The house of God

by Samuel Shem

  "You can't treat me like this. Besides, I looked up 'microdeckia,' and there's no such thing."

  "Microdeckia? Sure?'not playing with a full deck.' Night."

  I went to bed. Molly was night nurse, and all our efforts to get to bed had been frustrated, first by the Bruiser, then by the gomers. But now the Bruiser was in the library and I'd BUFFED the gomers for the night, and I sat on the on?call bed, naked, awaiting my nurse. Hazel had BUFFED the sheets, and next to the House of God pillow was a doll made from rubber tubing and gauze pads with a note pinned to it: "Roy the noisy boy, Molly the jolly girl; am coming in if you're my toy and not too busy for a whirl. Call me." Finally!

  In delicious anticipation I found myself looking out the window at the nursing?school dorm. In one of the rooms a nurse was undressing. She took off her uniform and then made that wonderful motion of hyperextending the elbows around her back to undo her bra. Just as Molly walked in, she let them fly. Fine, fine. I was a time bomb. Molly sat on the bed and I showed her what I was watching. I unbuttoned her dress and unhooked her bra and caught her little?girl breasts by their longing nipples. All over me, her dress was off her pantyhose were off her bikinis were off and she was going off. I thought of the Englishman's idea of perfection, when he, his alarm, and his mistress all go off at the same time, and just before we got that firm fun thing into her hollow funnelly thing, she stopped and in between her little gasps of pleasure said, "Did I ever show you what the nuns teach nurses to do when a patient gets an erection?"

  "Nope."

  "The nuns said to slap it and it would go down."

  "Do you want it to go down?"

  "No, I want it to go up me and fuck me:"

  And we started doing that more and more and more and more, and just as we were about to go off, there was an incredible CRASH that rocked the bed and my beeper lady fired again and she wanted me right away, but Molly wanted me more right away, saying, Jesus Christ Almighty oh finish it off ah ahhh ahhhhhh!

  The CRASH had come when the Bruiser, in trying to make up for all he'd done wrong that day, had decided to help me out by using the TURF?tool, the electric gomer bed to TURF Mrs. Biles, the bruised and hypnotized Little Otto'd Mrs. Biles, elsewhere. He'd chosen the Orthopedic Height, and it looked from the right?angle bend in Mrs. Biles's left trochanter that she'd broken her hip.

  "I did it for you, Dr. Basch," said the Bruiser proudly, smiling. "I've already paged ORTHO."

  "Bruiser, it's hard for me to tell you this: I appreciate what you did, but that gomer?bed thing was a joke."

  "A what?"

  "A joke. The Fat Man was joking."

  "Oh, God. Oh, my God. I think I've made a terrible mistake. I'd better go and phone Dr. Kreinberg right away."

  "Bruiser?"

  "Yes?"

  "Call your analyst first."

  Many of the dying young died. Jimmy, in the SICU with the BALLS TO RIDE A HARLEY guy, was treated with the standard ratbane used to wipe out cancerous bone marrow, and, bald and infected and bruised and bleeding, he died. Fast Henry, who in fact also had a cancer, got his wish to be the happiest man alive one tomorrow when he died, and many other young ones died. When I asked Chuck, "Hey, how come the ones our age die?" he said, "Dunno, but we sure are leading a great life, ain't we?" Everyone knew that eventually the Yellow Man would die, and all that time Dr. Sanders had been dying.

  Dr. Sanders had been dying a long time. Bald and infected, quiet and cachectic, he was getting his life in order. We were friends. He was dying with a calm strength, as if his dying were part of his life. I was beginning to love him. I began to avoid going into his room.

  "I understand," he said, "it's the hardest thing we ever do, to be a doctor for the dying."

  Talking about medicine, I told him with bitterness about my growing cynicism about what I could do, and he said, "No, we don't cure. I never bought that either. I went through the same cynicism?all that training, and then this helplessness. And yet, in spite of all our doubt, we can give something. Not cure, no. What sustains us is when we find a way to be compassionate, to love. And the most loving thing we do is to be with a patient, like you are being with me."

