The house of God

by Samuel Shem

  I put in big lines everywhere, monitored everything, and the nurse and I got ourselves rigged up, ready to launch. This would be my moon landing, my techno-Lisa, my grenade. Over the orange belly of the young mother of two we slaved away in erotico?synch, taking fluid out, putting fluid back, watching numbers, setting's dials, bathed in the eerie space light of the Unit, humming the melodies dished up by MUZAK. Hushed admiring others, doctors and nurses, dropped in to observe. Time turned timeless. The husband, having suffered the treatment and having lived with the death that the House red?hots had been denying his wife, informed us that he wanted us to stop, to do no more. Knowing that this last prolongation of life was worthless, done out of collective impotence and guilt, I convinced the husband to let us continue, assuring him-falsely??that her suffering would not be prolonged. Too enraged to cry, he left. I watched him go, huggin his little boy and little girl. They had quizzical looks in their eyes.

  At about midnight the arrest alarm sounded in room 5, where a pithed?frog woman died. In confirmation Ollie spewed forth a flat?line EKG. I walked into her room. Her husband sat there, content with the illusion of life provided by the respirator inflating and deflating the corpse that had been his wife. I asked him let me see her. He looked at me and began to weep. I helped him up and led him out to a cup of coffee. A nurse asked me what to do. Heading back into young mother's room, I told the nurse to turn off pithed woman's respirator.

  "I don't turn off respirators," said the nurse.

  I was puzzled. Why not? She's dead. I looked at nurse in silence, trying to understand. I went into room with the body. I looked at it, a female, now turned a waxy death?white, without heartbeat or blood flow, dead?brained with a skull filled with clotted blood, the lungs rippled by machine: I searched through thewired undergrowth in back of the bed for the respirator plug. I paused. Bona fide dead. Saul the tailor flashed through. It was easy enough. I did it. Time turned timeless again.

  The pleasing symmetry of the shape of that night continued through the next day, the day of the Marathon. I was doing extremely well. I felt extremely good for Pinkus, and planned to get off work early to watch him run up the worst hill, the Humbler. On rounds that morning, things went as smoothly as the MUZAK. A single incident, with the hepatitis woman, made it hard for me to do extremely well for a minute or two. Having spent much of the night completing the tricky hyro?digitotechnics of the Unit's equivalent of the moon walk, at about noon the nurse and I?she working a double shift out of compassion for this poor "salvageable" woman?were accosted by the husband, who get real red in the face and said, "I think you're both incredibly callous for keeping my poor wife alive!" The nurse burst into tears. I, in agreement with the husband, fell silent. The nurse and I stood there with the dying woman who stank of disinfectant and infection and bilirubin and ammonia, until the husband had done his punch?drunk catharting and left. For a few minutes I felt as if I were on the edge of some disaster, some abyss that seemed familiar from a nightmare. Then it passed, and again I felt calm.

  From noon until I left, I was to work in my Outpatient Clinic downstairs. With some apprehension I left my Unit and entered the hopelessly inefficient world of the rest of the House of God. As I was going into my office, I ran into Chuck going into his. He looked even worse than usual.

  "Well, man," he said, "bad news. I been found out."

  "Found out! Found out what?"

  "Well, you know how I always had the amazin' luck that the old ladies would never seem to show up at my Clinic, no matter what appointments they made?"

  "Yeah, it was amazing," I said.

  "Well, the reason they never showed up was that they was daid."

  "Dead?"

  "Un?hun, daid. See, I used to go over to the record room and pull charts, use daid names for appointments. Hardly any of 'em showed."

  My own Clinic was ridiculous. I employed a useful anatomical concept for Clinic medicine, called Scruffy's Rhomboid Space, which was formed by unbuttoning the fourth button down on the shirt or blouse, forming a diamond?shaped opening for my stethoscope. With clever wrist action, the stethoscope could be rotated and pushed in such a way that all major organs could be examined without having the patient undress. Using this technique, I waded through my familiar patients with their trivial complaints, my mind filled with the precision and elegance of the techniques of the Unit, like popping a steel needle into a virginal radial artery. My outpatients seemed wary of me, and many of them kept asking me if I was sure I felt all right I told them I was feeling extremely well. One in particular, my basketballing Jehovah's Witness, was insistent: "Why, Dr. Basch, you nevah for months used that stethelscope on me. We allas used to jes' talk I knows in mah heart that there's sumpin' gone wrong What is it?" I told her there was nothing wrong, and finished ex aminin g her. Shaking her head, she left.

