by Samuel Shem
"Even coffee?" I asked, not aware of this risk faotor.
"Cardiac irritant. Latest Green Journal. Work done right here at the BMS by intern Howard Greenspoon."
Finally, after a lengthy discussion of running, informing me that he was up to sixty miles a week at present in preparation for the Marathon in three weeks, Pinkus invited me to his office to feel his legs. We adjourned there, where he directed my examination.
From the waist up, he was toothpickoid; from the waist down, Mr. Olympia. His quadriceps, hamstrings, and calves were sleek and rippling, fastened to tendons of steel.
Returning to the MICU, repulsed by the disease and boggled by the machines, I had an urge to escape. Jo cornered me, insisting that I learn how to pop a big needle into the radial artery of the wrist, a brutal, dangerous, and more or less unnecessary procedure. After that, I escaped as far as the staff room, saying I had to read up on the patients. I picked up the chart of the BMS with the total body wipe?out of unknown etiology, and started to read. He'd started with a sore throat, a cough, a cold, a slight fever. I had a sore throat, a cough, a cold, a slight fever. My red throat was a plowed field, getting a viral seeding from the BMS. I would catch what he had. I would die. I looked around me and realized it was the nursing change of shift. The nurses came in in their street clothes and used an alcove off the staff room, where there were lockers, to change. Since there was a mad crush at about three, when everyone rushed in, there were too many nurses for the alcove, and with a nonchalance, a few spilled out into the room, slipping out of their blouses and skirts or jeans, radiating the light of their bras and panties and other undies into the staff room, and then wrapping around the green cotton MICU uniform. Even the braless ones would spill out and change in my sight, smiling at my gawking, and I was thrilled with that ease of body I'd grown to know so well, that was somehow connected with doctors and nurses who dealt, day after day, with the decay of other human flesh.
I left. As I drove through the chill April rain, my mind stuck on the Unit. What about it had been so different?
Quintessence. That was it. The Unit was the quintessence. There, after all the sorting had been done, lay the closest representation, in living terms, of death.
That was to have been expected. That was the bronze Zock plaque on the wall. And there, also, lay the closest representation, in living terms, of sex. I could not fail to notice. I did not pretend to understand. Amidst the dying, these nurses were flaunting life.
Berry asked me how it had been, and I told her that it had been different, high?powered, kind of like being part of the manned space program, but that it was also like being in a vegetable garden, only the vegetables were human. I was down about it because of course they were young and would die, but that didn't matter because I too was going to die from whatever tropical virus had attacked the little BMS. Berry suggested that my fear of dying was yet another "medical?student disease" and that she was more worried about my heart. Thinking of Pinkus, I said, "Oh, yeah, how'd you know I was going to key more on controlling my cardiac-risk factors?"
"No, I don't mean the mechanics, I mean the feelings. It's been weeks since Potts's suicide, and you haven't said anything about it. It's as if it didn't happen."
"It happened. So?"
"So he was a damn good friend of yours and now he's dead."
"I can't think about it I got a new job to do, in the Unit."
"Amazing. In spite of everything that happens, there's no past."
"What's that supposed to mean?"
"You and the other interns obliterate each day, in order to start the next one. Forget today today. Total denial. Instant repression."
"Big deal. So what about it?"
"So nothing ever changes. Personal history and experience mean nothing. There's no growth. Unbelievable: all across the country, interns are going through this, and going on each day as if nothing had happened the day before. 'Forget it; all is forgiven; come home; love, the Medical Hierarchy.' It rolls on, greater than anyone's suicide. That's what makes a doctor. Terrific."
"I don't see what's so wrong with that."
"I know you don't. That's what's so wrong. It isn't the medical skills you learn, it's the ability to wake up the next day as if nothing had happened the day before, even if what happened is a friend killing himself."
"There's a helluva lot new to learn in the Unit. I can't afford to think about Potts."
"Stop it, Roy?you're not some dumb clod, you're a person."
"Look, I'm not your red?hot intellectual anymore. I'm just a guy out to learn a trade and make a buck, OK?"
"Wonderful. All the shadows have been taken from your sun."
"How can you ask me to think, when tomorrow I'm gonna die?"
