The house of God

by Samuel Shem

  "I love who you are. To me, underneath it all, you're still there:" She paused, and then, eyes sparkling, said, "And you might even be better."

  "What? What do you mean?"

  "This might have been the only thing that could have awakened you. Your whole life has been a growing from the outside, mastering the challenges that others have set for you. Now, finally, you might just be growing from inside yourself. It can be a whole new world, Roy, I know it. A whole new life" Eyes wet with tears, she said, "I'm going to love you even more, Roy, because I've been waiting a long time for you to begin."

  Overwhelmed. Speechless. Excited, even happy. Yet it seemed too easy. "I want to believe you, but it all seems so painful. The whole year seems like a nightmare now."

  "Not all of it. There was pleasure in it, too: the pleasure of the mastery of medicine, the pleasure of your group of guys, of latency."

  "Latency? What's latency?"

  "Latency is the lull before adolescence. Latency is the time of clubs, groups, teams, when baseball is the most important thing in your life and the days are too short for all that you want to do. Latency is caring. This year's been a latency trip: during your internship, with all of you scared and brutalized, the caring in your bunch of guys sustained you:"

  Cradled in her arms, I think back to then, to the tree house in the overgrown shallow ravine, to the early summer nights running out of the house leaping up and up in the warm dusk, to the baseball games when the pepperpot shortstop pegged a two-hop bouncer over to first base to just nip the runner in time, and as I began to curl down into the river must of sleep, like a song hummed by a tyrant and picked up by the birds and spread all along and away, a blanket of soothing ideas spreads itself over me, and I think of days so still that a match flame won't bend and I think of blind fish in the black world of a mammoth?painted cave who somehow, even in their icy smooth?walled limestone pool know about the flat hot slabs of summer slapped against the mime?white walls to warm a dozing cat in the middle of a street of a French hill village overlooking a river valley laced with chateaux of the real sort and of the mirrored marbled butchershop sort caressing chilled meat laced with ribbons of lard and a box of patisserie tied with a green ribbon with a loop looped for a child's finger and a market ebbing quiet as the words flow louder from the mouths of the cafes where men caricaturing French peasants sit with their cigarettes stuck to their lips and a cemetery which chimes "Priez pour elle, Priez pour elle" in deathly silence and then I think that outside the House of God even in a cemetary there is no result just process and that here at last, with my love holding me, each day might be filled with all things and all colors and the eternal repetition of all colorful things renewed, and I feel that it just might be that in the flow of time the layers of bitterness might begin to peel away, until bitterness itself had become but a faint etching on a glass wall, layers of etched glass walls leading down a life toward a latency, a summergame, a summer of fun, and as I struggle to rest the layers of bitterness are beginning to peel off, are peeling off, leaving me homing upriver toward innocence and nakedness and rest, as in the time before the House of God with Berry thank God for Berry and except for Berry where would I be for without her I could never learn to love as once I did love and will love and love. Humbly, I ask her to marry me.

  THE END.

  LAWS OF THE HOUSE OF GOD

  I. GOMERS DON'T DIE.

  II. GOMERS GO TO GROUND.

  III. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.

  IV. THE PATIENT IS THE ONE WITH THE DISEASE.

  V. PLACEMENT COMES FIRST.

  VI. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.

  VII. AGE + BUN = LASIX DOSE.

  VIII. THEY CAN ALWAYS HURT YOU MORE.

  IX. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.

  X. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.

  XI. SHOW ME A BMS WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.

  XII. IF THE RADIOLOGY RESIDENT AND THE BMS BOTH SEE A LESION ON THE CHEST X?RAY, THERE CAN BE NO LESION THERE.

  XIII. THE DELIVERY OF MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

  GLOSSARY

  Admission: a patient entering the House of God; two types: emergency, through the emergency room; elective, scheduled.

  Agonal: just before death, as in "agonal" respirations.

  Amyloidosis: chronic degenerative disease with increasing deposits of a starchy substance, amyloid, in many organs; rare; incurable.

  Anal: pertaining to the anus, as in fissure (tear), sadism (a Freudian concept whereby a sadistic urge is related to early anal activity), and Mirror (cf. Dr. Jung's).

  Aneurysm: a ballooning out of a vessel, especially an artery, before it bursts.

