by Samuel Shem
‘Why? It was either her or me, that’s why.’
‘Maybe she didn’t mind it, right?’ asked Fats.
‘Oh, she minded it. She screamed bloody murder. And at three A.M. I heard some maniac whistling “Daisy, Daisy, give me your answer troo.”’
‘Daisy, Daisy . . .’ said Fats, looking out the window into the face of a hardhat hanging like a spider from the rising web of the Wing of Zock. ‘It wasn’t really the Leggo who came in at that hour. Why should he? I mean, there’s no Wing of Tokerman, is there?’
‘Tina was so mad she smashed me in the nose and I got that stinging feeling all up and down my face and tears in my eyes. I realized then that I needed a big CVP line in her internal jugular in her neck.’
‘You didn’t put in a big CVP line, because you know that the Leggo hates them because they managed without them in his day and he can’t understand them anyway, right?’
‘Right, I didn’t.’
‘Good, Eddie, good,’ said Fats.
‘But I tried like hell to, and as I was trying, the Leggo came in and asked Tina, “Is there anything wrong, dearie?” and Tina screamed out “Yes! This needle in ‘my neck!” and the Leggo turned to me and said “We managed without those in my day. Take it out and come see me tomorrow morning.” And Tina refuses to sign for dialysis.’
‘Eddie,’ said Fats quietly, ‘don’t do what you’re doing. Believe me, it’s not worth it to antagonize these guys. Go easy, it’s better to go easy, see? Ah, it’s a tough case: the only relief for her dementia is dialysis, but the thing that keeps her from signing for dialysis is her dementia. A real tough TURF.’
‘How about holding a pen in her hand and scribbling her name with it?’ asked Hooper. ‘I do that to get my gomers to sign for posts.’
‘Well, stop doing that, it’s illegal!’ yelled Fats.
‘No sweat,’ said Eddie, ‘when Tina realizes that at night, when I’m on call, she’s totally at my mercy, she’ll sign, Fats, she’ll sign.’
Later that morning, Hooper and Fats and I were sitting at the nursing station. Fats was into his Wall Street Journal, and Hooper and I were watching the flow. We were still chuckling at having seen Lionel from HELP, paged by the nurse, checking out the room numbers and then, with a spiffy straightening of his Blazer and forelock, entering the room of the Lady of the Lice, the room crawling with the crabs. Eddie had been called to the Leggo’s office, and we had been worried, but we were relieved to see the Leggo come walking down the corridor with him, his arm around Eddie’s shoulder. While we waited for the Fish so we could start rounds with our leggy Chief, Fats collared Eddie and rushed us all into the on-call room, locking the door behind us.
‘All right, Eddie,’ said Fats, ‘you are in serious trouble.’
‘Whaddayamean? We had a nice chat. Go slow with Tina, was all he said. He even put his arm around me as we walked back down here.’
‘Exactly,’ said Fats, ‘that arm around you. Did you ever look closely at the anatomy of that arm? Fingers like a tree frog’s, with suckers on the ends. Arachnodactyly, like a spider. Double joints at the knuckles, universal joints at the wrist, elbow, and shoulder. When the Leggo puts his arm around someone, often it’s the end of a promising career. The last guy he put his arm around was Grenade Room Dubler, and do you know where he went for his Fellowship?’
‘Nope.’
‘Neither does anyone else. I doubt if it was on the continental USA. The Leggo puts his arm around your shoulders and whispers in your ear something like “Akron” or “Utah” or “Kuala Lummpoore” and that’s where you go. I don’t want my Fellowship in the Gulag, get it?’
‘Yours?’ asked Eddie. ‘And what about mine? In Oncology.’
‘What? You? Cancer?’
‘Natch. What could be better than a gomer with cancer?’
Chief’s Rounds that day were introduced by the Fish, and the patient was one Moe, a tough truckdriver who’d had to wait in the freezing cold during the gas crisis to fill up his rig. He had a rare disease of the blood called cryoglobulinemia, where with cold the blood clots in small vessels, and Moe’s big toe had turned as cold and white as a corpse on a slab in the morgue.
‘What a great case!’ cried the Leggo. ‘Let me ask a few questions.’
