House of God

by Samuel Shem

  ‘I’m having a heart attack!’

  Wonderful. Call a doctor. Wait—you are a doctor.

  ‘Are you real doctor or what? My nitros! Fast!’

  I put a tablet under his tongue. He told me to get lost. Crushed, I wished I could.

  Filled with great moments in medicine, the day wore on. Potts and I clustered around the Fat Man like ducklings around a mother duck. Fats sat there, feet up, reading, ostensibly into the world of stocks and bonds and commodities, and yet, like a king who knows his kingdom as well as he knows his own body, who feels the rages of a distant flood in the pulsating of his own kidneys, and the bounty of a harvest in his own full gut, he seemed to have a sense for any problem on the ward, instructing us, forewarning us, helping Potts and me. And once, only once, he moved—fast, unashamedly a hero.

  A scheduled admission, named Leo, had arrived for Potts. Gaunt, white-haired, friendly, a little breathless, Leo stood at the nursing station, suitcase at his feet. Potts and I introduced ourselves and chatted with him. Potts was relieved that here at last was a patient who could talk to him, who was not deathly sick, and who would not slug him. What Potts and I didn’t know was that Leo was about to attempt to die. In the midst of a chuckle at one of Potts’s jokes, Leo turned blue and fell down on the floor. Potts and I stood there mute, still, frozen, unable to move. My one thought was ‘How embarrassing for poor Leo.’ Fats glanced over, leaped to his feet, yelled out ‘Thump him!’ which we were too panicked to do and which I thought would be rather melodramatic, ran over to us, thumped Leo, breathed Leo, closed-chest-cardiac-massaged Leo, IV’d Leo, and organized with a cool virtuosity Leo’s cardiac arrest and Leo’s return from the world of the dead. A large crowd had arrived to assist in the arrest, and Potts and I had been pushed out of the action. I felt embarrassed and inept. Leo had been laughing at our jokes, his attempt to die was surreal, and I had denied that it existed. Fats was marvelous, his handling of the arrest a work of art.

  When Leo had returned to life, Fats walked us back to the nursing station, put his feet back up, opened the paper again, and said, ‘All right all right so you panicked and you feel like shit. I know. It’s awful and it’s not the last time neither. Just don’t forget what you saw. LAW NUMBER THREE: AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.’

  ‘I guess I wasn’t worried about him because he was an elective admission and not an emergency,’ said Potts.

  ‘Elective doesn’t mean shit around here,’ said Fats. ‘Leo would have died. He’s young enough to die, you know.’

  ‘Young?’ I asked. ‘He looks seventy-five.’

  ‘Fifty-two. Congestive heart failure’s worse than most cancers. It’s ones his age that die. There’s no way he’ll become a gomer, not with a disease like that. And that’s the challenge of medicine: gomers gomers gomers where you can’t do anything for them, and then, suddenly—WHAM!—in comes Leo, a lovely guy who can die, and you gotta move fast to save him. It’s like what Joe Garagiola said last night about Luis Tiant: “He gives you all his herky-jerky stuff and then, when he comes in with his heater, it looks a whole yard faster.”’

  ‘His heater?’ asked Potts.

  ‘Oh, Jesus,’ said Fats. ‘His fast ball—HIS FAST BALL!—where did they get you guys, anyway?’

  By that time I was wondering the same thing, and so was Potts. Both of us felt incompetent. For some reason, Chuck was different. He didn’t need help. He knew what to do. Later that afternoon I asked him about how he seemed so competent already.

  ‘Easy, man. See, I never read nuthin’. I just did it all.’

  ‘You never read anything?’

  ‘Just about them red ants. But I know how to put in a big line, tap a chest—you name it, I done it. Ain’t you?’

  ‘Nope. None of that,’ I said, thinking about my piddling around with Sophie’s aspirin.

  ‘Well, man, what all did you do at the BMS?’

  ‘Books. I know all there is to know about medicine in books.’

  ‘Well, it looks like that was your failing, man, that right there. Like my not joinin’ the army. Maybe I still . . .’

  Standing in the streaming July light was a nurse, the afternoon and evening nurse. She stood with her hands on her hips, reading the med cards, legs apart, rocking first one foot on its lateral edge, and then the other. The sharp sunlight made her costume almost transparent, and her legs flowed in smooth lines from her thin ankles and calves all the way up to where all seams meet. She wore no slip, and through her starched white dress I could see the bright patterns on her panties. She knew they would show through. Through her dress showed her bra strap, with its pleading unhookable hook. Her back was to us. Who could know about the front? I half-wished she would never turn around, never spoil the imagined breasts, the imagined face.