19
I awoke the next morning with my throat more sore. I drove to the House coughing, oblivious to all. but the tightness in the center of my back. I was about to follow the BMS into a premorbid coma. Jo had just completed examining the night's excretia, but before we started on work rounds, I insisted she listen to my chest. She said it was clear. Despite this, I was so worried I couldn't concentrate, and TURFED myself to X Ray for films. I went over them with the radiologist, who said they were normal. I got beeped to the unit for a cardiac arrest, and ran on up.
It was the BMS. Fifteen people had crowded into his room: a Messarabian breathing him; a nurse perch on her knees on top of the bed pumping his chest every systolic compression lifting her skirt to her waist; the Surgical Chief Resident with wiry black chest hair curling up over the V?necked green scrubsuit; barely in the room, Pinkus and Jo. Pinkus had been paged from his morning trot, and was in track shoes and gym shorts, looking distractedly out the window. Jo was all icewater, eyes riveted to the EKG machine, choosing medications, barking orders to the nurses. In the midst of all this, the BMS was meat.
Despite all efforts, the BMS continued to die. As usual at arrests, as if at a dud party, after about an hour people got bored and wanted to stop and it a day and let the patient really die, the heart following after the dead brain like a car motor stopping a few internal combustions after the ignition had been turned off. Jo, angered at the idea of failure, shouted out: "With this kid we're four?plussing it, all the way!" and wouldn't stop. When the heart finally did stop, Jo ordered the broiling of the chest, and when four shots of that didn't work, she paused, at the end of her medical bag of tricks. This was where the surgeons began, and the Chief Resident, sensing the chance to turn carnage into drama, got hot and said, "Hey, want me to open the chest? Manual cardiac massage?" Jo paused, and then, in the hush, said, "You bet. This kid walked in here. We're going all out. Four?plus!" The surgeon ripped the chest from armpit to armpit and spread the ribs. He grabbed the heart and began to pump it with his hand. Pinkus left the room. I stood, frozen. It was clear that the BMS was dead. What they were doing was being done for them. The surgeon, hand tired, asked me if I'd like to take over. Foggy, I did. I got my hand around the back of the young lifeless heart and squeezed. Tough, slippery, the sinewy muscle was a leather bag, filled with blood, rolling in the steamy chest cavity, tied to the tubes of the major vessels. Why was I doing this? My hand hurt. I gave up. The heart lay like a grayish?blue fruit on a tree of bones. Sickening. The face of the BMS was blue, turning white. The gash in his chest was bright red, turning to a clotted black. We'd ruined his body, even as he'd died. As I left the room, I heard Jo yell out with crisp authority: "Any BMS students here? This is a chance you don't often get in your training, to learn to massage the heart. Great teaching case. Come on." Sick, I retreated to the staff room, where the nurses were chattering, eating doughnuts, as if nothing had happened outside.
"Glad to see you're not wrecking your coronaries with doughnuts, Roy," said Pinkus. "I've tried to tell the girls, but they won't listen. They're lucky, of course, in that the estrogens lower their incidence."
"I'm not hungry," I said. "I think I've caught why the BMS had. I'm gonna die. I just timed my respirations: th
irty?two a minute:"
"Die?" asked Pinkus. "Hmm. Say, did that BMS have a hobby?"
The head nurse picked up the chart, turned to the special section created by Pinkus, called "Hobbies," and said, "Nope. No hobby:"
"There," said Pinkus. "See? No hobby. He didn't have a hobby, do you understand? Do you have a hobby, Roy?"
With some alarm I realized that I did not, and said so.
"You should have at least one. See, my hobbies are directed to the care of my coronary arteries: fishing, for calm, and running, for fitness. Roy, in my nine years on this Unit, I've never see a Marathon runner die. Not of an MI, not of a virus, not of anything. No deaths, period."
"Really?"
"Yes. Look: if you're not fit, your heart beats like this," and Pinkus made a motion with his fist, slowly moving his fingers toward his palm as if he were slow motion waving someone good?bye. "But if you run, your cardiac output goes up dramatically, and you really pump and I mean PUMP! Like this!" Pinkus clasped and unclasped his fist so hard that his knuckles turned white and his forearm musculature bulged. It was dramatic. I would be converted. I grasped his hand and asked, "What do I have to do to start?" Pinkus was pleased, and went right to shoe size. Instead viruses and atherosclerosis, my mind filled with New Balance 320s, anaerobic glycolytic muscle metabolism and a subscription to Runner's World. We planned out a schedule with which to begin, which would me to Marathon distance within a year. Pinkus was one great American.
