by Samuel Shem
I know she’s wrong. One lazy and succulent day, I am walking by myself from the graveyard at the top of the village, down the catnapping winding road overlooking the château, the church, the prehistoric caves, the square, and far below, the river valley, the child’s-toy poplars and Roman bridge indicating the road, and the creator of all this, the spawn of the glacier, our river. I have never taken this path before, this path along this ridge. I am beginning to relax, to know what I knew before: the peace, the rainbow of perfections of doing nothing. The country is so lush that the birds can’t eat all the ripe blackberries. I stop and pick some. Juicy grit in my mouth. My sandals slap the asphalt. I watch the flowers compete in color and shape, enticing the rape by the bees. For the first time in more than a year I am at peace, and nothing in the whole world is effort, and all, for me, is natural, whole, and sound.
I turn a corner and see a large building, like an asylum or a hospital, with the word ‘Hospice’ over the door. My skin prickles, the little hairs on the back of my neck rise, my teeth set on edge. And there, sure enough, I see them. They have been set out in the sun, in a little orchard. The white of their hair, scattered among the green of the orchard, makes them look like dandelions in a field, gossamers awaiting their final breeze. Gomers. I stare at them. I recognize the signs. I make diagnoses. As I walk past them, their eyes seem to follow me, as if somewhere in their dementia they are trying to wave, or say bonjour, or show some other vestige of humanness. But they neither wave nor say bonjour, nor show any other vestige. Healthy, tan, sweaty, drunk, full of blackberries, laughing inside and fearing the cruelty of that laughter, I feel grand. I always feel grand when I see a gomer. I love these gomers now.
‘Well, there may be gomers in France, but you don’t have to take care of them.’
She goes back to her artichoke, and the vinaigrette accumulates on her chin. She doesn’t wipe it off. She’s not the type. She enjoys the oily feel of the oil, the vinegar sting. She enjoys her nakedness, her carelessness, her oiliness, her ease. I feel that she’s getting excited. Now she looks at me again. Am I saying this out loud? No. As we watch each other, the vinaigrette drips from her chin to her breast. We watch. The vinaigrette explores, oozing slowly down the skinline, heading south toward the nipple. We speculate together, without words, whether it will make it, or if it will veer off, toward cleft or pit. I flip back into medicine, thinking of carcinoma of the axillary nodes. Mastectomy. Statistics crowd in. Berry smiles at me, unaware of my regression toward death. The vinaigrette stays on line, oozes onto the nipple, and hangs. We smile.
‘Stop obsessing about the gomers and come lick it off.’
‘They can still hurt me.’
‘No they can’t. Come on.’
As I put my lips to her nipple, feeling it rise, tasting the sting of the sauce, my fantasy is of a cardiac arrest. The room is crowded, and I am one of the last to arrive. On the bed is a young patient, intubated, being breathed by the respiratory tech. The resident is trying to put in a big intravenous line, and the medical student is running round and round the bed. Everyone in the room knows that the patient is going to die. Kneeling on the bed, giving closed-chest cardiac massage, is one of the intensive-care nurses, a redhead with great thighs and big tits, from Hawaii. Tits from Hawaii. It had been her patient, and she had been first to arrive at the arrest. I stand in the doorway and watch: her white skirt has ridden up her legs so that as she bends over the patient, she flaunts her ass. She wears flowered bikini panties. I can almost see the petals through the seams of the white stretch pantyhose. I think of Hawaii. Up and down, up and down her ass is moving up and down in the middle of all the blood and vomit and urine and crap and people. Waves of surf on volcanic beaches up and down up and down. Fantastic plush limousine of an ass. I go up to her and put my hand on it. She turns and sees who it is and smiles and says Oh hi Roy and keeps on pumping. I massage her ass as she moves up and down, around and around my hand goes. I whisper something raunchy in her ears. I take both hands and pull down her pantyhose, and then pull her panties down to her knees. She beats on the body. I take my hands, and slip one into her crotch and run the other down the inside of her thighs up and down and up and down in time to the chest compressions of the resuscitation. She takes her free hand and undoes the buttons of my white pants and grabs my erect penis. The tension is incredible. There are shouts for ‘adrenaline!’ and ‘the defibrillator!’
