The house of God

by Samuel Shem

  "You know how it is, man. I mean, just look at a me. When I firs' came here, I looked great, didn't I, guys? I was thin, ath?a?letic, dressed like a Bluenote, remember? Now I'm fat, and I'm dressin' like a janitor, a damn bum. Why? You dudes and them gomers, that's why. And mostly you?you made me what I am today. Thanks, man, thanks a lot. I be good god?damned if I stay here for round two."

  We were startled by Chuck's outburst. The Leggo, looked hurt and puzzled. He began to question Eddie, but the Runt, more and more angry, exploded: "Damn it, Leggo, you don't realize what we've been going through this year. You don't have a clue!"

  There was an ominous hush. The Runt, wild?eyed, looked like he was about to strangle the Leggo, the Fish shielded his Chief with his body and gestured toward the policemen. Snarling, the Runt continued "There's some good news, there's some bad news: bad news is there's shit around here; the good news is that there's plenty of it. You've broken us this year with your pious version of medical care. We hate this. We want out."

  "What?" asked the Leggo incredulously, "you me you don't enjoy doing medicine here at the House God?"

  "Get it through your fucking skull!" shouted Runt at the Leggo, and, according to Freud, at mom and pop in the Leggo, and sat down.

  "It's just a small radical nucleus."

  "Nope," I said in somber tone. "It's all of us morning I saw Howard Greenspoon bashing screaming at the elevator door like a maniac."

  "Howard? No!" said the Leggo. "My Howie?"

  The attention turned to his Howie. Silence. The tension billowed out. Howie squirmed. The tension hung, taut. Howie cracked: "Y?y?yes,. Chief, Sir, I'm sorry, but it's true. It was the gomers: one named Harry and a flatulent woman named Jane. See, it's my admitting days that kill me. Each admitting day?knowing that the total age of my admissions will be in the four hundreds?I get depressed and I want to kill myself. The tension had been incredible: those M and M Conferences where I get roasted every two weeks for my mistakes?I can't help making mistakes, can I, Chief??and then Potts splattering and his mess being spread around so we had to park right on him, and all these gomers. And then the young patients dying no matter what we do. The truth is, Chief, well . . . well, since September I've been on antidepressants, Elavil. And I'm staying on here; imagine how the other guys feel. Like the Runt: he used to be a fun guy, and now . . . why, just look at him."

  We all looked at him. The Runt was staring at the Leggo with a gaze as ferocious as Crazy Abe's. The Runt looked extraordinarily mean.

  The Leggo, shocked, asked, "You mean you don't look forward to your admitting days?"

  "Look forward?" said Howie. "Chief, two days before my admitting day?just after my last admitting day?I'm nervous, and I up my dose of Elavil twentyfive milligrams. One day before my admitting day, I add fifty of Thorazine. On my admitting day, as I start to see the gomers, I start to shake, and . . ." Shaking, Howie took out a silver pillbox faced with mother?of?pearl and popped a Valium into his mouth. ". . . and it's Valium all the way. On real bad days . . . well, it's hits of Dex."

  8o that was Howie's smile: the guy was a walking Pharmacopoeia.

  The Leggo had gotten stuck on something Howie had said, and asked the Fish: "Did they say they don't enjoy their admitting days?"

  "Yes, sir," said the Fish, "I do believe they said that, sir."

  "Strange. Boys, when I was an intern, I loved my admitting days. All of us did. We looked forward to them, we fought for those 'toughies' so we could show our Chief what we could do. And we did damn well. What's happened? What's going on?"

  "Gomers," said Howie, "gomers are what's going on."

  "You mean old people? We took care of old people too."

  "Gomers are different," said Eddie. "They didn't exist when you were a tern, 'cause then they used to die. Now they don't."

  "Ridiculous," said the Leggo emphatically.

  "It is," I said, "and it's true. How many guys have seen a gomer die under his own steam this year, without medical interference? Raise your hands."

  No hands went up.

  "But surely we help them. Why, we even cure."

  "Most of us wouldn't know a cure if we found one in a Cracker Jack Box," said Eddie. "I haven't cured anybody yet and I don't know an intern who has. We're all still waiting for number one."

  "Oh, come, now. Surely. What about the young?"

  "They're the ones who die," said the Crow. "Most of my posts were on guys my age. It was no picnic, Chief, winning your Award."