Except for frolicking in the occasional erotic fondle I spent the rest of the day avoiding Jo and running scared. Jo wanted to teach me everything about everything so that when she left that night, my first night alone, I would be able to handle things. Apprehensive about turning her Unit over to me, she loitered around, and telling me "I never turn off my beeper," she finally left. As usual in my medical training, knowing little, I was put in charge of all. I needed someone who knew the nuts and bolts of the Unit. I ran to the night nurse, and made it clear that I was her pawn. Pleased, she used me, and began teaching me things never mentioned in my four rarefied BMS years filled with enzyme kinetics and zebraic diseases. I became a technician, getting off on how to set a respirator's dials.
Just before the ten?o'clock meal, I was called to the E.W. for my first admission, a forty?two?year?old man named Bloom, with his first MI. He was coming to the Unit because of his age. If he had been sixty-two, he would have been fending for himself on the wards, his chances of immediate survival halved. Bloom was lying on his stretcher in the E.W., white as a sheet, puffing with anxiety and cardiac pain. His eyes showed the terrified longing of a dying man wishing he'd spent his last days differently. He and his wife turned to me, their hope. Uncomfortable, I was surprised to find myself thinking of Pinkus, and asking Bloom if he had a hobby.
"No," he gasped, "I don't have a hobby."
"Well, after this you might think of developing one. I'm taking up running, for fitness. And there's always fishing for calm."
The risk factors were weighted against Bloom. He'd suffered a serious MI, and for a period of four days he'd camp on death's door, courtesy of the Unit. I wheeled him into the MICU, where the nurses swarmed over him, wiring him for sound, light, and whatever else they could grab onto. Ollie's face lit up with Bloom's ratty EKG. What was I doing for poor Bloom's heart? Not much. Watching for when Bloom stopped.
The Runt and Chuck, knowing what a strain my first night on call in the Unit would be, stopped by to talk. Even though it had gotten increasingly hard to make contact with each other, what had happened to Eddie and Puts had made us try to be with each other more. I said to the Runt, "I always meant to ask you, Runt, what's the matter with Angel's language centers. I mean, she starts to talk, fades out, and waves her hands around. What's it all about?"
"I never noticed," said the Runt. "She seems to talk fine to me."
"You mean you still haven't talked about anything?"
Thinking it over, the Runt paused, and then broke out in a wide grin, walloped his knee, and said, "Nope! Never! HA!"
"Damn," said Chuck, "you sure come a long way from that poet."
"I think I do love Angie, but I don't think I'll marry her. See, she hates Jews and she hates doctors and she says I whistle too loud and that I follow her around too much when we're not in bed. I think I might . . . Oh, hi, Angie?Wangie, I was just tell?"
"Runt," said Angie, "you know what"?gesture toward self?"I think?" Gesture toward Runt. "You; talk too"?gesture toward cosmos?"Goddamn much, Roy, Mr. Bloom wants to"?gesture toward mouth "talk to you. We need"?gesture toward heaven-"help."
Chuck and the Runt left, and left me to the shocks and thrills of my first solo night in space. Walking a tightrope with Bloom and the other patients, balancing over their catastrophies, I passed the evening. At eleven came the striptease, the nursing change of shift: smooth leading thighs, a black lace panty rolling down as the tight dungarees came off, flashing pubic hair, the side slope of a jiggly breast, the full frontal of two firm ones, errant nipples, the works. Testosterone storm. Who had each been abed with, how had each been abed with, before coming to work, to me? When I'd calmed down, I went to bed. A nurse awoke me at four A.M.: new admission, age eighty?nine; small MI; no complications.
"We don't take them that old," I said, "she goes to the ward."
"Not if her name's Zock. Not if it's Old Lady Zock."
Old Lady Zock turned out to be a typical gomere except for her money, which was three bags full. I was impressed. I would be nice to this Zock, she would give me a bag of money, I would leave medicine and marry the Thunderous Thigh and promise not to whistle, ever, or follow her around. I wheeled Old Lady Zock?whose shriek was MOO?ELL MOO?ELL?up to the Unit. If Bloom and Zock were to have clamored over the last intensive?care bed, who would have gotten it? No contest.