Finally they’re ready to put the paddles of the defibrillator on the patient’s chest, to shock the dying heart. Someone shouts: ‘Everybody off the bed!’ and the Hawaiian slides down onto my penis.
‘Shock him!’
SSZZZZZZ!
They shock the patient. The body convulses up off the bed as the muscles contract from the 300 volts, but the cardiac monitor is flat line. The heart is dead. An intern, the Runt, enters the room. The patient is his patient. He seems upset. He looks like he’s about to burst into tears. Then he sees the Hawaiian and me going to it, and his eyes show his surprise. I turn to him and say:
‘Cheer up, Runt, it’s impossible to be depressed with an erection.’
The fantasy ends with the young patient dead and all of us consoling ourselves in sex on the blood-slippery floor, singing as we rocket toward orgasm:
‘I wanna go back to my little grass shack in Kooalakahoo Ha-WAAAAA—EEEEEEEE! . . . .
Part II
The House of God
We came here to serve God,
And also to get rich.
—Bernal Diaz del Castillo, History of the Conquest of Mexico
2
The House of God had been founded in 1913 by the American People of Israel when their medically qualified Sons and Daughters could not get good internships in good hospitals because of discrimination. A great tribute to the dedication of the founders, it soon attracted red hot doctors, and was blessed with an affiliation with the BMS—the Best Medical School—in the world. Built up to this status, internally it had broken down into many hierarchies, at the bottom of which now lay the very people for whom it had been constructed, the House Staff. Consistently, at the bottom of the House Staff lay an intern.
While the straight shot down from the top of the medical hierarchy got the intern, the intern was at the bottom of the other hierarchies only indirectly. In many tricky ways he had the opportunity to be abused at any time by Private Doctors, House Administration, Nursing, Patients, Social Service, Telephone and Beeper Operators, and Housekeeping. The latter made the beds and regulated the heat, cold, toilets, linen, and general repairs. The interns were completely at their mercy.
The House medical hierarchy was a pyramid—a lot at the bottom and one at the top. Given the mentality required to climb it, it was more like an ice-cream cone—you had to lick your way up. From constant application of tongue to next uppermost ass, those few toward the top were all tongue. A mapping of each sensory cortex would show a homunculus with a mammoth tongue overlapping an enormous portion of brain. The nice thing about the ice-cream cone was that from the bottom, you got a clear view of the slurping going on. There they were, the Slurpers, greedy optimistic kids in an ice-cream parlor in July, tonguing and tonguing and tonguing away. It was quite a sight.
The House of God was known for its progressiveness, especially in relation to the way it treated its House Staff. It was one of the first hospitals to offer free marital counseling, and when that failed, to encourage divorce. On average, during their stay, about eighty percent of the married medically qualified Sons and Daughters would make use of this suggestion, separate from their spouses, and take up with some bombshell from Private Doctors, House Administration, Nursing, Patients, Social Service, Telephone and Beeper Operators, and Housekeeping. In a further progressive gesture, the House believed in introducing its incoming interns to the horrors of the year in a gentle fashion, inviting us to an all-day talk session broken by a lunch catered by the B-M Deli, taking place on Monday June the thirtieth, the day before we were to start.
At this meeting we were to be exposed to representative members of each hierachy.
On the Sunday afternoon before the B-M Deli Monday before the horrific Tuesday July the first, I was in bed. June was ending with a final sunny flash, but my shades were drawn. Nixon was off on yet another summit junket to masturbate Kosygin, ‘Mo’ Dean was breathless in her agony over what dress to wear to the Watergate hearings, and I was in pain. My pain was not even the modern pain of alienation or ennui, the kind that many Americans currently felt while watching the TV documentary on ‘The California Family: the Louds,’ with their expensive ranch house, three cars, kidney-shaped pool, and no books. My pain was fear. Despite always having been a red-hot, I was scared out of my mind. I was terrified of being an intern in the House of God.
