The house of God

by Samuel Shem

  "He's all right," the Runt had said, looking away.

  "Wait a sec," I'd said, "did you tag his belly or not?"

  "Nope."

  "Jesus Christ! Why the hell not?"

  "I never learned how. You need to use a big needle and I . . . I was scared I'd hurt him."

  Limp. Cursing, I went into Lazarus' room, where he was dying again in earnest, and since I'd been in this situation with him every other night on call, I knew what to do, and got busy raising him up yet again:

  Molly came up and said I had a phone call. It was the Runt.

  "How's Mrs. Risenshein?" he asked.

  "Fine, but Lazarus just started to go down the tubes," I said, telling myself I won't yell at him for not having tapped his belly.

  "I should have tapped his belly:"

  "Where are you?"

  "Chinatown. But how's Lazarus?"

  "What did you have?"

  "Lo mein, moo goo gai pan, and a lotta rice, but how is he?"

  "Sounds delicious, he went down the tubes," I said. "Oh, no! I'm coming in!"

  "But I saved him."

  "Hey, great!"

  "Hang on," I said, watching Molly gesture from Lazarus' room, "he's trying to go down the tubes again."

  "I'm coming in!"

  "What are you doing after dinner?"

  "I thought I'd take her back to my place."

  "What? With June there, are you nuts?"

  "Why not?"

  "Never mind. I gotta go, but listen, whatever you do, do not take her back to your place. Go to her place. Remember: FAKE HIGH, GO LOW. So long:"

  For some reason, admission diagnoses in the House of God ran in spurts: three cardiac, two renal, four pulmonary. That hot and dismal night, the disease matched the oppression?it was cancer night at the House. First it was a little tailor named Saul. As I read his chart in the E.W., Howard?the tern who seemed to love every aspect of the ternship and whom I hated for that?bubbling with excitement at "really being a doc," told me that Saul had pneumonia. The blood smear told me that Saul had acute leukemia, his pneumonia being part of his generalized sepsis because his white cells didn't work. Saul knew he was sick, although he didn't know yet how sick, and when I wheeled him to X-Ray for his chest film, I asked him if he could stand up by himself.

  "Stand up? I could peech a full game," said Saul, and fell down. I propped him up, this little bony just-young?enough?to?die old man, whom I'd just told he had leukemia. As I left him to himself in front of the X?ray beam, his boxer shorts fell down.

  "Saul," I said, "you're losing your shorts."

  "Yeh. So? Here I'm losing my life, and you tell me I'm losing my shorts?"

  I was moved. He was all of our grandfathers. With the laconic resignation of a Diasporic Jew he was watching the latest Nazi?leukemia?force him from his only real home, his life. Leukemia was the epitome of my helplessness, for the treatment was to bomb the bone marrow with cell poisons called cytotoxins until it looked, under the microscope, like Hiroshima, all black, empty, and scorched. And then you waited to see whether the marrow regenerated any healthy cells, or the same old cancer. Since there was a period of time when there were no blood cells?no whites to fight infection and no reds to carry oxygen and no platelets to stop bleeding?to deliver care was to fight: the infection and transfuse red cells for oxygen ands platelets to control bleeding, all the time creating more bleeding and anemia by drawing blood for countless' tests. Terrific. I'd gone through it with Dr. Sanders,: and I hated it. The start of this horrific treatment was to inject modified rat poison, nicknamed the Red Death for its color and the way it eroded your skin if you splashed it around; directly into Saul's veins. Thinking "so long, marrow," I did so, brimming with disgust.

  The second E.W. admission: Jimmy the name, cancer the game. Young enough to die for sure. Howard, smiling, chubby, smoking his chubby pipe like a TV doc, presented the case to me: pneumonia, and Howard thought he might have leukemia. One look at Jimmy's chest X Ray showed that Howie had missed a homungus lung cancer that would kill Jimmy pretty quick. As I worked on him in the E.W., trying to shoo away the hovering Howie, I heard Hooper battling a gomere behind the next curtain. The gomere, his third admission of the night, was trying to kick him in the nuts. I asked Hooper how it was going.

  "Terrible. MOR, Roy, MOR."

  "MOR?"