  I tried to sit with him. I watched Molly take care to clip his fingernails and toenails so he wouldn't scratch himself and bleed or get infected. I watched everyone keep sterile around his bed. I watched Jo treat him like "a case," and I watched his oncologist chatter to him with perfect objectivity about his impending death, and all the time I hoped against hope that when he died, he would die neat.

  His death was a mess. I was called in the middle of the night, and found him, despite massive platelet transfusions that had been dissolved by the cytotoxic rat poison in his system, bleeding out. Barely conscious when I got to him, his blood pressure almost nothing, he had trickles of geranium?red blood dripping from both nostrils and from the corners of his bloated bruised mouth, and I knew that he was bleeding from every little ruptured capillary in his gut. He was only conscious enough to say, "Help me, please help me."

  I realized that there was nothing I could do to help him except what he'd said was the only thing a doctor could do, be with him. I took his head in my lap and sponged away the blood and looked into his sightless eyes and said, "I'm here," and I think he knew that I was.

  "Help me, help me."

  More blood trickled out, and I wiped it away and said, "I'm here," and I just cried. In silence, so as not to scare him, I wept.

  "Hi, Roy boy, how's it going, anyway?"

  Howard was in the doorway, filling it with his asinine grin and his pipe smoke, and I hissed at him,

  "Get out of here." Sitting down in the chair across the room, he puffed and said, "Looks bad for Dr. Sanders, doesn't it? Gosh, it's tough."

  "Get the hell out of here. Now!"

  "You don't mind if I watch, do you? Follow?up, you know. It's tough in the E.W., because you don't get any follow?up on the patients you admit. I always like follow?up. Sense of completion. Ending. Learn a lot."

  "Get outta here, Howard, please."

  "Help me."

  The blood ran. My lap was wet with it. The eyes were glazing.

  "I'm here," and I hugged him.

  "You gonna get the post?" asked Howard.

  I wanted to leap up and kill him, but I couldn't I wouldn't leave Dr. Sanders until he left me. I begged Howard to leave, and he smiled and said how hard it was to have someone dying whom you cared about, " and he puffed his pipe, and stayed.

  "Help."

  So I tried to obliterate Howard and as I was wetted with Dr. Sanders' thin blood I found myself wanting; only to be able to kill Dr. Sanders with something painless and neat instead of being with him in my helplessness.

  "Help me, God, this is awf . . ."

  I tried to think of good things, of a woman in a punt on the willowed Cherwell at Oxford, trailing her finger in the leafy stream, but all I could think of was the day's headlines, the sixteen?year?old girl who'd run away to see the world and who was found off a Florida beach naked folded up in a weighted traveling case, and a beaten child wheeled into a courtroom curled up in a fetal position in a crib, who was a vegetable and who "was not going to get any better" and the surgeon said that when he'd first gotten to the child he didn't even know what he was looking at because it was a mass of rotten flesh, days old, and on the abused child's back, burned into his flesh and scabbed over, were the letters: I?C?R?Y.

  When I looked back down into my lap, Dr. Sanders was dead. Much of the eighty?percent blood?water that had been him was drained out onto me.

  I held his head in my lap until his sick killer blood had oozed out of his heart and brain and into his gut and skin and all the places it should never have been, and, refusing to clot, had flowed out of all the open holes in his body, the last his lazing anus. I held his hairless head in my lap and in my arms until the flow stopped. I laid him back in his bed and covered him gently with his sheet and I wept. He was the first patient whom I'd loved who'd died.
I went to the nursing station. The way I put my feet down, one in front of the other, made me think of a chronic schizophrenic I'd seen, a former Ziegfeld Girl who'd been at an asylum since the Follies, and who, each day, rain or shine, would trudge across the meadow with a determined and precise step in an unerring and, clean straight line that would have brought joy to a surveyor's heart, CLOMP CLOMP CLOMP, going nowhere, empty inside.

  "Dr. Sanders is dead," I said, sitting down.

  "That's too bad. Did you get the postmortem?" asked Jo.

  "What?"

  "I said, did you get the postmortem?"