To the first question, a real toughie he asked Hooper, Hooper said, ‘I don’t know,’ and so the Leggo answered the toughie himself and gave a little lecture on it. To the next question, not a toughie, to Eddie, Eddie answered, ‘I don’t know.’ The Leggo gave him the benefit of the doubt and gave a little lecture none of which was news to Eddie or to anyone else. The Fish and the Fat Man were getting apprehensive about what we were doing, and the tension rose as the Leggo turned to me and asked me an easy one that any klutz who read Time could answer. I paused, knit my brow, and said, ‘I . . . sir, I just don’t know.’ The Leggo asked, ‘You say you don’t know?’
‘No, sir, I don’t, and I’m proud to say it.’
Startled and troubled, the Leggo said, ‘In my day, the House of God was the kind of place where on Chief’s Rounds the intern would be embarrassed to say “I don’t know.” What is going on?’
‘Well, sir, you see, the Fish said that he wanted the House to be the kind of place where we’d be proud to say “I don’t know,” and, damnit, Chief, we are.’
‘You are? The Fish said? He . . . never mind. Let’s see Moe.’
The Chief fairly burned with the excitement of getting at Moe the Toe’s toe, and yet at Moe’s bedside, for some strange reason, he went straight for Moe’s liver, poodling around with it sensually. Finally the Leggo went for Moe the Toe’s toe, and no one was sure exactly what happened next. The toe was white and cold, and the Leggo, communing with it as if it could tell him about all the great dead toes of the past, inspected it, palpated it, pushed it around, and then, bending down, did something to it with his mouth. Eight of us watched, and there were to be eight different opinions of what the Leggo did with Moe’s toe. Some said look, some said blow, some said suck. We watched, amazed, as the Leggo straightened up and, kind of absentmindedly fondling the toe as if it were some newfound friend, asked Moe the Toe how it felt and Moe said, ‘Hey, not bad, buddy, but while you’re at it could you try the same thing a little higher up?’
‘The Ten Commandments and Chicken?’ I asked the Fat Man later that night as we awaited our admissions and the ten-o’clock meal.
‘Right. Charlton Heston, Jews squashed under rocks, and then the House of God “chicken with tire tracks.” And Teddy.’
‘Who’s Teddy?’
Teddy turned out to be one of the horde of patients who loved Fats. A concentration-camp survivor, Teddy had been brought into the House E.W. bleeding out from an ulcer one night when Fats was on call. Fats had TURFED him to surgery, and, losing half his stomach, Teddy was convinced that Fats had saved his life. Teddy ‘owns a deli and is lonely so he comes in when I’m on call, with a bag of food. I deck him out in whites and a stethoscope, and he pretends he’s a doctor. Sweet guy, Teddy.’ Sure enough, as Fats and I and Humberto, my Mexican-American BMS, sat down in the TV room to watch the MGM lion begin to roar, in walked a thin, worried-looking fellow in shabby black, in one hand a radio spewing a melancholic Schumann, and in the other a big paper bag splotched with grease. As Moses grew from being a baby bulrushing around the Italian extras to being a six-foot-three Egyptian red-hot looking like Charlton Heston, Fats and I and Teddy and Humberto ran the ward via the Bell Telephone System. Just about the time that God, playing doctor, handed down the Ten Commandments, saying, ‘Take these two tablets and call me in the morning,’ Harry the Horse had chest pain. I sent Humberto to take an EKG, and when he returned, without looking at it Fats said it was ‘an ectopic nodal pacemaker taking over from the sinus node and producing chest pain.’ He was right.
‘Of course I’m right. Harry’s Private, Little Otto, has worked out a method to keep Harry here indefinitely: whenever Harry’s ready to be TURFED out, Otto tells him he’s leaving, Har
ry wills his heart into that crazy rhythm with chest pain, and Otto tells him he’s staying. Harry’s the only man in history to have conscious control of his A-V node.’
‘The A-V node is never under conscious control,’ I said.
‘For Harry the Horse, it is.’
‘So how do we get him to leave?’
‘By telling him he can stay.’
‘But then he’ll stay forever.’
‘So? So what? He’s a landsman, a brother. Nice man.’
‘So you don’t have to take care of him, I do,’ I said, irritated.
‘He’s no work for you. Let him stay. He loves it here. Who doesn’t?’
‘I do,’ said Teddy. ‘Here was the best six weeks of mine life.’
As The Ten Commandments finished, we got a call for an admission from the E.W., and Fats gathered us to him and said, ‘Men, pray that this is our sleep ticket.’
‘What?’ asked Teddy. ‘You need a ticket to sleep here?’
