The house of God

by Samuel Shem

  I couldn't wait to slip into my shorts and Pinkus's old shoes. Well-worn, they cradled my feet. Tired as I was, I put myself through the Pinkus stretching maneuvers, and trotted out to the street, and with the sun lowering in front of my eyes, with the soothing PLONKA PLONKA of the wide cushioned soles against the asphalt, I was carried a few miles farther toward the land of dilated coronary arteries, patent to rich red well?oxygenated blood. I was a child, free after supper, floating on Icarus wings in the first warm evening breeze of Daylight Saving Time, of spring.

  I came back with chest pain, worried that I had angina pectoris and that I had started exercising took late in life. I would die from an MI while running: Pinkus would view my corpse and say wistfully, "Too bad. Too late."

  Berry was waiting for me at home, and given my usual sedentary life, she couldn't believe her eyes.

  Taking her hands, I put them on my gastrocnemis and said, "Here, feel that."

  "Yeah?"

  "That's BEFORE. I want you to form a clear mental image of that, for when you get to feel AFTER."

  20

  By the end of the first two weeks I was doing four miles a day. To my relief, what I'd feared was anginal pain was, according to Pinkus, pain referred from the stretching of the intercostal ligaments as the rib cage expanded, common to beginning runners. I began to run the four miles to work, floating along the cycle path?named in honor of a famous marathoning cardiologist who'd died of old age?next to the river, the dawn breaking over the awakening city, my PLONKA PLONKA a soothing affirmation of my lifebeat.

  But all was not Pinkus yet. Unlike him, I had yet to come to terms with the Unit. One side of me was filled with the horror of human misery and helplessness; the other was exhilarated, king in an erotic diseased kingdom, competent to run machines. Being on call every other night meant that there was never time to think about the world outside the House, and the conflicts of the Unit became the main conflicts of life. The nurses? Like the background in Vermeer's Lady with a Guitar, the empty black highlighting the glow of candle on lithe fingers, the disease highlighted the sex.

  Often I'd find myself entwined in variants of the same erotic theme: late at night, the eerie artificial Unit light punctured only by the green-flashing BLEEP-BLEEP of the cardiac monitors. The nurse calls me from the bed to see a comatose patient whose body is being run by the machine, one parameter of which has gone awry. Following her to the bedside, I notice her bralessness, that she wears no pantyhose. I put a stethoscope on the body. I need to listen to the chest, and ask the nurse to help me. She bends over, the two of us hoist the body to sitting, tube dangling down. I listen to the clogged lungs, inflated by respirator, my fingers on the waxy skin, fighting the stench of chronic disease. I smell her perfume, coconut. Our heads are close together. I drop my stethoscope, put my free hand around her neck, kiss her. Her tongue and my tongue slither together. I lean my shoulder against the patient's body, freeing the other hand. The kiss prolonged, I fondle her breast through her cotton dress, a feeling the coarse fabric scratching against the skin, pulling the nipple erect. We part, the body falls back THUMP on the bed. Later, on her break, she comes to the on?call bunk bed, hoisting up her green surgical skirt because there isn't time to undress. We two begin to take out our hatred, our loneliness, our horror with human suffering and our despair at human endings in the most tender of human acts, making love. Knowing that she hates me for being a doctor, for forgetting her name three times that shift, for being a Jew who views her eunuch Pope's pronouncements on "Human Life" as comical at best, for running her Unit, for her being trammeled on by men like me, for my always being the smarter one in the class, for all those hates and for the arousal bred by hates, bash away at each other savagely, skin on skin, cock in cunt, with the desperation of two space travelers on a journey of light?years, with death at the far end and no way back, imprisoned in a spacecraft of chrome and lights and computers and MUZAK. She will not talk to me about her hatred, she will not even gesture to me about her hatred, she will only fuck me for her hatred, and let it go at that. Groaning, we rattle the springs of the bunk bed, secured by the vigilance of two machines: her IUD, and each of our abilities, the next morning, to forget. California, here I come! We finish. Blushing from the clitoris and not from the heart, she goes back to work.

  In tune with this spring theme of sex and death, like eight vultures, the days of Passover swooped down upon the House of God. Despite the false hope offered by Good Friday and Easter Sunday, with the coming of Passover there was no question of God's intent: death. Despite the technocratic thrust toward life, God flexed his biceps and triceps and, for all we knew, infini?omniceps, and began to mock us, with death. During Passover, patients began to drop like flies.

