House of God

by Samuel Shem

  When the Runt showed up, he was so nervous—from having spent eight weeks with a Double O Resident named Mad Dog and with Hyper Hooper and Eat My Dust Eddie, from having heard about ‘the toughies’ awaiting him on our ward, from living with the fear that he was gonna die from being stuck with a needle from the Yellow Man’s groin, and also from his intellectual poet June, who was furious at him for spending time away from her—he was so nervous that he seemed to be flying, living three inches above the floor. His hair was frazzled and his mustache seemed to be alive, and he tugged first at one end and then at the other. Chuck and I tried to talk him down, but it was no use, and so we called for Molly to get the syringe of Valium.

  ‘OK, man,’ said Chuck, ‘pull down your pants.’

  ‘Here? Are you crazy?’

  ‘Go ahead,’ I said, ‘we’ve got things all ready for you.’

  The Runt pulled down his pants and bent over the nursing-station desk. In walked Molly, with a friend of hers, a nurse from the MICU—Medical Intensive Care Unit—named Angel. Angel was red-headed, buxom, Irish, with wraparound muscular thighs and a creamy complexion. Working in Intensive Care, the Death Row of the House, was rumored to have intensified her sexuality, and it was said that year after year Angel gave intensive care not only to the sick, but also to the male tern. This talent, perhaps apocryphal, had at any rate yet to be experienced by anyone in our group.

  ‘Molly,’ I said, ‘I’d like you meet the new tern, the Runt.’

  ‘Pleased to meet you,’ said Molly. ‘This is Angel.’

  Craning his neck around, the Runt blushed, his bulbococcygeals tightened, causing his testes to leap up in his scrotum like startled fish in an electrified pond, and he said, ‘Pleased to meet you. I . . . I’ve never met anyone in this position before. It’s their idea, not mine.’

  ‘Oh it’s’—gesturing up toward the thin air—‘nothing new for a’—gesturing toward herself—’nurse,’ said Angel.

  How strange that Angel had difficulty putting words together without gesturing, but it must have had something to do with her nervousness at meeting the Runt from the rear. Angel seemed to be having a hard time resisting the impulse to go to the Runt and run her creamy hands over his leering lumpy rump, his cheeks, his testicles, even the crenellations of his anus, why not? We settled on Angel delivering the dose of Valium, which she did with professional skill, finishing by planting a kiss on the spot. The nurses left, and we asked the Runt how he felt and he said fine and in love with Angel but that he was still scared stiff about starting with the toughies on the ward.

  ‘Man, there’s nothing to worry about,’ said Chuck. ‘Even though you inherit Potts’s disasters, you inherit Towl too.’

  ‘Who is Towl?’

  ‘Towl? Towl, boy you get in here stat!’ yelled Chuck. ‘Towl is the best damn BMS you ever saw.’

  He was. In he walked: four feet tall with thick black glasses and thick black skin, with a voice gruff as a drill sergeant’s and a vocabulary that was short and tough like him. The words Towl knew, he slurred, and his main gift was action, not talk. He was a locomotive. A locomotive from Georgia.

  ‘Towl,’ said Chuck, ‘this is the Runt. He’s gonna be your new tern, starting tomorrow.’

  ‘Rhmmmmm rhmmmm hi the Runt,’ growled Towl.

  ‘Boy,’ said Chuck, ‘You gotta run the Runt’s service, just like you did Potts’s. OK? Now, you tell him about it.’

  ‘Rhhmmmmm rhmmmm twenty-two patients: eleven gomers, five sickees, and six turkeys who nevah shoulda been heah in the foist place. All in all, nine of ’em are on da rola coasta.’

  ‘Rolla coasta?’

  ‘Right,’ said Towl, making a motion with his hand like a car on a roller coaster, up and down, up and down, and finally up and flying out into space.

  ‘He means TURFED out of the House,’ I said.

  ‘But what about the sickees?’ asked the Runt. ‘I’d better start seeing them right away?’

  ‘Rhhmmmmm rhmmmm, nope, You don’t have to. Ah takes care of ’em. I nevah lets the new tern touch ’em, not till I’m sure he knows what he’s on about.’

  ‘But you can’t write orders,’ said the Runt.

  ‘Oh, I can write ’em, I jes cain’t sign ’em. Go home, Runt, and come on back in tamarra. Well, gotta go finish mah shit on the ward so I can take off early. So long, Runt. Tamarra.’