  ‘Hey, man, that’s somethin’ else.’

  ‘I love nurses,’ I said.

  ‘Well, man, what is it about nurses?’

  ‘It must be all that white.’

  She turned around. I gasped. I blushed. From her ruffled front unbuttoned down past her clavicular notch showing her cleavage, to her full tightly held breasts, from the red of her nail polish and lipstick to the blue of her lids and the black of her lashes and even the twinkly gold of the little cross from her Catholic nursing school, she was a rainbow in a waterfall. After a day in the hot smelly House, after a day of being whacked by the Privates and the Slurpers and the gomers, she was a succulent chilled wedge of an orange squirting in my mouth. She came over to us.

  ‘I’m Molly.’

  ‘Gurl, the name’s Chuck.’

  Thinking to myself is it true what they say about interns and nurses, I said, ‘I’m Roy.’

  ‘This your first day, guys?’

  ‘Yeah. I was just thinkin’ of joinin’ the army instead.’

  ‘I’m new too,’ Molly said. ‘Started just last month. Scary, eh?’

  ‘No foolin’,’ said Chuck.

  ‘Hang in there, guys, we’ll make it. See ya round the campus, eh?’

  Chuck looked at me and I looked at him, and he said, ‘Sure does make you glad to be spendin’ time in here makin’ it with the gomers, don’t it?’

  We watched Molly disappear down the corridor. She stopped to say hello to Potts, who was talking to a young Czech patient, a man yellow from liver disease. The Yellow Man flirted with Molly, and then ogled her as she, giggling, wiggled down the corridor. Potts came over to us and picked up the lab results from the morning.

  ‘Lazlow’s liver functions are getting worse,’ he said.

  ‘He looks mighty yellow,’ said Chuck. ‘Lemmee see. Too high. If I was you, Potts, I’d give him some roids.’

  ‘Roids?’

  ‘Steroids, man, steroids. Whose patient is he, anyhow?’

  ‘He’s mine. He’s too poor to afford a Private doctor.’

  ‘Well, I’d give him the roids. Never know if he don’t have fulminant necrotic hepatitis. If’n he does, unless you hit him with the roids now, he’s gonna die.’

  ‘Yeah,’ said Potts, ‘but the tests aren’t that high, and steroids have a lot of side effects. I’d just as soon wait a day.’

  ‘Suit yourself. Looks awful yellow, though, don’t he?’

  Thinking about what the Fat Man said about the young dying, I got up to do some work. When I returned to the nursing station I saw two LOLs in NAD peering through their thick cataract-defying glasses at the blackboard on which were written the names of the new interns on the ward. They mentioned my name and I asked them if they were looking for me. Tiny, a foot below me, huddled together, they peered up at me. ‘Oh, yes,’ said one.

  ‘Oh, aren’t you the tall young doctor.’

  ‘Handsome and tall,’ said the other. ‘Yes, we want to hear the news about our brother Itzak.’

  ‘Itzak Rokitansky. The professor. Brilliant, he was.’

  ‘How is he, Dr. Basch?’

  I felt trapped, not knowing what to say. Fi
ghting the impulse to say PURRTY GUD, I said, ‘Well . . . I’ve only been here a day. It’s too early to tell. We’ll wait and see.’

  ‘It’s his brain,’ said one. ‘His marvelous brain. We’re glad you’ll be taking care of him, and we’ll look for you tomorrow. We visit every day.’

  ‘We spend much of our time now visiting the ones who are ill. Good-bye Dr. Basch. Thank you so much.

  I left them, and noticed them pointing at me to each other, pleased that I would be their brother’s doctor. I was moved. I was a doctor. For the first time that day, I felt excited, proud. They believed in me, in my art. I would take care of their brother, and them. Take care of the whole world, why not? I marched down the hallway with pride. I fingered the chrome of my stethoscope with a certain expertise. Like I knew what I was doing. Far-out.

  It didn’t last. I got more and more tired, more and more caught up in the multitudinous bowel runs and lab tests. The jackhammers of the Wing of Zock had been wiggling my ossicles for twelve hours. I hadn’t had time for breakfast, lunch, or dinner and there was still more work to do. I hadn’t even had time for the toilet, for each time I’d gone in, the grim beeper had routed me out. I felt discouraged, worn. Before he left for the day, the Fat Man came by and asked if there was anything else I wanted to talk about.