  I muttered to myself as I walked through the fresh April afternoon toward the Humbler, all this education just to write prescriptions for padded bras withs pockets? What the hell was I in, anyway, ladies' lingerie?

  The gaily colored marathoners began to pass. The first, the leaders, looked fit and eager even after these twenty miles, even facing the terror of the Humbler .The build of the leaders was like that of Pinkus: thin to the waist, solid below. They ran through waves applause. How jealous I was! The blur of color went on and on and after about five hundred had gone by, there came Pinkus, in a determined sure style that might well bring him in under three hours. I shouted "Go get 'em, Pinkus!" and he looked up, without waving or smiling, and trudged on up the Humbler, with calm, deliberate strides. He looked good. He was doing extremely well, and I watched him go wistfully, the GOTTA HAVE HEART on his rear end disappearing over the crest. My man Pinkus hadn't even broken stride. The Humbler? Ha!

  Later that evening, at the high?school gym after playing some hoop, I ran into a Unit nurse, whose name I'd always forgotten and couldn't recall then. Wearing a tight black Danskin, she was working out with weights. I was surprised and delighted with her body and with her interest in her body. Dripping sweat, we chatted. I asked her out for a drink. In the bar we watched Nixon, who, even though Haig thought that Nixon "didn't sell on TV anymore," had gone ahead with a prime?time TV address from the Oval Office, something about "edited transcripts" of the tapes. The packaging was terrific! On a side table to which the camera intermittently panned were shiny black vinyl binders, each embossed with a gold presidential seal. "I am placing my trust in the basic fairness of the American people."

  Nuzzling the nurse's sweaty neck, I said, "Damn good idea. It's about time. Get the goddamn thing straightened out, once and. for all." To me, the lockerroom aroma of this tough nurse was more enticing than perfume. I loved it.

  After the drink, before the bedding, she went with me to an all?night sporting?goods store, where I bought myself my first ever fishing rod and reel.

  22

  Having done extremely well in the Unit, it was difficult for me to say good?bye. I felt sad. I wanted to stay on. How do astronauts say good?bye? As befit a pro, my good?byes were unemotional. Neal Armstrong saying good?bye to Frank Borman. John Ehrlichman saying good?bye to Robert "Bob" Haldeman. Good?bye to Pinkus, my hero, who had run two hours fifty seven minutes thirty?four seconds and who said, "Cardiology can be very rewarding in financial and personal terms, and with the implementation of hobbits, a very healthful life. Think about it, Roy, you're a young man with a bright future."

  I left.

  Later that afternoon. Berry and I, ROR, were driving out into the countryside to relax. I was reading a letter from my father.

  . . Your experience undoubtedly is stimulaling and I am sure that you are totally absorbed. Soon it will be over and you will have to decide about your future life . . .

  "You know," I said to Berry, "after all these years of disagreement with him, I finally think he's right.."

  We sat on the edge of a park, the spring blushing chaotically all around us. The swath of green, lush with a fresh rain, swe
pt across in front of us, from the pond reflecting the mansion on the left, past the hundred?year?old oak under which the WASPs held their weddings, to the old stone wall and in back of it, the symmetric and rooted old houses. A dog came up to play, dropping a twig closer and closer until I threw it and he chased it. After a while I got tired, and he sensed it, and left. My mind, like a missile, kept homing to the Unit.

  On the drive back, I felt restless, and Berry noticed and asked, "What's the matter, Roy? You're done with the hardest part of the year."

  "I know. I miss it. It's hard to relax. Even fishing would be easier than this. Did I tell you I bought a rod and reel? You know, I need your help. With your psychological expertise, maybe you could tell me how I can change."

  "Change what?"

  "My personality. I want to go from Type A to Type B."

