by Samuel Shem
"The Ten Commandments and Chicken?" I asked the Fat Man later that night as we awaited our admissions and the ten?o'clock meal.
"Right. Charlton Heston, Jews squashed under rocks, and then the House of God 'chicken with tire tracks.' And Teddy."
"Who's Teddy?"
Teddy turned out to be one of the horde of patients who loved Fats. A concentration?camp survivor, Teddy had been brought into the House E.W. bleeding out from an ulcer one night when Fats was on call. Fats had TURFED him to surgery, and, losing half his stomach, Teddy was convinced that Fats had saved his life. Teddy "owns a deli and is lonely so he comes in when I'm on call, with a bag of food. I deck him out in whites and a stethoscope, and he pretends he's a doctor. Sweet guy, Teddy." Sure enough, as Fats and I and Humberto, my Mexican?American BMS, sat down in the TV room to watch the MGM lion begin to roar, in walked a thin, worried?looking fellow in shabby black, in one hand a radio spewing a melancholic Schumann, and in the other a big paper bag splotched with grease. As Moses grew from being a baby bulrushing around the Italian extras to being a six?foot?three Egyptian red?hot looking like Charlton Heston, Fats and I and Teddy and Humberto ran the ward via the Bell Telephone System. Just about the time that God, playing doctor, handed down the Ten 'Commandments, saying, "Take these two tablets and call me in the morning," Harry the Horse had chest; pain. I sent Humberto to take an EKG, and when he returned, without looking at it Fats said it was "an ectopic nodal pacemaker taking over from the sinus node and producing chest pain." He was right.
"Of course I'm right. Harry's Private, Little Otto has worked out a method to keep Harry here indefnitely: whenever Harry's ready to be TURFED, Otto tells him he's leaving, Harry wills his heart into that crazy rhythm with chest pain, and Otto tells him he's staying. Harry's the only man in history to ha conscious control of his A?V node."
"The A?V node is never under conscious control," I said.
"For Harry the Horse, it is"
"So how do we get him to leave?"
"By telling him he can stay."
"But then he'll stay forever."
"So? So what? He's a landsman, a brother. Nice man."
"So you don't have to take care of him, I do," I said, irritated.
"He's no work for you. Let him stay. He loves it here. Who doesn't?"
"I do," said Teddy. "Here was the best six weeks of mine life."
As The Ten Commandments finished, we got a call for an admission from the E.W., and Fats gathered us to him and said, "Men, pray that this is our sleep ticket."
"What?" asked Teddy. "You need a ticket to sleep here?"
"We need an admission around eleven that's not too much work, so we can get to bed and the rotation doesn't hand us another admission at four A.M. Pray, men, pray, to Moses and Israel and Jesus Christ and the entire Mexican nation."
He heard. Bernard was a young eighty?three, not a gomer, and able to talk. He'd been transferred from MBH, the House's rival. Founded in Colonial times by the WASPs, the insemination of MBH by nonWASPs had taken place only mid?twentieth century with the token multidextrous Oriental surgeon, and, finally, with the token red?hot internal?medicine Jew. Yet MBH was still Brooks Brothers, while the House was still Garment District. For Jews at MBH the password was "Dress British, Think Yiddish." It was rare to get a TURF from the MBH to the House, and the Fat Man was curious: "Bernard, you went to the MBH, they did a great work?up, and you told them, after they got done, you wanted to be transferred here. Why
"I rilly don't know," said Bernard.
"Was it the doctors there? The doctors you didn't like?"
"The doctus? Nah, the doctus I can't complain."
"The tests or the room?"
"The tests or the room? Vell, nah, about them I can't complain."
"The nurses? The food?" asked Fats, but Bernard shook his head no. Fats laughed and said, "Listen, Bernie, you went to the MBH, they did this great work up, and when I asked you why you came to the House of God, all you tell me is, 'Nah I can't complain.' So why did you come here? Why, Bernie, why?"
"Vhy I come heah? Vell," said Bernie, "heah I can complain."
As I headed to bed on the ward, the night nurse came up to me and asked me to do her a favor. I wasn't in the mood, but asked what it was.
"That woman transferred from surgery yesterday, Mrs. Stein."