When a Zock gets admitted to the House of God, the whole ice?cream cone of Slurpers shakes and shimmers like a belly dancer in a hall of mirrors. The Leggo gets a call, and he calls on down the cone to the lower Slurpers, and as the nurses were settling Old Lady Zock into her bed, in trotted Pinkus. I looked at him and said, "Great case, eh?"
"Does she have a hobby?"
"Sure does. Moo?elling."
"Never heard of that one," said Pinkus, "what is it?"
"Ask her."
"Hello, dearie. What's your hobby?"
"MOO-ELL MOO-ELL!"
"What a funny joke, Roy," said Pinkus. "Say, look at this." Pinkus unbuttoned his shirt, revealing a running shirt on which was a giant-sized full-color healthy heart. He took off his trousers, revealing pink shorts on which, in blood red, was the slogan YOU GOTTA HAVE HEART. PINKUS. HOUSE OF GOD. "Here," he said, motioning the nurses' and my attention to his calves, "just feel these."
We fondled the steel cords that were his gastrocs and soleus. Pinkus reached into his tote bag and produced a pair of running shoes and said, "Roy, these are for you, a pair of my shoes that I don't use anymore. Already broken in, so you can start right away. Here, I'll teach you the stretching exercises. I'm on my way out for my A.M. six miles."
Pinkus and I performed the ritualized stretching of the muscles from the pelvis to the toes. Warmed up, he began to walk out of the Unit as dawn was beginning to break. He passed the room with the lights on, Bloom's, and asked, "Who's that?"
"New admission. Name's Bloom. No hobbies. None at all."
"Figures. So long."
The next day I was surprised that I was not tired. I felt excited. I'd been in control of the sickest, deadest patients alive. By watching the numbers and occasionally giving a med or turning a dial, I'd averted disaster all night long. Bloom had made it through the night. My biggest thrill that morning was Pinkus turning to me at the end of rounds and saying, much to Jo's chagrin: "Roy, good job on your first night on call. And not just a good job, no, I mean darn good job, Roy. Darn good job indeed."
For the rest of the day I rode the backs of the rolling waves of intoxication at my competence. Before I left, I
went to "M and M Rounds," which stood for "Morbidity and Mortality." At this conference, mistakes were aired, with the idea of not repeating them. In practice, it was a chance for the higher-ups to shit on the lower-downs. Given the propensity for mistakes on the part of some of the terns, the same terns would appear over and over again. That day, again it was Howie, being shat on for mismanaging someone with disease in his future specialty, renal medicine. Unfortunately, Howie had missed the diagnosis, and had treated the man for arthritis until he died from renal failure. I entered at Howie pronouncing the death.
"Did you get the post?" asked the Leggo.
"Of course," said Howie, "but I'd made a mistake the patient was not dead after all."
"Well, what happened next? '
"I called the resident," said Howie, as the audience laughed.
"Yes?" asked the Chief.
"Then. the patient really died and we got the post. The dying words were something like 'the nurse is incompetent' or 'the nurse is incontinent.' "
"What difference does that make?" asked the Leggo harshly.
"Why, I don't know," said Howie.
And Molly loves that asshole? I dozed off, and awakened to the Leggo discussing the case, saying, "Most people who have glomerulonephritis and spit blood have glomerulonephritis and spit blood." I thought I'd been dreaming until, awakening again, I heard the Leggo's next pearl: "There is a tendency for healing in this fatal disease." How pedestrian. Poodling around with kidney disease, and I was doing high-powered medicine with exact regulation of every known body parameter, in the Unit. I left M and Ms, signed out, drove home. I was surprised to find myself whistling, happy, thinking of the musculature of the leg. I would become like Pinkus. The deadness I'd felt in Gomer City was being replaced by the excitement of the Unit. Like the E.W., it was not a place where the gomers could come to linger and outlast me, no. From the Unit, unless they were rich or young, they would be TURFED elsewhere. The thrill of handling the complexity of disease, of running the show well and with power, on top of the pile, the elite of the profession. I was king. Hotcha.