  I had a vision of lifting the little prodigy up by her thin shoulders, shaking her until her brain splattered against her shell of skull and she convulsed, kneeing her in the guts until I'd wrecked her ovaries from ever spitting out another egg, and then heaving her through the sixth?floor window so she'd splatter arid have to be sucked up by noisy, powerful sucking?up machines and become a bag of goo, picked .over and strained by Hyper Hooper's Israeli Pathology Resident in the morgue. But Jo was pitiful, and so I gritted my teeth and just said, "No."

  "Why not?"

  "I didn't want to."

  "That's not good enough," said Jo.

  "I didn't want to see his body ripped to shreds in the morgue."

  "I don't understand what you're saying."

  "I loved him too much to see his body ripped apart downstairs."

  "That kind of talk has no place in modern medicine."

  "So don't listen," I said, beginning to lose control.

  "The postmortem is important," said Jo. "It's the flower of the science of medicine. I'll call the next of kin myself."

  "Don't you dare!" I screamed. "I'll kill you if you do!"

  "How do you think we're able to deliver such precise medical care to those entrusted to us?" asked Jo.

  "That's bullshit, that we deliver medical care at all," I said.

  "Have you gone mad? This ward?my ward is looked up to in the House for being the most efficient and having the most success with placement and handling the toughies with skill. My ward is a legend. Damnit," said Jo, jutting her jaw, "I want that post."

  "Jo. Go fuck yourself."

  "I'll have to report this to the Fish and the Leggo. I won't have sentimentality ruining my ward. My ward has become a legend in its own time."

  "Do you know why it's become a legend? You don't want to hear."

  "Of course I want to hear, even though I know why already."

  So I told her. I started by telling her about how Chuck and I had, after our original empirical test on Anna O., become fanatics at doing nothing and had lied to Jo about it, making up all forms of imaginary tests and BUFFING the charts. I told her how in modified form we'd done the same with the dying young, who went ahead and died, but died without the hassle, pain, and prolongation of suffering that their care might otherwise have produced. The final thing I told her about was placement.

  "Placement picked up because the Social Service liked me and I did such a good job running my ward," said Jo anxiously.

  "Jo, everybody hates you and the only reason that placement picked up is that the Runt and I are fucking Rosalie Cohen and Selma respectively. Not to mention the clean sheets."

  "What about the clean sheets?"

  "Chuck has been fucking Hazel from Housekeeping."

  "I don't believe you. No one would do this to me"

  "Everyone would if they could, but your terns are in a privileged position."

  "You just think you're above it all," said Jo. "Better than everyone else, like you don't have to stoop down to get postmortems. You're afraid of the dirty side of medicine, right?"

  "No, sir," I said.

  "You mean you're not afraid of the dirty side of medicine?" asked the Leggo, his eyes running up and down my bloody whites.

  "No, sir, to my knowledge I am not."

  Clad in his butcher?length white coat and with stethoscope, as always, wending its way down into God knows where, he was standing looking out the window, holding my curriculum vitae in his hand. He looked lonesome. Like Nixon must have looked. I stood in front of his large desk. Diplomas buzzed me from all directions, and I was mesmerized by a model of the urinary tract, filled with colored water and driven by an electric motor, bubbling red urine through everything at a healthy clip. My mind was empty of everything but how Dr. Sanders had become a bag of blood?squishy, bloated, and dead.

  "You know," said the Leggo, waving my C.V. around in the air, "you look great on paper, Roy.. When I punched your name into the computer to match you for this internship, I was happy. I thought you could be a leader of the interns and of the residents, and even, someday, Chief Resident."

  "Yes, Sir, I understand."

  "Say, you've never been in the military, have you?"

  "No, Sir."

  "Yes, I knew that, because that's why you call me 'sir.' 'Sir' is the military form of address, do you see?"

  "I don't get it."

  "People who have been in the military never call me 'sir.' "

  "Oh? Why not?"

  "I don't know why not. Do you?"

  "No, I don't. Except it seems to fit."

  "It's the strangest thing. I mean, you'd think it would be the other way around, right?"

  "What does it mean?"

  "I don't know, do you?"

  "No. It's the strangest thing. Sir."