I was not alone in bed. I was with Berry. Our relationship, having survived the trauma of my years at the Best Medical School, was blossoming, rich in color, woven with liveliness, laughter, risk, and love. Also in bed with me were two books: the first, a gift from my father the dentist, an ‘internship’ book, something called How I Saved the World Without Dirtying My Whites, all about this intern rushing in at the last minute, taking over, crisply barking orders which saved lives in the nick of time; the second book I’d bought for myself, something called How to Do It for the New Intern, a manual that told you everything you needed to know. While I ransacked this manual, Berry, a Clinical Psychologist, was curled up with Freud. After a few minutes of silence, I groaned, let the manual drop, and pulled the sheet over my head.
‘Help, hellllp,’ I said.
‘Roy, you really are in a terrible shape.’
‘How.bad is it?’
‘Bad. Last week I hospitalized a patient who was found curled up under the covers just like that, and he was less anxious than you.’
‘Can you hospitalize me?’
‘Do you have insurance?’
‘Not till I start the internship.’
‘Then you’d have to go to the State Facility.’
‘What should I do? I’ve tried everything, and I’m still scared to death.’
‘Try denial.’
‘Denial?’
‘Yes. A primitive defense. Deny that it exists.’
So I tried to deny that it exists. Although I didn’t get very far with this denial, Berry helped me through the night, and the next morning, B-M Deli Monday, she helped me to shave, dress, and she drove me downtown to the House of God. Something stopped me from getting out of the car, and so Berry opened my door, coaxed me out, and pressed a note into my hand that said ‘Meet you here at five P.M. Good Luck. Love, Berry.’ She kissed me on the cheek and left.
I stood in the steamy heat outside a huge urine-colored building which a sign said was THE HOUSE OF GOD. A ball and chain were demolishing one wing, to make way, a sign said, for THE WING OF ZOCK. Feeling like the ball and chain were swinging back and forth inside my skull, I entered the House and searched out the ‘function room.’ I sat down as the Chief Resident, named Fishberg and nicknamed the Fish, was giving a welcoming speech. Short, chubby, scrubbed to a shine, the Fish had just completed his training in Gastroenterology, the specialty of the House. The position of Chief Resident was smack in the middle of the ice-cream cone, and the Fish knew that if he did a good job that year he’d be rewarded by the higher-up Slurpers with a permanent job and become a permanent Slurper. He was the liaison between the interns and everyone else, and he ‘hoped that you will come to me with any problems you might have.’ As he said this, his eyes slithered over to the higher-up Slurpers arrayed at the head table. Shifty, slimy, he oozed. Too cheerful. Not in touch with our dread. My concentration waned, and I looked around the room at the other new terns: a smooth black guy slouched down in his chair with his hand wearily shading his eyes; more striking was a giant of a guy with a bushy red beard, wearing a black leather jacket and wraparound sunglasses, twirling a black motorcycle hat on his finger. Far-out.
‘ . . . and so, day or night, I’m available. And now it gives me great pleasure to present the Chief of Medicine, Dr. Leggo.’
From the corner where he’d been standing, a thin, dry-looking little man with a horrific purple birthmark on the side of his face walked stiffly to the center of the speaker’s table. He wore a butcher-length white coat and a long old-fashioned stethoscope wended its way across his chest and abdomen and disappeared mysteriously into his pants. A question flickered across my mind: WHERE DID THAT STETHOSCOPE GO? He was a renologist: kidneys, ureters, bladders, urethras, and stagnant urine’s best friend, the Foley catheter.
‘The House is special,’ said the Chief. ‘Part of its being special is its affiliation with the BMS. I want to tell you a story about the BMS, that showed me how special the BMS and the House are. It’s a story about a BMS doctor and a BMS nurse named Peg. It showed me what it is like to be affiliated with the . . .’
My mind wandered. The Leggo was a less chubby version of the Fish, as if, given the fact that the Leggo had published rather than perished to become Chief, all the human juice had been sucked out of him, and he had been left drained, dehydrated, even uremic. So this was the top of the cone, when finally, and with all men, as Chief, one was perpetually more slurped against than slurping.