  "Marriage On Rocks. We're both doing everything we can?joined a California?style sauna where they whip you with hot eucalyptus leaves and give you some aquanude group psychotherapy but I don't think it's going to work. The little woman is mad as hell that I'm here all the time, and that I'm into death."

  "You're into death?"

  "Who isn't? It's where we're all headed, you know."

  "I can't deny that, but I guess I just don't get the charge out of it that you do. I'm sorry about the MOR," I said, wondering if my R?for Relationship?would get to the point of ROR during the internship.

  "Doesn't matter," said the hyperactive tern, "no kids. In California, being married two years means you've hit the median. Hey, I got a question for you: do you think it's legal to have this woman sign her own postmortem permission slip along with her insurance voucher?"

  "It's probably legal, but I'm not sure it's ethical."

  "Great," said Hooper, "another post coming up. In Sausalito nobody's heard of ethics. Hey, thanks. I didn't want to stay married to that bitch anyway. You should see what I've got simmering down in the morgue."

  "In the morgue?"

  "A female pathology resident from Israel. Dynamite. Grooves on thanatos, like me. Romeo and Juliet, man, so long."

  I sat in the E.W. nursing station thinking about how the Leggo and the Fish had blessed our ward with "the toughies," the dying young, like Jimmy, like my friend Dr. Sanders, out there on his last fishing trip before his last autumn?

  "That's tough to do, to face the dying and the dead"

  I looked up. It was one of the policemen, the fat one, Gilheeny.

  "Strength of character," said the other one, Quick, "it doesn't grow on trees."

  "Nor can one buy it in any store," said the redhead. "It's the toilet training that does it, I do believe. So said Freud and Cohen."

  "Where did an Irish cop learn about Freud?" I asked.

  "Where? Why, here, man, here, from spending the last twenty years here, five nights a week; in trialogues of discussion with fine young overeducated men like: you: Better than night school, more broad and useful.' And we get paid to attend."

  "Not only that," said Quick, "but all the different viewpoints contribute. Over twenty years one learns a good deal. Currently a surgeon named Gath brings?the news from the Southern Rim, and with Cohen we are in the middle of a gold mine of psychoanalytical thought."

  "Who is Cohen?"

  "A sophisticated, jocular, and unrestrained resident in psychiatry," said Quick. "A textbook in himself."

  "You must make his acquaintance," said Gilheeng Twitching his red eyebrows so that they coerced the rest of his fat face into a gap?toothed smile, he went on, "We can hardly wait to hear from a Rhodes Scholar like yourself, a man with high qualities of body mind, with experience gleaned from corners of the round globe, like England, France, and the Emerald Isle, which I have visited only twice."

  "A textbook in yourself," said Quick.

  Upstairs, I had just finished working Jimmy over, putting in lines and tubes and starting to treat his untreatable diseases, when Mrs. Risenshein arrested and I was surprised to hear myself cursing under my breath as I resuscitated her, "I wish she would die so I could just go to sleep," and I was shocked when I realized that I'd just wished a human being dead so I could go to sleep. Animal. Eat My Dust rolled up from the MICU to take Risenshein away and I asked how he was.

  "Glad you asked. It's going just great. Here, Bob," he said, nodding to his BMS, "wheel this stretcher on down to the Unit, will you, pal? Keep pumping the oxygen and keep the lines open, I'm just going up to floor eight for a minute to jump off and kill my
self."

  He left, and Molly?clean and pretty and sexy and off duty left, and I was desolate watching her go.

  I should have been going with her. The Runt called back again.

  "How's Lazarus?" he asked.

  "Stable. Where are you?"

  "At Angel's. I'm scared. How's Risenshein?"

  "There's nothing to be scared about. Risenshein's had a cardiac arrest and is in the MICU:"

  "Oh, no! I'm coming in right away!"

  "You do and I'll kill you. Put Angel on"

  "Hi, Roy," said a healthy drunk voice, "I'm"?gesture?"drunk."

  "Fine. Listen, Angel, I'm worried about the Runt. He's not going to make it unless he gets some confidence in himself. He's a great guy, but he needs some confidence. Chuck and I are really concerned?suicide?that's how concerned we are"

  "Sruicide!" Gesture. "Wow! WhatcanIdo?"