  It was eerie. We'd work like hell on someone, who'd appear to have made it, and then?BLEEP?a cardiac arrest and death. I'd pick up a patient in the E.W., and as I put my stethoscope on him, he'd clutch his chest, turn blue, and die. I'd be sleeping peacefully, and?BUZZ?the arrest button would sound and I would run, blinking and trying to hide my sleep erection, into the bright neon and MUZAK searching out the room with the panic, and sure enough God had made his move and another had cooled on us. Afterward, looking back over the recordings stored up by Ollie, we'd find that despite our preparations, an aberrant beat would have landed at the vulnerable period and?BLEEP?ranting, arrogant, in strutted death.

  All of us were shocked. The families of the dead, set up with hope and then smashed with despair, suffered beyond words. Blitzed, their own hearts cut from their moorings and rolling and floating in their chests like balls of wool in empty bags, they washed us with their tears. Jo, the perfectionist, was hard hit. By Day Four of Passover, she was frantic. Fighting the specter of what she took as a personal failure to keep her patients alive. Jo adopted a sort of phlogiston theory, deciding that there was something contaminated somewhere in the Unit. When Pinkus arrived, she assaulted him with this idea and insisted that the Unit be torn apart, top to bottom, to find the noxious agent that was killing her patients. Pinkus, phlegmatic, told her she could do as she wished, although he didn't think that was it. He asked me to feel his legs, and I did, and said, "Amazing."

  "The Marathon's only six days away. Carbohydrate loading starts today,"

  "Pinkus," said Jo with great intensity, the circles under her eyes even blacker, "I want to make one thing perfectly clear: we are going to win this war against; death."

  The penultimate setback for Jo, was at four o'clock in the middle of the Fifth Night. Jo usually stayed up most of the night, but the stress of being the first woman resident to wrestle directly with the Angel of Death had worn her out, and with things seemingly under control, she'd gone to bed for an hour. Shortly thereafter, all hell broke loose, with a man named Gogarty, a spanking?fresh virgin MI, having a cardiac arrest. Jo was called, and with a fanaticism hardly ever seen in the Unit, spent an hour 4?plussing the victim back toward life. Unfortunately, Gogarty turned out to be a smokescreen, for as Jo and the nurses left room what sight should greet their eyes but Old Lady Zock spread?eagled nose?down on the tiled Unit floor-stone dead. It turned out that, having heard the commotion in Gogarty's room, Old Lady Zock, in a fine philanthropic gesture, had wished to pitch in at the arrest, and following the most heart?rending of House LAWS: GOMERS GO TO GROUND, had done so, in the process dislodging the cardiac pacemaker which was prodding her generous heart, and had died.

  The final irony, of course?the story of Jo's life?that Jo's insisting all nurses tend to Gogarty had caused the neglect of Zock. When a Zock gets neglected, it shakes God's House.

  The next morning, there was much commotion. It was Zocks versus Medicine. Recrimination City. Although in the confrontation the Leggo restrained himself from asking for a postmortem, Jo did not, and things got sticky. The Leggo told Jo to "get the hell back inside," and we watched as the caravan led the flock of Zocks away to one of the green plush "function rooms" donated by the Zocks and used only for the stroking of p
hilanthropists of the House of God.

  Fed up with Jo's "contamination" theory, I announced that I was going another route. Jo asked what it was, and I said, "Fight fire with fire." I picked up the phone and told the operator to page the Rabbi on call, STAT. Alarmed that his beeper had gone off, and STAT at that, huffing and puffing, young Rabbi Fuchs arrive. I told him about the Reign of Death, and about my conviction that this was, in some way, a Visitation of the Lord God, over Passover, mistaking us for Egyptians.

  "I don't understand," said Rabbi Fuchs.

  "Isn't it just possible that God is punishing us with these deaths, and that we should do everything within our power to follow his Passover Laws? Like paint the doorposts of the Unit, use special Passover dishes, leave a cup of wine for Elijah the Prophet, and so on?"