  "Yes, well, you are all my boys," said the Leggo as if he had forgotten to turn on his hearing aid that day, "and before I close this meeting I'd like to a few words about the year. First, thanks for the terrific job. In many ways it's been a great year, one of the best. You'll never forget it. I'm proud of each every one of you, and before I end, I'd just like to say a few words about one of you who isn't today, a physician with a tremendous potential, Dr. Wayne Potts."

  We stiffened. Leggo was asking for trouble if he messed with Potts.

  "Yes, I'm proud of Potts. Except for some defect that led to his . . . accident, he was a fine young physician. Let me tell you about him. . . "

  I tuned out. Instead of anger, I felt sorry for the Leggo, so stiff and so clumsy, so out of touch with the human, with us, his boys. He was another generation, that of our fathers, who in restaurants before paying, added up the arithmetic of the check.

  ". . . maybe this year has been a little difficult, but all in all it was a pretty typical year, and we lost one in the middle, but sometimes that happens, and the rest of us will never forget him. Yet we can't let our dedication to medicine suffer because . . ."

  The Leggo was right: it had been your standard internship year. All across the country, at emergency lunches, terns were being allowed to be angry, to accuse and cathart and have no effect at all. Year after year, in eternam: cathart, then take your choice: withdraw into cynicism and find another specialty or profession; or keep on in internal medicine, becoming a Jo, then a Fish, then a Pinkus, then a Putzel, then a Leggo, each more repressed, shallow, and sadistic than the one below. Berry was wrong: repression wasn't evil, it was terrific. To stay in internal medicine, it was a lifesaver. Could any of us have endured the year in the House of God and somehow, intact, have become that rarity: a human?being doctor? Potts? Fats had done it, yes. Potts?

  ". . . and so let's have a moment of silence for Dr. Wayne Potts."

  After about twenty seconds the Runt blasted off again, shouting, "DAMNNIT, YOU KILLED HIM!"

  "What?"

  "YOU KILLED POTTS! You drove him nuts about the Yellow Man, and you didn't help him when he was crying for help. If an intern sees a shrink, you stigmatize him, you think he's nuts. Potts was scared that if he saw Dr. Frank it would damage his career. You bastards, you eat up good guys like Potts who happen to be too gentle to 'tough it out' It makes me want to puke! PUKE!"

  "You can't say that about me," said the Leggo sincerely, looking crushed. "I would have done anything to save Potts, to save my boy."

  "You can't save us," I said, "you can't stop the process. That's why we're going into psychiatry: we're trying to save ourselves."

  "From what?"

  "FROM BEING JERKS WHO'D LOOK UP TO SOMEONE LIKE YOU!" screamed the Runt.

  "What?" asked the Leggo shakily, "what are you saying?"

  I felt that he was trying to understand, and I knew he couldn't but that he was crying inside because we'd pushed the button that had him hearing the tapes of all his failings, as father and son, and I said as kindly as possible, "What we're saying is that the real problem this year hasn't been the gomers, it's been that we didn't have anyone to look up to."

  "No one? No one in the whole House of God?"

  "For me," I said, "only the Fat Man."

  "Him? He's as kooky as Dubler! You can't mean that, no."

  "What we mean, man," said Chuck forcefully, "is this: how can we care for patients if'n nobody can for us?"

  At that, for the first time
, the Leggo seemed to hear. He stopped, still. He scratched his head. He made gesture with his hands, as if to say something, but nothing came out. He bent at the knee, and sat down. He looked hurt, a kid about to cry, and as we watched his nose twitched and he dug into his baggy trousers for his handkerchief. Saddened, sobered, yet still mad, we filed out. We'd played for keeps. The door closed behind the last of us, leaving our Chief alone. Boozy, babbling, Nixon was coming apart in public places. People were filing out. What he was feeling, no one wanted to know.

  Berry, Chuck, and I were at the mansion of Nate Zock. We sat in the fake Elizabethan garden basking in the late?afternoon summer sun, looking back up toward the multimillion?dollar palace, a mixture of millennia of architectural vogue. Nate finished retelling the "Basch's a tough guy, don't cross him" story. Berry and I excused ourselves to play tennis, leaving Chuck to booze it up with Nate and Trixie and the overweight bovines grazing on the hors d'oeuvres and low?calorie celery tonic. The tennis court was wind?sheltered by beech and poplar, and roses coated the fence enclosing it. The splash of color and waves of scent made it like playing tennis inside a rose. We sweated. We stopped, and Nate urged us to cool off in the indoor pool. We hadn't brought swimsuits.