  I told Angel exactly what she could do to prevent the Runt's suicide.

  "Sruicide!" Gesture. "You mean he's freee?"

  "Not yet, Angie. Right now, he's still a bird in a cage. Open it up, Angel, set him free, let him fly."

  "Flyfly his"?gesture?"fly bye?bye," and the phone went dead.

  Hot, sweaty, with the dried sweat salt like sand on my eyelids, with my flu declaring itself in malaise, photophobia, myalgia, nausea, and diarrhea, cursing being in the House while Molly was out and Berry was out where and with whom??and while the Runt was getting seduced out of "sruicide," I tried to finish my write?up of young and soon?to?be?dead Jimmy. Chubby, grinning, puffing his pipe, Howard appeared.

  "What the hell are you doing up here?"

  "Oh, I just thought I'd do some follow?up on Jimmy. Great case. Guess he's had it, huh? Oh, and I wanted to ask, you about that nurse in the MICU, Angel. Very fine girl, and I thought I might ask her out."

  I watched him puff his pipe, and, hating him because his happy life even in the House was a puff on his pipe, I said, "Oh, so you haven't heard about the Runt and Angel?"

  "No. You don't mean?"

  "Exactly. At this very moment. And, Howard, listen carefully: you should see what she does with her mouth."

  "With her . . . her what?"

  "Her mouth," I said, knowing that by morning Howard would have puffed what Angel did with her mouth all over God's House. "See, she takes her lips and she puts them around his?"

  "Well, I don't want to hear about that, and I'm glad you warned me before I asked her out. But I want to know why when I took Jimmy's blood pressure just now it was only forty systolic."

  "It's what?" I said, rushing into Jimmy's room, where I found that it was forty systolic and Jimmy was trying to die right away. I panicked. I didn't know where to start, to save him. I looked at Howard leaning casually against the doorway lighting his pipe and smiling, and I said, "Howard, help me with this."

  "Oh, yes? And what might I do?"

  I didn't know what he might do or what I might do either, but then I thought of the Fat Man and I said, "Page the Fat Man, stat."

  "Oh? Do you think you need him? No, you can handle it, Roy. Besides, they say you can't become a real doctor without killing a few patients at the least."

  "Do something to help me," I said, trying to think clearly.

  "What might I do?"

  The Fat Man arrived, puffing from the race up the stairs, and sensing my panic, ordered me to take my own pulse. As I did so, he began to get Jimmy organized so he would not die right then. Fats attacked Jimmy with that fantastic smooth expertise of his, and you could almost hear the click click click of each essential procedure. Fats chattered as he worked, addressing comments to us all, including the nurse and a woman named Gracie from Dietary and Food Services who somehow at that late hour had been with him in bed?!-

  "What's wrong with Jimmy?" asked Fats, putting in a big needle.

  "Cancer of the lung," I said.

  "Christ," said Fats, "and he's young enough to die."

  "If I were you, I'd try laetrile," said Gracie from Dietary and Food Services.

  "Try what?" asked Fats, stopping trying to save Jimmy.

  "Laetrile. A cure for cancer," said Gracie.

  "A what for what?" shot out Fats, standing up stockstill.

  "The Mexicans have found that an extract from apricot pits, called laetrile, can cure cancer. Controversial, but—"

  "But worth a big fortoona," said Fats, eyes aglitter: "Hey, listen, I gotta hear more about this, Roy," he said, starting to leave.

  "Fats, wait!" I said. "Don't leave me yet!"

  "Did you hear what Gracie said, Roy? A cure for cancer. Come on, Gracie, I want you to tell me more."

  "It's bullshit," I said. "There's no cure for cancer, it's a hoax."

  "It's not," said Gracie from Dietary and Food indignantly, "it worked on my cousin's husband. He was dying and now he's fine."

  "Dying and now he's fine," said Fats, and then, walking toward the door, he murmured, as if in a trance, "dying and now he's fine."

  "Please, Fats," I said, "don't leave me alone yet," as Jimmy began once again to die and I began once again to panic.

  "Why not?" asked Fats, puzzled.

  "I'm scared."