  The black?bearded intellectual Fuchs looked puzzled, peered through his granny glasses at Ollie's sempiternal flickering console, and said, "The Haggadah, the Passover Story to which you refer, is not literal, it's homiletic. Yes, that's it: the exigesis of the Haggadah, since the eleventh century, has produced commentaries that are mostly homiletic, although sometimes mystical, in character."

  "Did you understand that, Pinkus?" I asked.

  "Nope."

  "Me neither. What do you mean, Rabbi?"

  "Don't take it literally. It is myth. God doesn't work that way anymore. These deaths have to do with physiological fact, not with the whims of Deity. Body, not soul, is what's dying here."

  Leave it to the House of God to produce some red-hot Theology student as its Rabbi. I turned to him and asked, "What denomination are you anyway, Rabbi Fuchs?"

  "Me? Why, Reform."

  "Figures," I said, picking up the phone. "Thank you very much. I'm calling the Orthodox boys, the Hasidim."

  The Orthodox Rabbi was an aged, white?bearded patriarch from a half?abandoned synagogue in the black ghetto. Excited by my idea, he quoted cabalistic writings about "the homes of the sick during the Exodus," telling me about the timeliness of the Passover teachings, as in the Mishnah: "In every generation let v each man look on himself as if he came forth out of Egypt." Unfortunately, this Rabbi suffered from congestive heart failure, and before we could get on,, with the chanting and painting, he wanted some gratis medical advice. This took us up to lunchtime, and the Rabbi said he must stop and eat. He produced a small: screwtop jar, sat down with the nurses and me, and. as he opened it, I knew what it was.

  "Herring," he said to the nurses, "piece herring."

  "I thought you were low salt?" I asked.

  "Yeh, I em. Would you believe: the whole low salt for one day is in this tiny piece herring?"

  Finally, Maintenance delivered the can of bloodred paint, and with the Rabbi belching herring, beginning to pray, chanting and dovening back and forth, I slapped the red paint around. I wished the Rabbi well, made small donation to his shul, and reentered the space lab. That evening, as I listened to the Runt blather on about his ecumenical fornications with Angel, befittingly menstrual during Easter and Passover both, I listened for the wingbeats of the Angel of Death passing over my Unit.

  For a night it worked. The main threat that night was Dr. Binsky; a middle?aged Private, who'd suffered a serious MI. I knew that he knew he might die, despite the pull of being colleagues, my fear of getting involved pulled me away from him. During the night Dr. Binsky served up most of the cardiac arrythmias known to man. Luckily, miraculously, each responded to my efforts, and dawn saw Binsky, and vice versa. The Orthodox boys had come through.

  The next morning, the Seventh Day, Jo was ecstatic. Seeing none dead, she beamed from ear to ear, clasped my hand, and affirmed that, "by God, we're going to win, and if it takes painting the doorposts, why of course we'll paint the doorposts, in the interest of patient care." We want to see Dr. Binsky, and Pinkus, his old friend, said, "Hi, Morns. How's Morris today?"

  "I feel OK, Pinkus. What's it been now, forty hours?"

  "Just about."

  "How's my rhythm strip today?" asked Morris.

  "Dr. Binsky," said Jo, putting her hand in an olderbrother fashion on his shoulder, and with a crinkle in her voice, "it's normal sinus rhythm again. NSR, at last."

  "What a relief," said Dr. Binsky, "what a gigantic relief."

  Ten seconds later he had a cardiac arrest and despite our efforts, within the half?hour he was dead.

  Jo broke. She sat in the staff room with Pinkus and me, crying, repeating over and over, "He couldn't have died, he was in normal sinus. Normal sinus rhythm and now he's dead? It doesn't make any sense, statistically. I can't take this absurdity anymore."

  "People do die in NSF," said Pinkus calmly. "It shows that we did all we could, right, Roy?"

  I nodded my agreement. Of course Pinkus was right.

  "Look, Jo," said Pinkus, "he went out in perfect, normal sinus rhythm. With class. Yes, he went out the House of God way."

  I thought of a House LAW: THE PATIENT IS THE ONE WITH THE DISEASE. It was his heart, not mine. I was immune from responsibility or concern. My world was for running, eating right, and staying calm. I left Jo to puzzle it out, and tended to the others of the Unit. Later that afternoon I said goodbye, wished Jo good luck, and on the four?mile run home filled my mind with Pinkus and God. I had done all I could, and Dr. Binsky had died. To get anxious about it, to eat away at myself, would only increase my stress, and boy did I know about the risk factor, stress. Personality Type A, the cardiac grenade. No thanks.