  "That's OK," said Nate, "no one's going to watch."

  "And no one's keeping track of the time," said Trixie, "we know all about the sex lives of our young Dr. Kildares."

  We wandered up the lawn to the house, and I realized that unlike the rich, I was unused to privacy, to being unwatched, to things?pools and tennis courtscoming in ones. We passed the garage, where the butler was waxing Berry's Volvo, trying to match the shine on Nate's white El Dorado. In the indoor pool, tile?echoing, secluded, we stripped, embraced, dived down into the perfectly right water. We played. Delight delight. Splash splash not the best splash splash but the most splash splash not the splash best but the splash fuckin' most.

  At dusk, after dinner, continuing with drinks, we chatted about the Letter of Zock. Nate had sent his letter about me to the Leggo, and had gotten a cordial reply. Not one to be satisfied with anything short of "the most," Nate had called up the Leggo and the Fish "to find out why those guys didn't think youboth of you?were as great as I thought you were, 'cause I'm a helluva judge of talent or I wouldn't be where I am today." After some discussion with the Leggo and the Fish and a few other Slurpers, Nate had cleared it right up. Not only that, but to make sure that this clear area would remain clear, Nate had decided on something more permanent: there would be named, in my honor, in the Wing of Zock, a Room of Basch. Not only that, but in addition to the ***MVI*** and the Crow, there would be, annually, the Basch Award, a free trip for two to Palm Springs for the tern "who best exemplified the qualities of Roy G. Basch, M.D." the principal one being "how to leave the patient alone." On hearing of the Room of Basch and the Basch Award, both the Leggo and the Fish had been filled with emotion, too choked up to speak. My Redeemer, Zock, liveth. My name would live on in the House of God.

  Cigars were lit. The night was so still, the match games stood upright. Chuck and Nate related their life stories. Chuck told the story of the postcards, the latest: WANT TO BE AN OFFICER IN THE NATIONAL INSTITUTE OF HEALTH? IF SO, FILL OUT AND: RETURN THIS CARD. Nate loved it. Nate told the story of "out of the valley of the Depression rode the five hundred bucks to manufacture not the best but the most nuts and bolts," and ended with tears in his, eyes. Chuck loved it. The long June evening ushered in a serenade of crickets, and the dusk lingered in the air like a dozing kitten's purr. Berry leaned her head on my shoulder. Nate and Trixie loved her. They suggested she be a weight?control therapist for their fatties. Nate suggested, about me and Berry, that, as he been told by Trixie's father years ago: "If you milk the cow, you gotta buy it," that we should get married. Chuck chimed in, warning me, "Like they say back home, man, if'n you plant it, you gotta watch it grow." Arm?around me and Berry and Chuck, Nate kissed us good night, tears in his eyes, wishing we would accept his offer to start us in a private practice. At peace, at the level of love, I watched the silver liquid moonlight flow over the orange stucco roof of the House of Zock, reminding me of the stuccoed farmhouses of France.

  26

  In the House of God, whosoever had sighted the humps' had been repulsed. These pneumatic, stupendous, astounding humps had stirred up even more speculation: than a Zock. Given her rate of respiration?six breaths per minute?the oxygen theory was much favored, and many thought that the slightly green gomere had turned into a plant. And so, the last week of the ternship LP Leon, his Fellowship secure, relented, and I lays on the top bunk going over her chart, the full story of Olive O., formulating how best to spring them of our Chief. I wanted to see if he'd show any human, emotion upon sighting the horrible humps.

  After the eye?opening lunch, the Leggo had in fact made some concessions and it looked like all but two or three terns would stay. The Runt and I were definitely leaving; Chuck hadn't yet said. The others were staying. In years to come they would spread out across America into academic centers and Fellowships, real red?hots in internal medicine, for they had been trained at the Best Medical School's best House, the House of God. Although a few might kill themselves or get addicted or go crazy, by and large they'd repress and conform and perpetuate the Leggo and the House and all the best medical stuff. Eat My Dust had been praised by the Leggo that he could start off the second year as ward resident, with "a free rein" on his terns. And so, saying already that the ternship been "not so bad," Eddie was preparing to indoctrinate his new charges: "I want them on their knees from day one." A year later it would be back to California for his Fellowship in Oncology. Hyper Hooper was staying as well. He'd sent us a postcard from Atlantic City, signed with a picture of a black crow. Upon returning to the House, he'd shown he hadn't lost his touch; walking into a room containing a LOL in NAD who'd been getting better, Hooper had said, "Hi, dearie," she'd gasped, clutched her chest, and five minutes later was dead. The post showed a massive pulmonary embolus. Hooper had been promised by the Leggo that he could start off the second year in a Path elective, doing his own personal autopsies on his own personal patients. And so, saying that the ternship had been "not so bad," Hooper was also dreaming California Fellowship, in "Thanatology: " The Runt was going west for a "classic Eastern" psychiatric training program on the "mountain campus" of the U. of Wyoming, run by a guru named Grogyam with a Ph.D. from the U. of Kansas. The Runt was so emphatic about his entry into psych being diametrically opposed to the psychoanalytic viewpoint of his parents' "classic Western"?that it seemed pretty clear that this "Eastern" jag was a penultimate step that the Runt had to take in order to rebel against it and come on back to mom and pop and Freud to roost. Thunder Thighs had told the Runt that she would not miss him. The Runt imagined this was OK with him. Little did he know how lonely Wyoming could be.