‘We need an admission around eleven that’s not too much work, so we can get to bed and the rotation doesn’t hand us another admission at four A.M. Pray, men, pray, to Moses and Israel and Jesus Christ and the entire Mexican nation.’
He heard. Bernard was a young eighty-three, not a gomer, and able to talk. He’d been transferred from MBH, the House’s rival. Founded in Colonial times by the WASPs, the insemination of MBH by non-WASPS had taken place only mid-twentieth century with the token multidextrous Oriental surgeon, and, finally, with the token red-hot internal-medicine Jew. Yet MBH was still Brooks Brothers, while the House was still Garment District. For Jews at MBH the password was ‘Dress British, Think Yiddish.’ It was rare to get a TURF from the MBH to the House, and the Fat Man was curious: ‘Bernard, you went to the MBH, they did a great work-up, and you told them, after they got done, you wanted to be transferred here. Why?’
‘I rilly don’t know,’ said Bernard.
‘Was it the doctors there? The doctors you didn’t like?’
‘The doctus? Nah, the doctus I can’t complain.’
‘The tests or the room?’
‘The tests or the room? Veil, nah, about them I can’t complain.’
‘The nurses? The food?’ asked Fats, but Bernard shook his head no. Fats laughed and said, ‘Listen, Bernie, you went to the MBH, they did this great work-up, and when I asked you why you came to the House of God, all you tell me is, “Nah I can’t complain.” So why did you come here? Why, Bernie, why?’
‘Vhy I come heah? Veil,’ said Bernie, ‘heah I can complain.’
As I headed to bed on the ward, the night nurse came up to me and asked me to do her a favor. I wasn’t in the mood, but asked what it was.
‘That woman transferred from surgery yesterday, Mrs. Stein.’
‘Metastatic cancer,’ I said, ‘inoperable. What about it?’
‘She knows that the surgeons opened her, took a look, and then just sewed her up.’
‘Yeah?’
‘Well, she’s asking what that means, and her Private won’t tell her. I think that someone should tell her, that’s all.’
Not wanting to face it, I said, ‘It’s her Private’s job, not mine.’
‘Please,’ said the nurse, ‘she wants to know; someone has to—’
‘Who’s her Private?’ asked Fats.
‘Putzel.’
‘Oh. It’s OK, Roy, I’ll take care of it myself.’
‘You? Why?’
‘’Cause that worm Putzel will never tell her. I’m in charge of the ward, I’ll take care of it. Go to sleep.’
‘But I thought you’re telling me and Eddie not to make waves.’
‘Right. This is different—this woman needs to know.’
I watched him enter her room and sit on the bed. The woman was forty. Thin and pale, she blended with the sheets. I pictured her spine X rays: riddled with cancer, a honeycomb of bone. If she moved too suddenly, she’d crack a vertebra, sever her spinal cord, paralyze herself. Her neck brace made her look more stoic than she was. In the midst of her waxy face, her eyes seemed immense. From the corridor I watched her ask Fats her question, and then search him for his answer. When he spoke, her eyes pooled with tears. I saw the Fat Man’s hand reach out and, motherly, envelop hers. I couldn’t watch. Despairing, I went to bed.
At four A.M. I was awakened for an admission. Cursing, I wobbled into the E.W. cubicle and found Saul the leukemic tailor, at whose remission in October we’d wept with joy. Saul was dying. As if enraged at the delay in its onrush to death, Saul’s marrow had gone wild, spitting out deformed cancerous bone cells that left Saul delirious with fever, oozing blood, anemic, in pain, and, where the malignant white cells had failed to prevent the spread of his normal skin flora, his body coated with maggoty pustules of staphlococcus. Too weak to move, too mad to cry, gums swollen and tongue bruised, he shooed away his wife and motioned me to bend down to him, and whispered, ‘Dis is it, Dr. Basch, right? Dis is the end?’
‘We can try for another remission,’ I said, not believing it.
‘Don’t talk to me remission. Dis is hell. Listen—I want you to finish me off.’
‘What?’
‘Finish me off. I’m dead, so let me die. I didn’t want no treatment—she forced me. I’m ready, you’re my doctor, so give me something to finish me off, OK?’
‘I can’t do that, Saul.’
‘Crap. Remember Sanders? I was dere, next bed. I saw. Suffered? Terrible. Don’t make me go like him. So? You want me to sign something, I sign. Do it.’
‘I can’t, Saul, you know that.’
‘So find me someone who will.’
‘I promise you’ll have no pain. That’s the best I can do.’