"Metastatic cancer," I said, "inoperable. What about it?"
"She knows that the surgeons opened her, took a look, and then just sewed her up:"
"Yeah?"
"Well, she's asking what that means, and her Private won't tell her. I think that someone should tell her, that's all."
Not wanting to face it, I said, "It's her Private's job, not mine."
"Please," said the nurse, "she wants to know; some one has to?"
"Who's her Private?" asked Fats.
"Putzel."
"Oh. It's OK, Roy, I'll take care of it myself."
"You? Why?"
"'Cause that worm Putzel will never tell her. I'm in charge of the ward, I'll take care of it. Go to sleep."
"But I thought you're telling me and Eddie not make waves."
"Right. This is different?this woman needs to know."
I watched him enter her room and sit on the bed.
The woman was forty. Thin and pale, she blended with the sheets. I pictured her spine X rays: riddled with cancer, a honeycomb of bone. If she moved too suddenly, she'd crack a vertebra, sever her spinal cord, paralyze herself. Her neck brace made her look more stoic than she was. In the midst of her waxy face, her eyes seemed immense. From the corridor I watched her ask Fats her question, and then search him for his answer. When he spoke, her eyes pooled with tears. I saw the Fat Man's hand reach out and, motherly, envelop hers. I couldn't watch. Despairing, I went to bed.
At four A.M. I was awakened for an admission. Cursing, I wobbled into the E.W. cubicle and found Saul the leukemic tailor, at whose remission in October we'd wept with joy. Saul was dying. As if enraged at the delay in its onrush to death, Saul's marrow had gone wild, spitting out deformed cancerous bone cells that left Saul delirious with fever, oozing blood, anemic, in pain, and, where the malignant white cells had failed to prevent the spread of his normal skin flora, his body coated with maggoty pustules of staphlococcus. Too weak to move, too mad to cry, gums swollen and tongue bruised, he shooed away his wife and motioned me to bend down to him, and whispered, "Dis is it, Dr. Basch, right? Dis is the end?"
"We can try for another remission," I said, not believing it.
"Don't talk to me remission. Dis is hell. Listen —I want you to finish me off."
"What?"
"Finish me off. I'm dead, so let me die. I didn't want no treatment?she forced me. I'm ready, you're my doctor, so give me something to finish me off, OK?"
"I can't do that, Saul."
"Crap. Remember Sanders? I was dere, next bed. I saw. Suffered? Terrible. Don't make me go like him. So? You want me to sign something, I sign. Do it."
"I can't, Saul, you know that."
"So find me someone who will."
"I promise you'll have no pain. That's the best can do."
"Pain? What about pain inside, in my heart? What do I have to do, Dr. Basch," he said angrily, "beg? You don't want me to suffer like Sanders. You liked him too, I know."
I looked into his bloodshot eyes, the infection creeping over the lids toward the conjuctival vessels that were pale because there were so few red cells, and I wanted to say, No, I don't want you to suffer, Saul, I want you to die easy.
"Dere, see? It's a cinch. Please, finish me off."
As I continued to protest, remembering how Sanders had suffered and died, a horrible thought crossed my mind, horrible because for an instant it didn't see horrible, like seeing a baby and thinking of putting icepick through a fontanelle of its skull, the though Yes, Saul, I'll do it, I'll finish you off. I began to work like hell to save him.
I went back to the ward, and came to the room with Putzel's
terminal?cancer woman. Fats was in there, playing cards, chatting. As I passed, something surprising happened in the game, a shout bubbled up and both the players burst out laughing.
After the next morning's cardflip, when Fats had gone to eat and Hooper had gone to Path, EMD got a silly look on his face and told me that Lionel Blazer had paged him to take a look at some "little red things" on his gorgeous pubis that itched like hell. Eddie asked me what to do, and I said, "Do? You're a doc, so do what docs do: examine him. Give five minutes and do it in here."