  My Clinic patients had been sad to hear I was leaving. They'd brought presents, brought family members, wished me good luck. One, who I'd recently told had incurable cancer and who continued to deny that it exists, had asked me, "Where will you hang up your shingle?" When I'd told her I'd be taking a year off, she'd said, "That's OK, I'll be your patient when you get back." No. She'd be dead. It was hard, too hard. I went through my last Clinic taking deep breaths to keep back the tears. Mae, my black Witness, concerned about my puffing, asked, "Oh Doctuh Bass, you ain't done caught my asthma from me, has you?" When I'd told people I was thinking of going into psychiatry, many were surprised.

  . . NOT GOING ON IN YOUR MEDICAL RESIDENCY?! YOU PROMISED THEM! HOW WILL IT LOOK ON YOUR RECORD? RECONSIDER! I AM AMAZED! . . .

  My father. For the first time, he'd been nudged out of his conjunctions. But then, calming himself again, he embraced his grammar, he embraced his son, and went on:

  . . I can't understand your taking a year off and it is a waste of a potential year's income. I'm amazed at your going into psychiatry and it seems a waste of your talent. I hope I am explaining the point well and probably not. I kno
w that you will always give yourself over to your new field of medicine and I am sure you have all the attributes to make an outstanding practitioner of psychiatry. Your deep interest in people and what makes them tick will be a great basis for your work and I do hope you will be able to make a living at it. The new philosophy for people of all ages is to enjoy each day and do what you plan on doing within the limits of responsibility, work, and commitment, and mom and I will try to do this as we have always tried to, only more so now.

  The weather has been wet, and remember, dear son number one: IT NEVER RAINS ON A GOLF COURSE. . .

  I finally realized what all these conjunctions meant: hope. What was my hope now? To take a year off, to risk, grow, be with others, even to be with parents' who'd loved me despite my shabby treatment of them, through so many arrogant years. Was the Fat Man my hope any longer? In what he'd taught me, yes, in showing me the one truly great American Medical Invention: the creation of a foolproof system that took sincere energetic guys and with little effort turned them into dull, grandiose docs who could live with the horror of disease and the deceit of "cure," who could "go with" the public's fantasy of the right to perfect health devoid of even the deterioration of age, a whole nation of Hyper Hoopers and other Californians who expected the day to be sunny, the body young, to be surfing along always on the waves of vitality, and who, when the clouds come, the marriage fails, the erection wilts, the brown blotches of age break out like geriatric acne on the backs of the hands, in terror, wipe out.

  And so I'd succeeded in keeping Olive O. from being killed by the Privates and Slurpers and BMSs and Blazers and even Housekeepers of the House. In a few days a dew?fresh tern would get the gomere. We had survived. The Leggo arrived for rounds. As I began to present the case to him, I realized that ever since the emergency lunch he'd been out of sight, withdrawn, secretoid. In his rare appearances, he'd seemed down, sad yet bitter, vulnerable and suspicious. For some reason, it troubled me. And yet Olive, a real "fascinoma," seemed to perk him up. I made no mention of the humps, and the Chief's questions were mainly to 789 about Olive's diabetes. Why, the Leggo wanted to know, with Olive's blood sugar three times normal on admission, had Sev infused more sugar, raising the level to nine times normal, a new House record? Sev gave a brilliant mathematical exigesis, drawing vector diagrams of enzyme action, which left us confused and subdued. In a rare burst of excitement the Chief said, "Great case! Come on, boys, let's go see her!"