  Angina pectoris: a pattern of cardiac pain, often felt in the chest, signaling severe disease of the coronary arteries, often a prelude to a heart attack.

  Ascites: fluid in the abdominal cavity, always abnormal, often associated with liver disease or infection, resulting in distended belly.

  Attendings: private doctors affiliated with the House of God.

  A?V node: Atrio?Ventricular node, a collection of pacemaking cells in the heart, between the atria and ventricles, which can, if the normal sinus node fails, take over the initiation of the heartbeat.

  Black Crow: the House Award given to the intern who collects the most postmortem permissions in the course of the year; prize is a tiepin and a free trip to Atlantic City, for AMA meetings.

  Blue Blazers: House Administration; often tanned, blond, gold?buttoned; comprising the staff of HELP; origin and function unknown.

  BMS: Best Medical School (in the world).

  BMS: a BMS student

  BUFF: polish to make look good, as BUFF a car, BUFF a chart, BUFF a gomer; part of BUFF and TURF.

  BUN: Blood Urea Nitrogen; indirect measure of heart failure.

  BOUNCE: to return to: "I BUFFED her and then TURFED her to Urology, but she BOUNCED back to me."

  Bowel Run: part of the Gastrointestinal Workup, a series of tests, including upper GI series with small bowel follow?through, barium enema, sigmoidoscopy, fiver scan, gallbladder series etc.; a specialty of the House; prior to the bowel run the "cleanout" is necessary, a series of enemas and cathartics to render the bowel, in the words of a surgeon, "so clean I can drink the stuff coming out"; The Emperor of the Bowel Run: Dr. Putzel; The Bowel Run of the Stars: the Fat Man's dream.

  Cardiac catheterization: threading catheters through veins and arteries into the heart so that radio?opaque dye can be injected and the structure of the vessels and the chambers can be seen.

  CHF: congestive heart failure, progressive incurable decay of the heart, in which it can't pump blood efficiently; leads to renal failure, pulmonary edema, stasis ulcers, death.

  Cirrhosis: chronic degeneration of the liver; usually fatal.

  Clavicular: of the clavicle, bone at the top of the chest running between the shoulders.

  CVP: central venous pressure, the pressure in the vein feeding directly into the heart; CVP line, a catheter placed in that vein to measure pressure.

  Cytology: study of cells, especially cells suspected of being malignant.

  Defibrillator: machine used to attempt to shock the heart back into normal rhythm or to start it again after it stops; electrodes are placed on chest wall; also called cardioverter.

  DERM: Dermatology, the study of skin; an NPC Specialty.

  Disimpaction: using a finger to dig impacted feces out of the rectum.

  Dr. Jung's Anal Mirror: allegedly the Fat Man's Great American Medical Invention, allowing the user to view his or her own anus "in the comfort and privacy of the home."

  Dyspareunia: pain during intercourse; especially in the female.

  Ectopic nodal pacemaker: abnormal initiation of the heartbeat from the A?V node instead of from the sinus node.

  Ectopic pregnancy: abnormal l
ocation of the fertilized ovum, often in the fallopian tubes; upon rupture, often fatal

  Egedystonic: a thought, feeling, or action which causes discomfort to oneself; opposite of egosyntonic.

  Episiotomy: incision in vagina during labor and delivery to allow baby to be born without damaging the mother unnecessarily.

  Feeding tube: polyethylene tube put into stomach through nostril, through which pureed food is injected.

  Flatulence: farting.

  Foley catheter: tube put into bladder through urethra to assure flow of urine.

  France: a country.

  Fulminant necrotic hepatitis: inflammation of the liver, acute; various causes; virtually always fatal.

  GAS: Anaesthesiology; an NPC Specialty.

  Gastrocnemius: muscle of the calf; soleus is another calf muscle.

  GI: Gastro?Intestinal, pertaining to the gut.

  Glomerulonephritis: inflammation of part of the kidney; often fatal.

  Gluteal: muscle forming the ass.

  GOMER: Get Out of My Emergency Room; "a human being who has lost?often through age-what goes into being a human being"(the Fat Man).

  GOMERE: feminine of GOMER.

  HELP: organization in the House of God, comprised of Blue Blazers, summoned by dialing H?E?L?P; origin and function unknown.