  Despite our preparations, Jo and ward 6-South began to destroy the Runt. Jo, on call with him, took up where Mad Dog had left off, making the Runt feel that he never could do enough and that he never should do anything without first consulting her. Afraid to risk, the Runt didn’t learn. Jo’s aggressive approach to the gomers soon created for the Runt the sickest, most pitiful service on the ward. The Runt was completely disorganized, and, worse, if a patient did poorly, he thought it was his fault. If Lazarus bled, it was his fault. If a birdlike woman with intransigent bowels hadn’t had a bowel movement, it was his fault. He began spending more time talking to his patients, and formed such an attachment to one old man that whenever the Runt showed up, the old fellow would grasp his hand, start to cry, kiss his hand, say that the Runt was his only friend, and when the Runt would try to leave, the old fellow would kiss his hand again, start to cry, and offer him, over and over, the same present, a used bowtie. Despite Chuck, Towl, and me, the Runt was being eaten up by guilt. We’d seen it happen to Potts, and we didn’t want it to happen again. Chuck and I decided that if the Runt could only get something going with Angel, he might gain some confidence. His poet, fed up with his being too preoccupied with medicine to read her runes, now demanded that he sleep out on the living-room couch. Yet the Runt was too unsure of himself to ask Angel out.

  ‘Why don’t you ask her out?’ I’d ask. ‘Don’t you like her?’

  ‘Like her? I’m nuts about her. I dream about her. She’s beautiful. She’s the kind of woman my mother would never let me go out with. She’s what I watched my roommate Norman screw for four years at BMS. A centerfold.’

  ‘So why don’t you ask her out?’

  ‘I’m scared she won’t like me and say no.’

  ‘So what? What have you got to lose?’

  ‘The possibility—if she says no—that she might have said yes. Whatever I do, I don’t want to lose that possibility.’

  ‘Look, man,’ said Chuck, ‘you know unless you get your dick moving a little faster, you never gonna learn medicine at all.’

  ‘What the hell does that have to do with it?’

  ‘Who knows, man, who knows?’

  And instead of asking her out, the Runt kept floundering in guilt on the ward and kept tossing and turning fitfully on the couch in the living room of the poet and kept going to the funerals of his dead young patients and kept letting Jo lop a bit off his schlong daily by telling him what he’d failed to do, and on top of all that, at his poet’s suggestion, she being deep into the anal sadistic stages of her psychoanalysis, the Runt followed the path of cure that had warped his organ in the first place in his hyperanalyzed family and went back to the therapist he’d had throughout BMS to work out the torment he’d felt from his promiscuous roommate, Norman, who had had an electric organ and played only one song: ‘If You Knew Suzie Like I Know Suzie’; that song because all of his girlfriends were named Suzie and each was oh so delighted when she knocked on Norman’s door and he leaped to his organ, yelled, ‘Come on in, Suzie,’ and in the words of each Suzie, ‘played my song.’

  One horrendously hot and steamy night I was on call, and the Runt, working late, refused to leave a patient of his who was in serious trouble. I urged the Runt to go home, and then I urged him to call up Angel and ask her out, and he would do neither. Towl had gone home and so the Runt was at a loss about what to do with his patients, a particular problem being Risenshein, a LOL in NAD whose bone marrow had been wiped out by our cytotoxic agents and had failed to regenerate blood cells, which meant that she was bound to die. The Runt kept asking me what to do with her. Since I was bu
sy with my admissions and with keeping track of the decompensating ward of ‘toughies,’ I blew my cool and said, ‘Get out of here, damnit! I’ll take care of things. Go home!’

  ‘I don’t want to go home. June’s at home. If I go back there, we’ll get into some argument about her anal sadism.’

  ‘So long,’ I said, walking off.

  ‘Where are you going?’

  ‘To the bathroom,’ I said, ‘I’ve got the flu.’ I retreated to the sanctuary of the toilet, wrapped in the latest graffiti: WAS ST. FRANCIS ASSISI?

  ‘What should I do?’ wailed the Runt outside the door.

  ‘Call up Angel.’

  ‘I’m afraid. Why should I call her, anyway?’ Receiving no answer, he struggled with the silence, and said, ‘All right. Damn! I almost forgot—I’m late for therapy. I’ll call her when I get back.’

  ‘Nope. Call her now, and don’t come back. I’m on call here, see?’