‘Pain? What about pain inside, in my heart? What do I have to do, Dr. Basch,’ he said angrily, ‘beg? You don’t want me to suffer like Sanders. You liked him too, I know.’
I looked into his bloodshot eyes, the infection creeping over the lids toward the conjuctival vessels that were pale because there were so few red cells, and I wanted to say, No, I don’t want you to suffer, Saul, I want you to die easy.
‘Dere, see? It’s a cinch. Please, finish me off.’
As I continued to protest, remembering how Sanders had suffered and died, a horrible thought crossed my mind, horrible because for an instant it didn’t seem horrible, like seeing a baby and thinking of putting an icepick through a fontanelle of its skull, the thought, Yes, Saul, I’ll do it, I’ll finish you off. I began to work like hell to save him.
I went back to the ward, and came to the room with Putzel’s terminal-cancer woman. Fats was still there, playing cards, chatting. As I passed, something surprising happened in the game, a shout bubbled up, and both the players burst out laughing.
After the next morning’s cardflip, when Fats had gone to eat and Hooper had gone to Path, EMD got a silly look on his face and told me that Lionel the Blazer had paged him to take a look at some ‘little red things’ on his gorgeous pubis that itched like hell. Eddie asked me what to do, and I said, ‘Do? You’re a doc, so do what docs do: examine him. Give me five minutes and do it in here.’
I got the operator to page Fats and Hooper and Selma and the nurses and the Fish and Housekeeping to come STAT to Gomer City, and then I watched Lionel come up the hallway, look around cautiously, and enter the on-call room. I ran up to the group I’d paged and said, ‘Hey, I got paged to go into the on-call room, STAT!’ and then the ten of us rushed into the room. Lionel was blue-blazered only from the waist up and was sitting on the table naked from the waist down, pawing through his brown pubic hair. Eat My Dust was sitting across from him, lost in contemplation. When Lionel saw us, he went red and started to explain. He realized that he didn’t want to explain and stopped, and blushed, and said, ‘It’s about a medical problem.’
‘Crab lice,’ said Eddie, ‘Lionel’s got the venereal crabs.’
‘Medical problem?’ I said. ‘You know, we can’t blame Lionel for this, no. We can only
blame the system, the one that has paramedical personnel seeking free medical advice. How often is it that here in the House one gets tapped on the shoulder and hears, “Hey, doc, I got this problem, you got a minute?”’
Lionel put on his spinnaker-patterned briefs and his classy gray slacks and left. From that time on, whenever any of us ran into Lionel we couldn’t help but think of him in terms of his unblazered, crab-infested prick.
‘You shouldn’t have done that, Basch,’ said the Fat Man, walking out onto the ward with me.
‘Why not?’
‘’Cause with guys like the Blazers, you can’t win: as soon as you engage in the struggle, you lose. Lionel’s boss, the flunky Marvin, who assigns admissions, is gonna make life miserable for you. Look, Roy, you’re older than Hooper and Eddie, you can step back a little, and roll with it. It’s hard enough without Blazers and Privates and Slurpers making it harder.’
‘Give in to those assholes?’
‘I never said that.’
‘What’s the alternative?’ I asked, challenging him.
‘Don’t let them use you, Roy. Use them.’
‘How?’
‘Like this,’ said Fats, sitting down across from Jane Doe and taking out his stopwatch. ‘Observe.’
‘What are you doing?’
‘Using them. In ten minutes I’ll explain.’
‘Look, I want to go home. I’m going to sign out to Hooper.’
‘Go ahead. Come back here in ten and I’ll explain.’
I went into the on-call room and signed out to Hooper, and even though I knew he hadn’t heard a word I’d said, I didn’t care, and I got up to go home. Hooper was reading the manual I’d used at the beginning of the year, How to Do It for the New Intern, the section on ‘How to Do a Chest Tap.’ I thought this strange, since we were more than halfway through the year and a chest tap was standard procedure. As we had gotten into the habit of helping each other out, even if it meant staying around a little longer, I asked Hooper if he needed help and he said, ‘You mean Lionel?’ and I said, ‘No, me,’ and he said, ‘Nah, I’ll just read this manual and then go tap Rose Budz’s chest.’ I left him poring over the book and pointing his own finger at his own chest in the imaginary needle track he was going to take on Rose Budz. On the ward I rejoined Fats, who clicked off his watch, turned to me, and asked, ‘What didn’t happen?’