  Hospice: French word; home, asylum, poorhouse.

  Hotel?Dieu: French word; literally "House of God"; hospital.

  House of God: hospital affiliated with the BMS; founded in 1913 by the American People of Israel when their medically qualified Sons and Daughters could not get good internships because of discrimination; competitor of MBH (See MBH).

  House Staff: interns and residents of the House of God.

  HTE Service: Hold The Elevator Service; allegedly promulgated by Grenade Room Dubler as an intern, to transport the allegedly murdered gomers down to the morgue.

  Intercostal: between the ribs.

  Intertrochanteric: between the protrusions of bone at the head of the upper legbone, the femur; often synonymous with fracture of the hip.

  Intubated: with a rubber tube inserted through the mouth down into the trachea, by which to artificially respirate a patient.

  IV: intravenous, inside a vein.

  Lasix: a drug; diuretic often used to treat congestive heart failure.

  LAWS OF THE HOUSE OF GOD: a series of rules, almost commandments, many formulated by the Fat Man.

  Lay analyst: a psychoanalyst who is not an M.D.

  Limbic: primitive part of the brain, thought to be a center of aggressive and sexual impulses; allegedly linked to cortex.

  LOL in NAD: Little Old Lady in No Apparent Distress; not a GOMERE.

  LP: Lumbar Puncture, the introduction of a needle into the spinal column to procure a sample of spinal fluid; also Low Profile, the intern technique of not being seen.

  M and M: Morbidity and Mortality; a regularly scheduled conference of the medical hierarchy at which mistakes are aired; an opportunity for the higher?up Slurpers (See SLURPERS) to roast the lower?down.

  MBH: Man's Best Hospital; a BMS?affiliated hospital founded by WASPs; competitor of the House of God.

  MI: Myocardial infarction, heart attack.

  MICU: Medical Intensive Care Unit.

  Monilia: a species of yeast, causing infection, often with swelling of lymph nodes; common cause of vagitch.

  MOR: Marriage On Rocks; frequent event during internship; cf. ROR.

  Mt. St. E.: Mount Saint Elsewhere, generic term for any hospital not affiliated with the BMS; often used to denote small community hospital.

  Multiple myeloma: one type of bone cancer; fatal.

  ***MVI***: Most Valuable Intern; allegedly the House Award given to the intern who is most valuable; alleged prize is a tiepin and a free trip for two to Atlantic City.

  Narcolepsy: disease in which the main symptom is sleepiness; endemic to radiologists.

  NIH: National Institute of Health; a step up the Slurper cone.

  Nitro: nitroglycerin, tablet placed under the tongue to relieve the pain of angina pectoris.

  NPC Specialty: No Patient Care Specialty in medicine, numbering, according to the Fat Man, six: RAYS, GAS, PATH, DERM, OPHTHALMOLOGY, PSYCHIATRY.

  NSR: Normal sinus rhythm, the normal working of the heart, in which the heartbeat is initiated in the pacemaking cells in the sinus node.

  Onanism: masturbation.

  OPHTHALMOLOGY: surgical specialty dealing with eye; an NPC specialty.

  ORTHO: Orthopedics, the surgical specialty dealing with bone.

  Parotid: gland in jaw that produces saliva.

  PATH: Pathology, an NPC Specialty.

  Perineum: Genital region, especially that between the anus and scrotum or vulva.

  Pishke: Yiddish word; tin box into which to place coins for charity.

  Placement: process of finding a home for a gomer or gomere, especially, finding a nursing home; a possible TURF.

  Primum non nocere: first of all, do no harm.

  PRIVATES: Private doctors of the House of God; "Double O" Private is one "licensed to kill."

  Psoriatic: pertaining to psoriasis, a disease producing scaly skin.

  PSYCHIATRY: an NPC specialty.

  Psychoanalysis: the Freudian technique of psychotherapy.

  Pulmonary edema: flooding of the lungs with fluid, often from a backed?up flow of blood during congestive heart failure; along with the bowel run, a specialty of the House.

  Pulinonary embolus: bloodclot lodging in the lung; often a sudden event in bedridden patients which produces death.

  Putzeled: to be treated as Dr. Putzel, House Double O Private, would treat; colloq.: "screwed."