  After dinner that night, Berry and I were walking home. She was surprised at my energy, given the fact that I'd been averaging only three hours' sleep a night since I'd begun in the Unit.

  "Pinkus says that within limits, fatigue is mental,; not physiological. Every other night is not bad. I kind of like it."

  "Like it? I thought you hated being in the House at night."

  "Outside the Unit, I did. Inside the Unit, I like it. In fact, I almost could say I love it. Like the surgeons say: 'The only drawback to being on call every other night is that you only get to admit half the patients' That's how I feel too. I might become a cardiologist."

  Berry stopped, grabbed me by the shoulders, forced me to look at her. She seemed far away as she said, "Roy, what's the matter with you? For months you've been telling me how the internship is wrecking your life?your creativity, your humaneness, your passion. What the hell is going on with this Unit anyway?"

  "Don't know. Lotta deaths. Jo cracked. Cried. High anxiety level. Type A. Even with estrogens, bad news for her."

  "Jo cracked? And what about the effect of these deaths on you?"

  "These deaths? So what?"

  "So what?" asked Berry, in a tone that came from the bottom of a well, far off, ringing of dismay and regret, "I'll tell you what?the more deaths, the less human you become."

  "You shouldn't worry. Like Pinkus says, 'anxiety's a killer.' "

  That night in bed, as I turned to her and touched her shoulder, I could feel her tension. She stopped me and said, "Roy, I'm worried. I could understand your shutting yourself off from grieving Potts's death, but this is too much. You're isolated. You never see your friends, you never even mention Fats or Chuck or the policemen anymore."

  "Yeah. I think I've left them all behind."

  "Listen to me: you don't love the Unit, it's a defense. You don't love Pinkus, it's a defense. You're hypomanic, identifying with the aggressor, idolizing Pinkus to save yourself from falling apart. It may work in the House, but it won't work with me. For me, tonight, you're a dead man. There's no spark of life."

  "Gee, I dunno, Berry. I feel healthy and alive." Thinking of Hal, the computer in 2001, I said, "Things are going extremely well."

  "How much longer does this MICU rotation last?"

  "Ten days," I said, and caressed her hair, thinking calmly of our supreme primeval exercise, sex. She pulled away, and I asked why.

  "I can't make love to you if there's this distance between us."

  "You mean you can't stand the thought
of another woman? Because that's all ov?"

  "NO! I can't stand you! I've just about had it with trying to get through to you. I've got to start thinking of myself. I'll give you the benefit of time, let you finish the Unit, to see if you can snap out of this. Otherwise, it's all over. After all this time, we're through. In your terms, it's ROR, Roy, ROR."

  As if from far off, I heard myself saying, "Better ROR than anxiety, Berry. Better that than Type A."

  "Goddamn you, Roy!" she screamed, in tears. "You are a jerk! Don't you realize what's happening to you? Answer me!"

  "At this point in time," I said, trying to remain calm in the face of all this turmoil of emotion and stress, "that's all I have to say." Berry let out a hissing sound, like a train makes braking into a station, and she said, "You're not a jerk, Roy. You're a machine."

  "A machine?"

  "A machine."

  "So what?"

  21

  She was wrong. I was not a machine. I was not dead. I was alive. I was doing extremely well. My life was full. The PLONKA PLONKA of my feet on the bicycle path beside the river basin helped to beat out an affirmation of these reassuring thoughts. My head felt clear, like a sleek coronary artery lumen, a sleek woman in a maillot bathing suit, wet from a tropical sea.

  That night was my masterpiece. A nurse and I had been told to do a marvelously difficult and intricate medical procedure. A young mother of two had been lingering toward death for months. Now, with endstage liver disease, she was finally about to die of massive infection and failure of her heart, liver, kidney, brain, and lung. She had been sent to the Unit, and we had been told to drain the infected fluid out of her belly and replace fluid in her circulation. Since the fluid that we put back into her circulation would, because of the low serum protein, soon migrate back into her belly, this procedure, if successful, would do no good. So what? Long ago I'd given up the idea that what I did to these bodies had any relevance to whether it did any good. I would do it well. Why should I mind being the final expiation for the failure of House medical care?