I got the operator to page Fats and Hooper Selma and the nurses and the Fish and Housekeeping to come STAT to Gomer City, and then I watched Lionel come up the hallway, look around cautiously and enter the on?call room. I ran up to the group I'd paged and said, "Hey, I got paged to go into the oncall room, STAT!" and then the ten of us rushed into the room. Lionel was blue?blazered only from the waist up and was sitting on the table naked from the waist down, pawing through his brown pubic hair. Eat My Dust was sitting across from him, lost in contemplation. When Lionel saw us, he went red and started to explain. He realized that he didn't want to explain and stopped, and blushed, and said, "It's about a medical problem."
"Crab lice," said Eddie, "Lionel's got the venereal crabs."
"Medical problem?" I said. "You know, we can't blame Lionel for this, no. We can only blame the system, the one that has paramedical personnel seeking free medical advice. How often is it that here in the House one gets tapped on the shoulder and hears, 'Hey, doc, I got this problem, you got a minute?"'
Lionel put on his spinnaker?patterned briefs and his classy gray slacks and left. From that time on, whenever any of us ran into Lionel we couldn't help but think of him in terms of his unblazered, crab?infested prick.
"You shouldn't have done that, Basch," said the Fat Man, walking out onto the ward with me.
"Why not?"
"'Cause with guys like the Blazers, you can't win: as soon as you engage in the struggle, you lose. Lionel's boss, the flunky Marvin, who assigns admissions, is gonna make life miserable for you. Look, Roy, you're older than Hooper and Eddie, you can step back a little, and roll with it. It's hard enough without Blazers and Privates and Slurpers making it harder."
"Give in to those assholes?"
"I never said that."
"What's the alternative?" I asked, challenging him.
"Don't let them use you, Roy. Use them."
"How?"
"Like this," said Fats, sitting down across from Jane Doe and taking out his stopwatch. "Observe."
"What are you doing?"
"Using them. In ten minutes I'll explain."
"Look, I want to go home. I'm going to sign out to Hooper."
"Go ahead. Come back here in ten and I'll explain." I went into the on?call room and signed out to Hooper, and even though I knew he hadn't heard a word I'd said, I didn't care, and I got up to go home. Hooper was reading the manual I'd used at the beginning of the year, How to Do It for the New Intern, the section on "How to Do a Chest Tap:" I thought this strange, since we were more than halfway through the year and a chest tap was standard procedure. As we had gotten into the habit of helping each other out, even if it meant staying around a little longer, I asked. Hooper if he needed help and he said, "You mean Lionel?" and I said, "No, me," and he said, "Nah, I'll just read this manual and then go tap Rose Budz's chest." I left him poring over the book and pointing j
his own finger at his own chest in the imaginary needle:
track he was going to take on Rose Budz. On the ward,~'
I rejoined Fats, who clicked off his watch, turned to me, and asked, "What didn't happen?"
"I don't know."
"Ten minutes, Basch, and Jane Doe didn't fart."
"So?"
"So her bowel is completely turned off, for the time in House memory. That extract might just the cure for that VA diarrhea. A good deed; a fortoona. Just what I and the world need. Use 'em, Basch, use 'em."
"Did you and the Fat Man get along any better?" asked Berry.
"Worse," I said, "not only does he love the gomers, but he's acting like a Boy Scout. He keeps telling us not to fight back, he makes me search the whole place for a demented ninety?seven?year?olds eyeglasses, and then he spends the whole night sitting up with a woman with terminal cancer after he's told her she's gonna die."
"He did that?"
"Yeah, why?"
"I never pictured him doing things like that. The way you described him, he seemed so cynical, so sick. Now I'm not sure."
"He's not cynical enough. He's turned into a patsy. It's almost like he's deserting me."
"He seems more reasonable now. You're the one who's acting sick."
"Thanks a lot."
"I'm concerned, Roy. This acting out is dangerous. Maybe the Fat Man is right: someone's gonna get burned."
I lay awake chewing on Berry's concern. It had been fun to say "I don"t know" to get the Fish, to get Lionel, to race around laughing and sarcastic, but there was a bud of bitterness in it that might blossom into savageness and make me sad enough to kill myself or mad enough to bite. I tried to get my worry in my hand, but I was a child grasping a sunbeam, opening my hand to find the light turned dark, the warmth gone. I drifted toward dream, finding myself ringside at a circus and seeing an elephant, yes, an elephant, and seeing a busty girl on a musty elephant puffing dusty sawdust under the roustabustybout and lusty really big and bustyredhot tent of a bighot top?WAIT! ?with some alarm I realized that Hyper Hooper had been sitting in the on?call room reading my manual with his finger as his needle pointing?no, it couldn't have been, but yes it was?pointing in a straight shot right toward Rose Budz the LOL in NAD's heart.