  So he finally called her and asked her out and rushed off to talk it all over with the therapist, whom he was paying fifty an hour to take the starch out of his penis. I sat at the nursing station, worn out by a nagging influenza that had me shitting on the hour, and overcome with gloom at the work I had to do. The sun was setting over the changing leaves, and even though it was a boiling-hot Indian-summer night, I knew that soon the days would turn crisp and clear and bright, football weather, when you huddled with a sweatered woman under a blanket and got drunk to avoid getting cold and kissed her lips and shivered . . .

  ‘Mrs. Biles is back from her cardiac catheterization,’ said my BMS, Bruce Levy the Lost. ‘The cath fellows wrote in the chart that “Mrs. Biles had excessive bleeding from the site of needle puncture in the groin.” I’d better work it up, Dr. Basch. She might have a bleeding disorder.’

  Mrs. Biles had no bleeding disorder. The cath boys always wrote ‘excessive bleeding’ to BUFF the charts in case of litigation. In fact, Mrs. Biles, Little Otto’s patient, didn’t even have cardiac disease at all, but—as everyone including Otto knew—bursitis. Little Otto was after the big bucks. Bruce Levy, the BMS, was after playing the invent-an-obscure-disease-to-make-an-A-in-medicine game. Who was I to stand in his way?

  ‘Sounds interesting, Bruce. How ya gonna work it up?’

  Bruce rattled off several blood tests he was about to order.

  ‘Wait a sec,’ said Jo, who’d been on her way out but who had stopped back in to make sure all was OK before she went back out to where she was just another lonely single woman and not an admiral of the gomers in the House of God. ‘Those tests cost a fortune. What evidence do you have that she has a bleeding disorder? For example, did you ask her if she suffers from nosebleeds?’

  ‘Hey, great idea!’ said Bruce, and ripped off down the hall to ask. Returning, he said, ‘Yeah, she suffers from nosebleeds. Great!’

  ‘Wait a sec,’ I said, ‘everybody will say that when you ask, right?’

  ‘Yeah, right,’ said Brucie, looking crestfallen.

  ‘Did you ask her if she bleeds after tooth extraction?’ asked Jo.

  ‘Hey, terrific idea!’ said Bruce, and ran out again. ‘Yup, she bleeds like crazy after tooth extractions.’

  ‘Brucie, everyone bleeds like crazy after extractions,’ I said.

  ‘Damnit, Dr. Basch, you’re right,’ said the BMS, and he looked sad, since to become an intern in the BMS system he had to make an A, and to do that he had to make a disease so he could make a cure and make a lecture, and he saw his grade fluttering down toward low C and his internship moving west of the Hudson River.

  ‘Say, Brucie,’ I said nonchalantly, ‘what about bruising?’

  ‘Bruising? Hey, fantastic idea—’

  ‘WAIT! Save yourself a trip. She’s gonna say yes, that she bruises easily, right?’

  ‘Right, Dr. Basch. Who wouldn’t say that?’

  ‘No one,’ I said. ‘But how can you test it out for sure?’

  ‘I don’t know,’ said Brucie, his fist furrowing his brow.

  ‘Too bad,’ I said. ‘Bleeding disorders are fascinating.’

  All of a sudden Brucie lit up, shouted, ‘I got it!’ and ran down the hallway, and a few seconds later there echoed back up to us a scream YEEE-OWWWW! and in a moment Brucie was back, grinning from ear to ear, and he said, ‘Well, I did it,’ and reached for the hematology slips.

  ‘You did it? You did what?’ asked Jo, eyes popping.

  ‘I bruised her.’

  ‘WHAT? YOU DID WHAT?’

  ‘Just like you suggested, Jo, I bruised Mrs. Biles. Punched her in the arm. You were right, I shouldn’t have gone ahead with this expensive work-up until I’d bruised her with my own two hands.’

  Just before the Runt returned from his therapy, a forty-two-year-old patient of his had a cardiac arrest, and as the Runt came down the hallway, he was passed by the intubated patient being wheeled to the MICU by Eat My Dust Eddie, the tern on rotation here. The Runt looked horrified and said, ‘I’m sure it was something I did wrong.’

  ‘Don’t be silly,’ I said, ‘it’s a good TURF. Now, get out of here—you’ll be late for your date with Thunder Thighs.’

  ‘I’m not going.’