  Berry didn't comment. We separated, planning to meet again that night. We had tickets to see Marcel Marceau.

  I was restless. I missed something. I was not doing well. I didn't want Marcel Marceau, I wanted the Unit. It would be strange if I went back there tonight, my first night off. After I had finished. But wait: Jo had done it. My first day there, she'd spent the night with Mrs. Pedley. I would do it too. Under the guise of concern for the old lady in V Tach, I would go and spend the night on the Unit. It wasn't until the hermetic doors slushed shut behind me, and I heard the ethereal "A?round the wurrtd in aay?tee dayzz . . ." and I settled into a chair in Pedley's room, that I felt calm again. .

  This calm was not to last. Berry appeared, dressed to kill, and said, "Roy, what the hell are you doing here? We're supposed to see Marcel Marceau. You bought the tickets, remember?"

  "Here, feel this," I said, indicating my gastrocs.

  "What about Marcel Marceau?"

  "Inoperative."

  "All right, Roy, it's either this or me: take y ow pick."

  I heard myself say, "It's this:"

  "That's what I thought you'd say," said Berry, "and I don't buy it, 'cause you're sick!' She made a motion out into the hallway, and in walked the two police men, Gilheeny and Quick. Following them were Chuck and the Runt.

  "A good evening to you from the depth's of my nervous stomach," said the redhead, limping in. "We have not seen you since you became a red?hot intern in this weird Unit."

  "We have missed you," said Quick. "Finton here, with his bolloxed leg, cannot pursue your company as once he could."

  "What the hell are you doing here?" I asked suspiciously.

  "Your girlfriend said that you have been crazy and were refusing to leave this Unit and go to the show with her," said Gilheeny.

  "I'm not going;" I said. "It's ROR with her and me. Face it. We're through."

  "Hey, man." said Chuck, "you don't want to sit here with these pitiful patients. You're done with Unit this shit, get out, get on down."

  "They're not pitiful. They're salvageable"

  "Roy," said the Runt, "you're acting like a donkkey."

  "Thanks a lot, my fairweather friends. I'm staying here. None of you can understand me anymore. Please leave me alone."

  "Trespassing is an offense," said Gilheeny, "and, we shall remove you. Boys, let's begin."

  With a good deal of furious struggling and on my part, under Gilheeny's direction Quick, Chuck, the Runt, and Berry hoisted me up and carried me out,ushered me down the stairs, and helped me into the police car, which, sirens blaring, raced through the downtown traffic and delivered Berry and me to the theater door. I sat there, bullshit. While I thought I'd escape when left alone with Berry, once again I had underestimated these policemen.

  "You're coming in with us?" I asked, amazed.

  "We are admirers of true genius," said Gilheeny, "and true is the genius of M. Marceau, a Jew of the French Catholic denomination, combining the better attributes of both."

  "How the hell did you get tickets on such short notice?"

  "Graft," said Quick simply.

  With Berry and me sandwiched tightly between the bulky Gilheeny and the sinewy Quick, I realized I was trapped, and I resigned myself to sitting there until intermission. I watched as the lights dimmed and the mime began. At first I was indifferent, my mind on the Unit, and yet, as Marceau went on, with Berry pressing my hand and the policemen reacting with all the spontaneity of kids, I couldn't help getting interested. The first mime was the Balloon Seller, giving a free balloon to a child, who, clutching it in his hand, is floated up and up out of sight. Everyone around me laughed. On my left I heard a chortle, erupting into a roar, and I realized from the smell of fat and sweat from a uniform that it came from Gilheeny. A hefty elbow slammed into my ribs, and the redhead turned to me, flashed his huge hippo smile, and screamed, flooding me with onions and hash. I laughed. Next, a mime I'd seen Marceau do in England: in thirty seconds he walked through the successive stages of youth, maturity, old age, death. I sat, hushed, with the others, touched, enthralled, as we recognized our lives ebbing past us in a matter of seconds. Blasts of applause crackled through the theater. I looked at Quick. Tears were in his eyes.