16
"OK, Hooper, let's hear about the postmortem on Rose Budz. Let's hear what you with your one little needle shot have done."
Fats was flipping cards as we lay in the icy ventric of dead February as it lay in the corpse of the year. There was no question that Eddie and Hooper and I were on our knees and that they were breaking us. Most of the House hierarchies hated us. Gomer City was turning out to be the worst. Far from taking care of it, it was beginning to take care of us.
"The post on Rose Budz confirmed what we thought from when they sectioned the needle I used," said Hooper in a tone of contrition mixed with a certain professional satisfaction. "I got spleen, lung, stomp heart, and . . . and liver:" Hooper paused, watching the Fat Man drum his fingers on the desk, and went on, "In other words, Fats, all the organs " named the other day, plus a helping of liver and stomach as well. I think it's a new world record for most organs hit with a single needle shot."
"Liver? The liver's nowhere near where you went in."
I thought back to that day when Hyper Hoops presented his attempt to tap the Chest of Rose and had told us that "there had been a little bleeding." If a Californian isn't enthusiastic, it means a disaster has occurred, and Hooper meant that Rose was dying. He'd sent her to the MICU, and Fats, concerned and thinking malpractice, brought his Gomer City A Team to the MICU to see where the needle had gone in. The hole in Rose's chest was in the front, right over her heart. Fats had said, "Come on, Hooper, you didn't really put your needle in there, did you?" and Hooper had said, "Yup, that's what Roy's manual said, unless I had it upside down." Although Hooper had seemed a bit contrite when the Fat Man had said, "You never tap a chest from the front because things like the heart get in the way," Hooper had brightened right up and said, "It's OK, Fats, it's a great family for the post.
"I know there's usually no liver," said Hooper, "but it seems as how in this case there was an aberrant lobe."
"Messy TURF, Hooper, messy TURF," said Fats solemnly, slowly ripping Rose Budz to shreds. Again Hooper had managed to snatch defeat from the jaws of victory. Holding up another card, Fats called out, "Tina? Eddie?"
"Dead," said Eat My Dust.
"What?!" shouted Fats. "Tina too? How? Who killed her?"
"Not me," said Eddie, "all I did was ge
t her to sign for dialysis. The Leggo's crack dialysis team did the rest."
Tina had died by being inadvertently murdered by a nurse in dialysis who'd mixed up the bottles. Instead of diluting Fast Tina's blood, the machine had concentrated it further, and all the water had been pulled out of Tina's body and her brain had shrunk and rattled around in her skull like a pea while the nurse sat and read Cosmopolitan. Tina's pea?brain had rattled and stretched until one of the arteries straining between her neck and thalamus burst and she had hemorrhaged to death.
"Sorry to say this, Hooper," said Eddie, "but since Tina was my patient, it's another postmortem for the kid."
"Stop!" said Fats. "Tina was the Leggo's patient. No Post."
"But the Leggo loves posts. He called them the flower?"
"Not when they prove malpractice!" said Fats in a tone that would hear no answer, all the while ripping Tina's cards to pieces. "Next? Jane Doe?"
"Hey, doin' great," said Hooper. "I coulda sworn that today she sat up and gave me a big hello?"
"Never mind," said Fats, irritated. "That woman's never given any intern a big hello and she's not gonna start with an intern like you, slobbering after her corpse. Any bowel activity yet?"
"Nope. No bowel sounds at all. Bowel might be dead. No nuthin' since you slipped her that 'extract' of yours last month."
"That stuff is dynamite," said Fats. "Keep running in the VA antibiotic, Hooper. We've got to turn her on again. Next."
We waded through all the rest and ended with the Lady of the Lice, and Fats asked Eat My Dust if he'd found the cancer or the allergy.
"Who knows?" said Eddie. "I'm OTC."
"OTC? What the hell's OTC?"
"Off The Case," said Eddie. "New concept."