The house of God

by Samuel Shem

  The house of God

  Samuel Shem

  Now a classic! The hilarious novel of the healing arts that reveals everything your doctor never wanted you to know. Six eager interns — they saw themselves as modern saviors-to-be. They came from the top of their medical school class to the bottom of the hospital staff to serve a year in the time-honored tradition, racing to answer the flash of on-duty call lights and nubile nurses. But only the Fat Man —the Clam, all-knowing resident — could sustain them in their struggle to survive, to stay sane, to love-and even to be doctors when their harrowing year was done.

  1

  Except for her sunglasses, Berry is naked. Even now, on vacation in France with my internship year barely warm in its grave, I can't see her bodily imperfections. I love her breasts, the way they change when she lies flat, on her stomach, on her back, and then when she stands, and walks. And dances. Oh, how I love her breasts when she dances. Cooper's ligaments suspend the breasts. Cooper's Droopers, if they stretch. And her pubis, symphasis pubis, the bone under the skin being the real force shaping her Mound of Venus. She has sparse black hair. In the sun, she sweats, the glisten making her tan more erotic. In spite of my medical eyes, in spite of having just spent a year among diseased bodies, it is all I can do to sit calmly and record. The day feels smooth, warm, pebbled with the nostalgia of a sigh. It is so still that a match flame stands upright, invisible in the clear hot air. The green of the grass, the lime?white walls of our rented farmhouse, the orange stucco roof edging the August blue sky?it is all too perfect for this world. There is no need to think. There is time for all things. There is no result, there is only process. Berry is trying to teach me to love as once I did love, before the deadening by the year.

  I struggle to rest and cannot. Like a missile my mind homes to my hospital, the House of God, and I think of how I and the other interns handled sea. Without love, amidst the gomers and the old ones dying and the dying young, we had savaged the women of the House. From the most tender nursing?school novitiate through the hard?eyed head nurses of the Emergency Room, and even, in pidgin Spanish, to the bangled and whistling Hispanic ones in Housekeeping and Maintenance?we had savaged them for our needs. I think back to the Runt, who had moved from two-dimensional magazine sex into a spine?tingling sexual adventure with a voracious nurse named Angel?Angel, who never ever did, the whole long year, to anyone's knowledge, string together a complete sentence made of real words. And I know now that the sex in the House of God had been sad and sick and cynical and sick, for like all our doings in the House, it had been done without love, for all of us had become deaf to the murmurs of love.

  "Come back, Roy. Don't drift off there, now"

  Berry. Finishing our lunch, we are almost to the hearts of our artichokes. They grow to enormous size in this part of France. I had trimmed and boiled the artichokes, and Berry had made the vinaigrette. The food here is exquisite. Often we eat in the sun?dappled garden of our restaurant, under the lattice of branches. The starched white linen, delicate crystal, and fresh red rose in the silver vase are almost too perfect for this life. In the corner, our waiter attends, napkin over his arm. His hand trembles. He suffers from a senile tremor, the tremor of a gomer, of all the gomers of the year. As I come to the last leaves of the artichoke, their purple surpassing their edible green, and throw them toward the garbage heap for the farmer's chickens and glass?eyed gomer of a dog, I think about a gomer eating an artichoke. Impossible, unless it were pureed and squirted down the feeding tube. I remove the thistly hairs, green abundant, covering the mound of choke, and come to the heart, and I think back to eating in the House of God, and to the one best at eating, best at medicine, my resident, the Fat Man. The Fat Man shoveling onions and Hebrew National hot dogs and raspberry ice cream into his mouth all at once at the ten?o'clock supper. The Fat Man, with his LAWS OF THE HOUSE and his approach to medicine that at first I thought was sick but that gradually I learned to be the way it was. I see us?hot, sweaty, Iwo Jima?heroic?hovered over a gomer:

  "'They're hurting us," the Fat Man would say.

  "They've got me on my knees," I'd reply.

  "I'd commit suicide, but I don't want to make the bastards happy."

  And we'd put our arms around each other and cry. My fat genius, always with me when I needed him, but where is he as I need him now? In Hollywood, in Gastroenterology, in bowel runs?as he always put it — 'through the colons of the stars." I know now that it was his zany laughter and his caring, and that of the two policemen of the Emergency Room?the two policemen, my Saviors, who seemed to know everything and who almost seemed to know it in advance?that had gotten me through the year. And despite the Fat Man and the policemen, what had happened in the House of God had been fierce, and I had been hurt, bad. For before the House of God, I had loved old people. Now they were no longer old people, they were gomers, and I did not, I could not love them, anymore. I struggle to rest, and cannot, and I struggle to love, and I cannot for I'm all bleached out, like a man's shirt washed too many times.

  "Since you drift off there so much, maybe you'd rather be back there after all," says Berry sarcastically.

  "Love, it's been a bad year."

  I sip my wine. I've been drunk much of the time we've been here. I've been drunk in the cafes on market day as the clamor ebbs in the market and flows in the bars. I've been drunk while swimming in our river, at noon the temperature of water, air, and body all the same, so that I can't tell where body ends and water begins and it's a melding of the universe, with the river curling round our bodies, cool and warm rushes intermingling in lost patterns, filling all times and all depths. I swim against the current, looking upstream where the winding riverpath rests in a cradle of willow, rushes, poplar, shadow, and that great master of shadow, the sun. Drunk, I lie in the sun on the towel, watching with blossoming arousal the erotic ballet of the English women changing into and out of swimsuits, glimpsing an edge of breast, a wisp of pubic hair, as so often I had glimpsed edges and wisps of nurses, as they changed into and out of their costumes before my eyes, in the House. Sometimes, drunk, I ruminate on the state of my liver, and think of all the cirrhotics I have watched turn yellow and die. They either bleed out, raving, coughing up and drowning in blood from ruptured esophageal veins, or, in coma, they slip away, slip blissfully away down the yellow-brick ammonia?scented road to oblivion. Sweating, I tingle, and Berry becomes more beautiful than ever. This wine makes me feel like I'm bathed in amnion, breathless, fed by the mother-bloodflow in the umbilical vein, fetal, slippery and tumbling over and over in the warmth of the beating womb, warm amnion, warmnion. Alcohol helped in the House of God, and I think of my best friend, Chuck, the black intern from Memphis, who never was without a pint of Jack Daniels in his black bag for those extra?bitter times when he was hurt extra bad by the gomers or the slurping House academics, like the Chief Resident or the Chief of Medicine himself, who were always looking at Chuck as illiterate and underprivileged when in fact he was literate and privileged and a better doc than anyone else in the whole place. And in my drunkenness I think that what happened to Chuck in the House was too sad, for he had been happy and funny and now he was sad and glum, broken by them and going around with the same half?angry, half?crushed look in his eyes that I'd noticed Nixon had had yesterday on our French TV, as he stood on the steps of the helicopter on the White House lawn after his resignation, giving a pathetically inappropriate V?for?defeat sign before the doors closed over him, the Filipinos rolled in the red carpet, and Jerry Ford, looking more flabbergasted then awed, put his arm around his wife and walked slowly back to the presidency. The gomers, these gomers…

  "Damnit, everything makes you think of those gomers," says Berry.

  "I hadn't realized that I'd been th
inking out loud."

  "You never realize it, but these days, you always do. Nixon, gomers, forget about the gomers. There aren't any gomers here."

  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 chateau, the church, the prehistoric caves, the square, and far below, the river valley, the child'stoy 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 at 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! . . ."

  2

  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

  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 hierarchy.

  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, heIlllp," I said.

  "Roy, you really are in 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"