  All of a sudden I felt as if a hearing aid for all my senses had been turned on. I was flooded with feeling. I roared. And along with this burst of feeling came a plunging, a desperate clawing plunge down an acrid chasm toward despair. What the hell had happened to me? Something in me had died. Sadness welled up in my gut and burned out through the slits of my eyes. A handkerchief was placed in my hand. I blew my nose. I felt a hug.

  The last mime skewered me: The Maskmaker switched back and forth a smiling mask, a crying mask, faster and faster, until finally the smiling mask got stuck on his face and he couldn't remove it. The human struggle, the frantic effort to be rid of a suffocating mask; trapped, writhing, wearing a smile.

  The theater erupted. Ten encores, twelve. BRAVO! BRAVO! we screamed, and flowed out with the rejuvenated crowd. I blinked, confused. Inside me, all was chaos. My calm had been the calm of death. More than anything, I wanted to jackboot Pinkus in his plump pink soleus. Thank God for Berry, for my orthodox samaritans, my policemen. As we parted from them, Gilheeny, touched, said, "Good night, friend Roy. We'd been worried that we'd lost you."

  "We've seen it happen before to interns," said Quick,

  "and if it had happened to you, it would have been a singular loss. God bless."

  Later, Berry welcomed me back to her, and I felt her caring arms around me as if for the first time. Awakening, I began to thaw. I began to feel a trickle, then a rush of feeling that was scary and overwhelming. Choked up, I began to talk. On and on into the night I talked about the things I'd blotted out. The theme, over and over, coating my bedroom walls with a grayish?white mottled skin, was death. I talked about the horror of the dying, and the horror of the dead. Guiltily I told her about injecting the KCL into Saul. She couldn't hide her shock. How could I have done that? Even if my head told me, Yes, it had been for the best, my heart cried out, No! I hadn't done it for him, for the humanity of it, no. Angrily, to shut him up and to get back at them, I'd done it for me. I'd killed a human being! How that phrase would haunt me, tail me like an Israeli agent a Nazi, search me out when I was least suspecting, clamor after me in sleepy tropical courtyards of my new life where I'd thought that I'd found peace. Finding me, it would accuse me, and I would say: "I must have been out of control, crazy." Coldly, rightly, it would say: "That can be no excuse."

  I talked on, about the families of the patients in the Unit, coming in, searching my eyes for hope. What had I done? I'd done everything I could to avoid them. I had been as far from the world of humans as I could get. Disgusted, I talked about how, in the face of suffering, I'd been professionally nonchalant. Where compassion had been needed more desperately than any medicine, I had been sarcastic. I'd avoided feeling everything, as if feelings were little grenades blasting off a fingernail, a toe, a fragment of a heart. Tears in my eyes, I asked Berry, "Where have I been?"

  "Regressed. I thought I'd lost you for good."

  "Why? Why di
d I get like that?"

  "The more the hurt, the more the fantasied need for defenses. Potts's death rocked you. You imagined yourself to be so fragile; you wouldn't let yourself grieve: Like a two?year?old scared of the dark, you locked onto rituals-your machines, your crazy idolization of Pinkus-to protect you."

  She was right. Since Potts's suicide, all of us had gone around like zombies, stunned, numb, too scared to cry. Each of us had been strung out trying to save ourselves, fighting against going really psychotic like Eddie or really killing ourselves by leaping from real buildings and splattering on a real parking lot eight stories below. We knew that it could have been any of us. Lethal, this becoming and being a doctor! Denying hope and fear, ritualized defenses pulled up around ears like turtlenecks, these doctors, to survive, had become machines, sealed off from humans-from wives, kids, parents-from the warmth of compassion and the thrill of love. I realized that it wasn't just that they'd kept on riding Potts about the Yellow Man, no. They'd ignored his suffering, his months of fatal depression. And because I felt helpless and didn't know what to do, I'd ignored it too.

  "This internship?this whole training?it destroys people."

  "Yes. It's a disease. The kind of stress you're under, unless you can find some safety, some caring, you've got only a few choices: kill yourself, go crazy, kill someone else. Potts had no one, no way to survive." Berry paused, took, my head in her hands, and more seriously than I'd ever seen her, said, "Roy, you're a survivor. You'll make it now, to bear witness, to record the ones who didn't survive."