  "Yes, it's the strangest . . : "

  As he trailed off out the window, I fantasized about him: his life had been lived with the vow never to be as cold as his own pop, and yet, like Jo, the Leggo had become a victim of success, had slurped his way up, and had become so cold that his own son must already be in treatment to work out his revulsion for his cold pop and his longing for his cold pop to be as warm and loving as his pop's pop, his grandpop. The Leggo had spent his whole life living for that electric moment in medicine when a concept cleared away the stench of a disease, and when this concept would be warmly applauded, as his cold pop never had applauded him. The Leggo was hell?bent on producing these electric moments in medicine. He thought that by being a kind of Van der Graaf generator in the House of God, he could get his boys to love him.

  "You know, Roy, at the other hospital, the City, my boys loved me. They always?do you understand always?my boys always loved me before, we shared some terrific moments together, but here at the House . . "

  "Yes, sir?"

  "Do you know why they don't?"

  "Perhaps it has something to do with your attitude toward medicine, especially toward the gomers:"

  "The what?"

  "The chronically ill, demented, geriatric?nursing home population, sir. Your idea seems to be that the more you do for them, the better they get."

  "Right. They have diseases, and by God we treat them: aggressively, objectively, completely, and we never give up."

  "Well, that's just it. I've been taught that the treatment for them is to do nothing. The more you do, the worse they get."

  "What? Who taught you that?"

  "The Fat Man."

  The words plowed two furrows in the dry man's brow, and he said, "Surely you don't believe the Fat Man, do you?"

  "Well, at first I did think it was crazy, but then I tried it out for myself, and, surprisingly, it worked. When I tried it your way?Jo's way?they developed incredible complications. I'm not sure yet, but I think the Fat Man had a point. He's nobody's fool. Sir."

  "I don't understand. The Fat Man taught you that to deliver no medical care is the most important thing you can do?"

  "The Fat Man said that that was the delivery of medical care."

  "What? To do nothing?"

  "That's something."

  "Ward 6?South is the best ward in the House, and you mean to tell me it's from doing nothing?"

  "That's doing something. We do as much nothing as we can without Jo finding out about it."

  "Even placement?"

  "That's another story."

  "Yes, well,
there are enough stories for today," said the Leggo, perplexed and haunted by the Fat Man, whom he'd thought he'd farmed out to the Mt. St. E. "So all this looseness that Jo talks about?IF YOU DON'T TAKE A TEMPERATURE YOU CAN'T FIND A FEVER?that's really trying your hardest to do something by doing nothing, right?"

  "Right. Primum non nocere with modifications," I said.

  "Primum non . . . But then why do doctors do anything at all?"

  "The Fat Man says to produce complications"

  "Why do doctors want 'to produce complications?"

  "To make money:"

  The word "money" hit the Leggo hard, and he was reminded of something else, and said, "That reminds me: Dr. Otto Kreinberg said that you're abusing his patients: bruising them, hypnotizing them, raising their beds to dangerous heights. He's quite a little guy, Otto, was in line for the Nobel, years ago. What about that?"

  "Oh, that wasn't me, sir, that was Bruce Levy:'

  "But he's your BMS: "

  "So?"

  "So, damnit, you're responsible for him, just like Jo is responsible for you and Dr. Fishberg is responsible for her and I'm responsible for him. Levy is your responsibility; understand? Talk to him. Straighten him out."

  Thinking that I'd better not ask the Leggo to whom he was responsible, I said, "Well, I tried to do that, sir, but I failed. Levy said that I couldn't take responsibility for his actions and that he had to take responsibility for them himself."

  "What? That goes against all I've just said."

  "I know, sir, but he's in psychoanalysis and that's what his analyst keeps telling him and he keeps telling me," and I found myself wondering who?when both Agnew and Nixon got thrown into the stammer at the same time?who would take responsibility for the rich pageantry that was America.

  "And you're telling me you believe what the Fat Man said?"

  "I'm not sure, sir. I've only been an intern four months"

  "Good. Because if everyone felt the way he does, there wouldn't be any internists at all."

  "Exactly, sir. There'd be no need. Fats says that that's why internists do so much, to keep medicine in demand. Otherwise we'd all be surgeons or podiatrists. Or lawyers."

  "Nonsense. If he were right, why in the world would sensible men like me and all the other Chiefs believe in medicine? Eh?"