  ‘I don’t get it,’ I said. ‘This isn’t medicine, this isn’t what I signed up for. Not writing orders for cleanouts for the bowel run.’

  ‘Bowel runs are important,’ said Fats.

  ‘But aren’t there any normal medical patients?’

  ‘These are normal medical patients.’

  ‘They can’t be. Hardly any of them are young.’

  ‘Sophie’s young; she’s sixty-eight.’

  ‘Between the old people and the bowel runs, it’s crazy. It’s not at all what I expected when I walked in here this morning.’

  ‘I know. It’s not what I expected either. We all expect the American Medical Dream—the whites, the cures, the works. Modern medicine’s different: it’s Potts being socked by Ina. Ina, who should have been allowed to die eight years ago, when she asked, in writing, in her New Masada chart. Medicine is “bedrest until complications,” Blue Cross payments for holding hands, and all the rest you’ve seen today, with the odd Leo thrown in to die.’

  Thinking of the Rokitansky girls, I said, ‘You’re too cynical.’

  ‘Did Potts get socked by Ina, or did he not?’

  ‘He did, but all of medicine isn’t like that.’

  ‘Right. In the teeth of our expertise, the ones our age die.’

  ‘Cynic.’

  ‘Ah, yes,’ said Fats, eyes twinkling, ‘no one wants you to know all this yet. That’s why they wanted you to start with Jo, and not me. I wish I could lie. Doesn’t matter, ‘cause I can’t discourage you yet. Like sex, you gotta find it out for yourself. So why don’t you go home?’

  ‘I’ve got some more work to do.’

  ‘Well, you won’t believe this either, but most of the work you do doesn’t matter. For the care of these gomers, it doesn’t matter a damn. But do you know to whom you’re saying goodbye?’

  I did not.

  ‘To the potential father of the Great American Medical Invention. Dr. Jung’s. More money than in the bowel run of the stars.’

  ‘What the hell is this invention, anyway?’

  ‘You’ll see,’ said Fats, ‘you will see.’

  He left. I felt scared without him, and troubled by what he’d said. Got to find it out for myself? In fifth grade, when I’d asked an Italian kid why he liked having sex, he’d said, ‘ ’Cause it feels good.’ I couldn’t understand someone doing something because it felt good. What sense was there in that?

  Just before I left I wanted to say good-bye to Molly. I found her carrying a bedpan toward the disposal. I walked with her, the shit sloshing in the pan, and said, ‘It’s not a very romantic way to meet someone.’

  ‘The romantic way has gotten me into all kinds of trouble in the past,’ she said. ‘This is much more realistic.’

  I said good night and drove home. The sun was a foreign diseased thing, glowering down a hot red contagion on the city. I was so tired that I had a hard time driving, the white lines weaving back and forth across the road like the visual aura to an epileptic’s seizure. The people I saw seemed strange, as if they should have some disease that I should be able to diagnose. No one had a right to be healthy, for my world was only disease. Even the braless women, sweat collecting in the hollows of their breasts, nipples poking out with the full expectation of a lush and sultry summer night, their eroticism magnified by the scents of the July blossoms and of their aroused bodies, were less the stuff of sex and more the specimens of anatomy. Diseases of the breast. I hummed, of all things, a bossanova: ‘Blame it on the carcinoma, hey hey hey . . .’

  In my mailbox was a note: ‘I think of you all night, I think of you in white. It’s hard to be an intern, but I know you will return. Love, Berry.’ Undressing, I thought of Berry. I thought of Molly, I thought of Potts and his bluesteel throbber, but my own blue steel was throbless that night, for they had started in on me and I was through with feeling anything more for that day, including sex, including love. I lay down on top of the cool sheets, which felt soft as the sole of a baby’s foot, soft as the inside of a baby’s mouth, and I thought of this puzzling Fat Man and that even if summer is green, death is an odd number, an odd odd number.