‘. . . and so Peg came up to me with a surprised look on her face and said “Doctor Leggo, how could you wonder whether that order had been done? When a BMS doctor tells a BMS nurse to do something, you can be sure it will be done, and it will be done right.”’
He paused, as if expecting applause. He was met with silence. I yawned, and realized that my mind had gone straight to fucking.
‘. . . and you’ll be glad to hear that Peg will be coming—’
‘HHRAAAK! HHRAAAK!’
An explosion of coughing from the tern in the black leather jacket, doubling him over, gasping, at his seat, interrupted the Leggo.
‘—coming from the City Hospital to join us here at the House later in the year.’
The Leggo went on to make a statement about the Sanctity of Life. Like the Pope’s statements, the emphasis was on doing everything always for everyone forever to keep the patient alive. At the time, we couldn’t have known how destructive this nuncio would be. Finishing, the Leggo returned to his corner, where he remained standing. Neither the Fish nor the Leggo seemed to have a firm grasp on what went into being a human being.
The other speakers were more human. A House Administration type in a blue blazer with gold buttons gave us some advice on how ‘the patients’ charts are legal documents’ and told us that the House had gotten sued recently because some tern, as a joke, had written in the chart that the Nursing Home had left the patient on the bed pan so long that stasis ulcers developed, which led to death on transfer to the House; an emaciated young cardiologist named Pinkus remarked on the importance of hobbies in preventing cardiac disease, his two hobbies being ‘running for fitness and fishing for calm,’ and then went on to say that every patient we would see during the year would seem to have a rumbling systolic heart murmur which in fact would turn out to be the jackhammers from the Wing of Zock and we might as well throw our stethoscopes away now; the House Psychiatrist, a sad-looking man with a goatee, turned his pleading eyes on us and told us that he was available to help. Then he shocked us all by saying:
‘Internship is not like law school, where they say look to your right and look to your left and one of you will not be here at the end of the year, but it is a strain, and everyone has a hard time. If you let it go too far, well . . . Each year the graduating class of at least one medical school—maybe two or three schools—must step into the ranks just to replace colleagues who commit suicide—’
‘HAA—RUMPH! HAA—REMMM!’
The Fish was clearing his throat. He did not like this talk about suicide and was clearing his throat of it.
‘—and even year after year right here in the House of God we do see suicides—’
‘Thank you, Dr. Frank,’ said the Fish, taking over, g
reasing the wheels of the meeting again so that it could roll on to the last medical speaker, a representative of the House Private Doctors, the Attendings, Dr. Pearlstein.
Even at the BMS, I’d heard of the Pearl. Once the Chief Resident, he had soon abandoned academics in pursuit of cash, had snatched the beginnings of his own practice from his older partner when the latter was away on a Florida vacation, and with a quick entry into computer technology that fully automated his office, the Pearl had become the richest of the rich House Privates. A gastroenterologist with his personal X-Ray machine in his office, he serviced the wealthiest bowels in town. He was the retained physician of the Family of Zock, whose Wing of Zock jackhammers would make us throw our stethoscopes away. Well-groomed, glittering with gems, in a handsome suit, he was a master with people, and in a few seconds he had us in the palm of his hand:
‘Every intern makes mistakes. The important thing is neither to make the same mistakes twice nor to make a whole bunch of mistakes all at once. During my internship, right here at the House, a fellow intern, eager for academic success, had had a patient die, and the family had refused permission for the post-mortem. In the dead of night, this intern wheeled the body down to the morgue and did the autopsy himself. He was caught and punished severely, being sent to the Deep South, where he practices in obscurity to this day. So remember: don’t let your enthusiasm for medicine get in the way of your feeling for people. It can be a great year. It started me on the way to what I am and what I have today. I look forward to working with each and every one of you. Best of luck, boys, best of luck.’
Given my aversion to dead bodies, he needn’t have bothered to warn me. Others felt differently. Sitting beside me, Hooper, a hyperactive tern whom I’d known as a classmate at the BMS, seemed to get off on the idea of doing the autopsy himself. His eyes gleamed, he rocked back and forth in his chair, almost quivering. Well, I mused, whatever turns you on.