  Q.E.D.: Quod Erat Demonstrandum, "which was to be demonstrated," "thus."

  Quadriceps: four large muscles of the thigh.

  RAYS: Radiology, an NPC Specialty.

  Redhot: hotshot, whizkid, face, young mensch, "my man."

  Renology: medical specialty dealing with kidney and urine.

  Respiratory tech: respiratory technician, in charge of machines to aid respiration of patients.

  ROR: Relationship On Rocks; frequent event during internship; cf. MOR.

  Rounds: meetings to discuss patients.

  Scapula: shoulderblade.

  Septicemia: infection of the blood, leading to infection of major organs, and to septic shock, in which the blood pressure falls.

  SICU: Surgical Intensive Care Unit.

  SIEVE: an intern in the Emergency Room who admits too many patients, who does not BUFF and TURF patients out to the street (the process known as MEET 'EM AND STREET 'EM); opposite of WALL.

  Sigmoidoscopy: process of introducing a long, lighted, straight tube, the sigmoidoscope, through the anus into the dark, twisted lower bowel to look at the feces and the pathology; a specialty of the House.

  SLURPERS: House Academics, striving to lick their way up the academic medical cone toward the one position at the top?the Chief.

  Stasis ulcers: erosion of the skin caused by pressure, often from lying in one position for too long; seen in debilitated patients who are unable to move themselves.

  STAT: at once, immediately.

  Steatorrhea: foul?smelling and oily diarrhea.

  Straight bendover: nursing maneuver in which, legs held straight, nurse bends over bed, flashing ass.

  Subarachnoid space: layer of spinal cord where cerebrospinal fluid circulates; aimed at in lumbar puncture.

  Superior mesenteric insufficiency: syndrome in which an artery of the gut, the superior mesenteric? artery, becomes blocked, resulting in loss of blood supply to bowel, necrosis, and foul?smelling infected stool.

  Systolic: contraction of the heart; opposite of relaxation or diastolic; systolic murmur is one which appears during contraction.

  TBC: Total Bowel Control, a concept of the Fat Man's, implying complete regulation of all bowel function.

  Tern: Intern, the first of a series of House Staff members, including Re
sident, Junior Assistant Resident, Senior Resident, Chief Resident, Fellow, Junior Fellow, Senior Fellow.

  Thorazine: A drug used to decrease anxiety, especially the severe anxiety related to psychosis; one of a number of mind?bending drugs used by the House Staff, others being Stelazine, Valium, alcohol, Elavil, Dexedrine, etc.

  Triage: to sort according to severity of injury, so that the more severe are attended to first.

  TURF: get rid of, as TURF a gomer to Urology; often preceded by a BUFF, as in BUFF and TURF; occasionally followed by a BOUNCE, as "I TURFED my gomere to Urology, but she, BOUNCED back to me"; to BUFF and; TURF, according to the Fat Man, is the essence of the delivery of medical care, the concept of the "revolving door."

  Uremic: a stage of renal failure in which waste products flood the blood.

  UROLOGY: surgical specialty dealing with the urinary tree; "plumbing"

  Vagitch: itch in the vaginal region; nonspecific; common.

  V.D.: Venereal disease.

  Villae: Fingerlike projections of gastrointestinal mucosae lining the gut, main function being absorption of nutriments.

  Visit: a medical teacher assigned to a team of interns and residents on; a ward of the House of God; selected from the pool of Privates, Slurpers, and Fellows.

  VTach: Ventricular tachycardia, rapid heartbeat in which the pacemaker is in the ventricle, is chaotic, and which often signifies impending death.

  WALL: an intern in the Emergency Room who keeps patients from being admitted to the House of God, mainly by using the TURF known as MEET 'EM AND STREET 'EM; opposite of SIEVE.

  Wing of Zock: addition to the House of God, financed by the astronomically wealthy philanthropoid Family of Zock, expressly dedicated to the bowel run of the rich, to contain the Room of Basch, and, ultimately, signifying hope.

  Zebra: an obscure diagnosis.

  Zock: hope.

  FB2 document info

  Document ID: e7aa8c62-0dc3-437b-822a-3f2cf0259558

  Document version: 1

  Document creation date: 2005-04-06

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