chance we got.Two out of every three nights Chuck and I would be off call together, and we'd help each other finish our work, evade Jo, sign out to Potts, shove our black bags into our lockers and take out our jointly owned regulation basketball and our black low?cut sneakers, which, as we laced them, sent hot memories of the times before the big games racing through us, change into our green surgical scrub suits, jog down the corridor of the House and out into the street with that "school's out!" feeling that we'd known for a quarter of a century. At the public playground, if it was just the two of us we'd go oneon?one, caught up in that electric moment of making the slick move that would fake your best friend out of his jock. At times, in pickup games, we'd play on the same team, and we'd have that thrill of playing together with just the right blend of dazzle and unselfishness, playing against a strange mixture of strabismic Jewish BMSs and tough ghetto kids, running and yelling and breathing hard and worrying about chest pain meaning heart attack, throwing sharp elbows and playing dirty under the boards and getting into all?out screaming arguments with fifteen?year?olds about disputed calls, the elbows in fact thrown at Jo and the Fish and the Leggo and the deaths and diseases and wasted healthy moments spent cooped up in the House of Gad. Afterward we'd go to bars or to Chuck's apartment, which looked, with its garish furniture, like a TV commercial, and we'd sit and drink bourbon and beer and watch the ballgame or, with the tube sound off and stereo playing Chicago soul, watch a movie. We began to understand each other. Turned into ten?year?olds by the pressures of the House, we became friends as only ten?year?olds can, and one day something happened that made me realize what I'd always suspected: my new friend's studied indifference was only and all an act.

  Chuck and I found ourselves in a basketball game with some BMSs who thought they were hot?shit ballplayers. With the same kind of ferocious competitiveness that had gotten them into the BMS, these guys started to play rough?hand?checking, fouling, calling us for the slightest foul and disputing calls?as if they were making an A in surgery if they won. Chuck's opponent was the worst, the kind of kid whose arrogance had oozed through the umbilical cord and breast and had always been the part of him that his mother loved, the kind of kid whom everybody hated and who played for the fans and not for the game, even when there weren't any fans to play for. Every time Chuck had the ball, this kid would foul, him, and every shot the kid took, he'd call a foul on Chuck. Despite the fact that Chuck was taking a beating, he never called a foul. Finally, on one outrageous call that even had his own team telling the wiseass to "jest play ball, Ernie, all right?" Ernie said to Chuck, "Hey if you didn't foul me, why don't you say so?" and all Chuck said was, "Fine, fine, let's play," and he handed over the ball.

  Something in that "Fine, fine" was ominous, and from then on Chuck began to play. He'd stay outside and bomb for hoops, and he'd take Ernie inside and overpower him despite the fouls, and he'd fake the shot from outside and slip past, and he'd fake the drive and stop and pop, and as he did all this, scoring point after point, wise Ernie got madder and madder and fouled more and more, but it had about as much effect as a fly on a racehorse. It became a ballet of strength and smarts and finesse. The game turned into a one-on?one, played out in a raging intense silence. Chuck made a fool of Ernie until finally somebody said it had gotten too dark to see the rim. Chuck asked Ernie for our ball, and Ernie threw it into some bushes. A hush fell. I wanted to smash Ernie in the teeth. Chuck said, "Well, Roy, I guess I better go get our ball, now that we won this game," and, smiling, arms around each other's sweaty shoulders, proud of winning, we left.

  Later, drinking with him, I said, "Damn, you are some ballplayer. Did you play in college?"

  "Yup. Small College All?American, my senior year. First team."

  "Well, I found you out," I said. "Your indifference is all an act. You care about everything you do:"

  "'Course it is, man, 'course I care."

  "Well, why do you pretend that you don't?"

  "On the street, it's the only way to be. If'n you let on what you are and who you are and what you got and how someone can use you, you get yourself used worse. Like Potts with Jo. I may be painin', man, but nobody's gonna know it. Being cool is the only way of stayin' alive."

  "Amazing. Where I come from, it's just the opposite?you keep showing your pain so that people will lay off you. What do you think about that?"