  4

  As I walked onto ward 6-South the next morning, my fear tempered by expectation, I saw a bizarre sight: Potts sat at the nursing station, looking like he’d been shot out of a cannon, his whites filthy, his straight blond hair tangled, blood under his fingernails and vomit on his shoes, his eyes pink, a sick rabbit’s eyes. Next to him, strapped to a chair and still wearing the Rams football helmet, was Ina. Potts was writing in her chart. Ina freed herself, screamed: GO AVAY GO AVAY GO AVAY . . . and took a swing at him with her left fist. Enraged, Potts—gentle Molière-perusing Potts of the Legare Street Pottses—screamed: ‘Goddamnit, Ina, shut the hell up and behave!’ and shoved her back down in her chair. I couldn’t believe it. One night on call, and a Southern gentleman had become a sadist.

  ‘Hi, Potts, how’d it go last night?’

  Raising his head, with tears in his eyes, he said, ‘How’d it go? Terrible. The Fat Man said to me “Don’t worry, the Privates know the new terns are here, and they’re only admitting emergencies.” So what happened? I get five and a half emergencies.’

  ‘What’s a half?’

  ‘A transfer from another service to medicine. I asked the Fat Man about that, too, and he said, “Since you only get half credit for the admission, you only do half an exam.”’

  ‘Which half?’

  ‘You do whichever half you want. With these patients, Roy, I’d suggest the top.’

  Ina rose again, and as Potts pushed her back down in the chair, the Fat Man and Chuck arrived, and Fats said, ‘I see you went ahead against my advice and hydrated Ina, eh?’

  ‘Yessir,’ said Potts sheepishly. ‘I hydrated her, and you were right, she got violent. She acted psychotic, so I gave her an antipsychotic, Thorazine.’

  ‘You gave her what?’ asked Fats.

  ‘Thorazine.’

  Fats burst into laughter. Big juicy laughs rolled down from his eyes to his cheeks to his chins to his bellies, and he said, ‘Thorazine! That’s why she’s acting like a chimp. Her blood pressure can’t be more than sixty. Get a cuff. Potts, you’re terrific. First day of internship, and you try to kill a gomere with Thorazine. I’ve heard of the militant South, but this is the limit.’

  ‘I wasn’t trying to kill her—’

  ‘Blood pressure fifty-five systolic,’ said Levy, the BMS.

  ‘Get her head down in her bed,’ said Fats. ‘Get some blood into it.’ As Levy and the nurse carried Ina to her room, the Fat Man informed us that Thorazine in gomers lowers the blood pressure so that the higher human levels don’t get perfus
ed. ‘Ina was struggling to get up so she could lie down. You almost did her in.’

  ‘But last night she went crazy—’

  ‘Sundowning,’ said Fats. ‘Happens all the time with gomers in the House. They don’t have much sensory input to begin with, and when the sun goes down, it gets dark, they go bananas. Come on, let’s do the cardflip, eh? Thorazine? I love it.’

  The Fat Man did the cardflip, beginning with the five and a half admissions that had turned Potts into a sadist. Again, like the day before, most of what I’d learned at the BMS about medicine either was irrelevant or wrong. Thus, for a dehydrated Ina, hydration made her worse. The treatment for depression was to order a barium enema, and the treatment for Potts’s third admission, a man with pain in his abdomen but who ‘knew all of you doctors are Nazis but I’m not quite sure just yet which one of you is Himmler,’ was not a barium enema and bowel run, but what the Fat Man called a ‘TURF TO PSYCHIATRY.’

  ‘What’s a TURF?’ asked Potts.

  ‘To TURF is to get rid of, to get off your service and onto another, or out of the House altogether. Key concept. It’s the main form of treatment in medicine. Just call up psychiatry, tell them about the Nazi stuff, don’t mention the gut pain, and presto—TURF TO PSYCHIATRY.’ Ripping up the index card containing the Nazi-seeker and throwing the bits over his shoulder, the Fat Man said, ‘The TURF, I love it. Let’s go. Next?’

  Potts presented his last admission, a man of our age who’d been playing baseball with his son, and who, while trying to beat out a hard screaming line drive, had dropped down in the base path unconscious.

  ‘What do you think it is?’ asked Fats.

  ‘Intracranial bleed,’ said Potts. ‘He’s in rough shape.’

  ‘He’s gonna die,’ said Fats. ‘Do you want him to have the benefit of a neurosurgical procedure first?’

  ‘I’ve already arranged it.’

  ‘Great,’ said Fats, ripping up the man our age and sowing him on the floor. ‘Potts, you’re doing great—a TURF TO NEUROSURG. Two TURFS outa three patients.’