  "Still? You still need some help?"

  "Yes, I do."

  "Well, then, you're going to get it. Let's get to work."

  We got to work, but soon I realized that Fats had slipped away, and I was left alone with Jimmy and Howie and Maxine, the night nurse. And then I knew that Fats's slipping away and leaving me in charge meant that he knew I could handle it, and I felt a warm rush go through me. I could handle it, and although all I wanted to do was to beat the shit out of Howard, I worked on Jimmy until it was clear that he needed to be breathed by a respirator, which meant a TURF to the SICU-Surgical Intensive Care Unit-and as I watched the cheery sadistic surgical resident wheel Jimmy off, Jimmy, who by now was surrounded by so much tubing that he looked like a meat ball in the middle of a plate of spaghetti, I felt great relief, and I heard Howard say, "Impressive job on a tough case," and he left and I was filled to my eyeballs with hate.

  With the sweat dripping from my brow onto Jimmy's chart and the flu dripping through every muscle and bowel villas in my body, I finished my write-up and sent the Bruiser along with it to the SICU. I sat for a moment musing: Well, this has been the worst night of my life, but now it's over, and now I can go to sleep. They can't get me now. Through the open window came that comforting smell of fresh rain on hot asphalt. The nurse came in and said, "Mr. Lazarus has just had a bowel movement that is all blood:"

  "Hey, that's really funny, Maxine. You got a great sense of humor."

  "No, I'm serious. The bed is solid blood."

  They wanted me to go on, and I could not. The world became the world just before the head?on crash. It could not be what it was. "I can't do anything more tonight," I heard myself say. "I'll see you in the morning."

  "Look, Roy, don't you understand? He's just bled out a gallon of blood. He's lying in it. You're the doctor, and you have to do something for him."

  Filled with hate, trying to get rid of thoughts that Lazarus wanted to die and I wanted him to die and I had to break my ass to stop him from dying, I went into his room and was face to face with black putrid sticky wet blood. On autopilot, I went to work. My last clear memory was putting a naso-gastric tube down into Lazarus' stomach and having the bloody vomit spew up and out and all over me, as Lazarus rolled his death-defying eyes.

  Just after Lazarus, just before dawn, Dr. Sanders came back in, bald from the chemotherapy, infected and bleeding, having had to cut short his fishing trip.

  "1'm glad you'll be taking care of me again," he said weakly.

  "So am I," I said, wondering if this admission would be his last, and realizing how attached to him I felt.

  "Just remember: no whispering behind my back, Roy. And as for heroic measures-we'll talk about that, together."

  I put him in the same room with Saul the leukemic tailor, thinking that while Sanders w
ould die, Saul might be just old enough to survive. How crazy was that? As I lay down in my spewed clothes for my hour's sleep, I found myself wondering where Molly was, more than where Berry was, and wondered if that meant that it was the beginning of the ROR?Romance On Rocks?and then I thought with pleasure of the phone call I'd gotten at about one A.M. from June, the Runt's poet, wondering if I knew where he was, and I chuckled at that and composed a letter in my head to give the Runt in the morning: "Congratulations on your bravo three?dimensional night of love. You are herewith charged with rape. Red pubic hairs, I might warn you, will stand up in court." But then I realized that, Goddamn! the Runt was seeing what Angel did with her mouth while I still hadn't gotten past Molly's long nipples, and then finally I recalled that no one yet knew what Angel did with her mouth because I'd just made that up to torment that optimist Howard, who knew that being a doc really was the cat's balls after all. And I realized that they could never hurt me more than they had just hurt me that night, and that out of chaos like this had to come confidence and skill. Something had happened when I was with Saul and Jimmy and Lazarus and Dr. Sanders, and I didn't know for sure what, but I knew that from taking the risks and learning and remembering Fats, I had pinned down my terror and exploded it to bits. From that night on, I might be everything else, but I'd never again be panicked in the House of God. It was a thrilling thought?almost like in the intern novels and in the inside of Howard's skull and in my father's letters?until I realized with alarm that I hadn't learned how to save anyone at all, not Dr. Sanders or Lazarus or Jimmy or Saul or Anna O., and that what I was thrilled about was learning how to save myself.