  "What do I think? I think, fine, man, fine."

  On those rare days when Potts came out to play ball, it was embarrassing. He was clumsy and shy, scared of hurting someone and scared of standing out. Open for a shot, he'd pass. In a dispute, the other guy was right. He rarely yelled. As the maples began to do their reddening, as the touch?football games sprouted on the browning fields and as the dawn dew got more and more chill, Potts got worse and worse. Left out of Chuck's and my lives, left for weeks on end by his wife, worried about his golden retriever's growing whine, hounded by the Yellow Man and by 70, Potts became scared of taking any risks. Since the only way to learn medicine was to take risks in those hard times when you were alone with your patient, Potts had trouble learning. Ashamed and afraid, in the computer rotation handed us on our first day. Potts moved on to his next assignment and left our ward.

  His replacement was the Runt. On the day of his arrival, Chuck and I were sitting at the nursing station, our feet up, drinking ginger ale from large House ice buckets. Knowing how nervous he would be, Chuck and I had filled a syringe with Valium and taped it under his name on the blackboard, with a prescription: "to be injected into right buttock upon arrival" The blackboard was the standard way that the House Privates communicated with the terns about their patients. Under my name was an insignia:

  ***

  *** MVI ***

  ***

  This cryptic insignia had begun to appear throughout the House. It was always the same, always only associated with my name, and no one knew who was writing it. Recently it had become known that it stood for Most Valuable Intern. The rumor was that there was a competition among the interns, sponsored by the Fish and the Leggo, for this award, the ***MVI***. Since this insignia was associated only with my name, people began to address me as "the ***MVI***" and often I was greeted with "here comes the ***MVI***." I asked the Fish whether I really was the front?runner for the ***MVI***. He said he hadn't known there was an award. I told him that I'd heard the Leggo say that there was an award and that it was "part of the special tradition of the House." I then asked the Leggo, who said he hadn't known there was an award, and I told him that I'd heard the Fish say that there was and that it was "part of the special tradition of the House." I began to protest to the Fish that I didn't enjoy having my name plastered with ***MVI*** all over the House, and the Fish said he'd get House Security on the case, and for the past few days I'd glimpsed a bouncer dressed in fake West Point peering out from a corner, hoping to catch whoever was putting up ***MVI*** unde
r my name.

  And yet the ones most irritated by the ***MVI*** were the Privates, and of the Privates the most irritated of all was Little Otto Kreinberg, the Private whose name still rang no bell in Stockholm. Since Otto wouldn't talk to the terns, and since the blackboard was the only way of communicating with the terns, and since the ***MVI*** left no room for communication, it drove Little Otto wild. As Chuck and I sat, we watched Otto march in, curse, erase the ***MVI***, write a note to me, and depart. Almost as soon as he was gone, when the bouncer's back was turned, there appeared under my name on the blackboard:

  ***

  *** MVI ***

  ***

  As the insignias continued to multiply, gnomes like Otto spent a greater and greater amount of time manning the erasers. And when the erasers disappeared, Little Otto got big in anger. As Otto got angrier, I got more and more angry with the Fish and the Leggo, protesting the abuse of my name. With my protests, they employed more and more bouncers to peer around more and more corners, and with all this attention given to the award, the other terns began to protest to the Fish and the Leggo that Basch, who spent so much time sitting with low?cut black?sneakered feet up drinking ginger ale, could not possibly be the front?runner for the ***MVI***, which award may not have existed at all, ever, anywhere, except on the blackboards of the House.

  "Hombre?"

  "Hey, hey, Hazel," said Chuck. "Come on in, gurl."

  Hazel from Housekeeping stood in the doorway. I'd seen her pushing mops and emptying trash, but I'd never seen her look like this: she wore tight white tights and a green uniform stretched tautly over her chest so that the buttons were tugging at the fabric, which parted to reveal enticing bits of black breast in white bra. Her face was marvelous: ruby?red lipstick on black lip, light?brown afro on head, mascara, eye shadow, false lashes, and a carnival of bangles. Her tongue lay like a cushion on the couch of her mouth. Her teeth were moonstones.