  ‘You are. Think of those red pubic hairs.’

  ‘I can’t. I better go see Mrs. Risenshein. I feel terrible that these young patients are all dying.’

  ‘LAW NUMBER FOUR: THE PATIENT IS THE ONE WITH THE DISEASE. Get the hell out of here,’ I said, pushing him out the door. ‘Scram.’

  ‘I’ll call you from the Chinese restaurant.’

  ‘Call me from the saddle or don’t call me at all.’

  ‘But why? Why?’ he screamed, his foot jamming the door like a salesman. ‘Why am I doing this?’

  ‘Because it’s limp.’

  ‘Because what’s limp?’

  ‘The whole goddamn shooting gallery. So long.’

  He left. As usual, all hell broke loose on the ward, mostly with the Runt’s patients. The Runt had learned to be aggressive with the gomers and cautious with the dying young, and since Chuck and I had begun to believe the Fat Man’s idea that the reverse was the essence of medical care, the Runt’s patients were disasters, and the first part of each night on call had to be spent BUFFING the Runt’s service, in secret, hidden from Jo, the Runt, and the charts. Surreptitiously I’d slip into the room containing the young asthmatic who would die without the steroids that the Runt was afraid to give her and BAM BAM hit her with a big secret dose that would get her through the night; next it would be his nice leukemic lady, whom Towl was keeping alive, and secretly I’d transfuse her six more units of platelets without which she’d bleed out before sunrise; and the final horrendoma was Lazarus, the alcoholic janitor, who was always in shock, always infected, and whom the Runt was always treating with homeopathic doses of meds for fear of doing something bad. Each day, Lazarus made a determined effort to die, usually by bleeding out, from nose or lip or gut or balls, and each night Chuck or I in a clandestine and almost religious operation would BUFF the shit out of him for his next day’s thrilling adventures with a tern who was limp and unstrung and scared to death of doing anything active, anything active at all. That night I remembered that I’d forgotten what the Runt had told me just before he’d left the first time, when I’d asked him if he’d tapped the infection in Lazarus’ ascitic belly:

  ‘He’s all right,’ the Runt had said, looking away.

  ‘Wait a sec,’ I’d said, ‘did you tap his belly or not?’

  ‘Nope.’

  ‘Jesus Christ! Why the hell not?’

  ‘I never learned how. You need to use a big needle and I . . . I was scared I’d hurt him.’

  Limp. Cursing, I went into Lazarus’ room, where he was dying again in earnest, and since I’d been in this situation with him every other night on call, I knew what to do, and got busy raising him up yet again. Molly came up and said I had a phone call. It was the Runt.

  ‘How’s Mrs. Risenshein?’ he asked.

 
; ‘Fine, but Lazarus just started to go down the tubes,’ I said, telling myself I won’t yell at him for not having tapped his belly.

  ‘I should have tapped his belly.’

  ‘Where are you?’

  ‘Chinatown. But how’s Lazarus?’

  ‘What did you have?’

  ‘Lo mein, moo goo gai pan, and a lotta rice, but how is he?’

  ‘Sounds delicious, he went down the tubes,’ I said.

  ‘Oh, no! I’m coming in!’

  ‘But I saved him.’

  ‘Hey, great!’

  ‘Hang on,’ I said, watching Molly gesture from Lazarus’ room, ‘He’s trying to go down the tubes again.’

  ‘I’m coming in!’

  ‘What are you doing after dinner?’

  ‘I thought I’d take her back to my place.’

  ‘What? With June there, are you nuts?’

  ‘Why not?’

  ‘Never mind. I gotta go, but listen, whatever you do, do not take her back to your place. Go to her place. Remember: FAKE HIGH, GO LOW. So long.’

  For some reason, admission diagnoses in the House of God ran in spurts: three cardiac, two renal, four pulmonary. That hot and dismal night, the disease matched the oppression—it was cancer night at the House. First it was a little tailor named Saul. As I read his chart in the E.W., Howard—the tern who seemed to love every aspect of the ternship and whom I hated for that—bubbling with excitement at ‘really being a doc,’ told me that Saul had pneumonia. The blood smear told me that Saul had acute leukemia, his pneumonia being part of his generalized sepsis because his white cells didn’t work. Saul knew he was sick, although he didn’t know yet how sick, and when I wheeled him to X Ray for his chest film, I asked him if he could stand up by himself.