The house of God

by Samuel Shem

  "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 blue?steel 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 AWAY GO AVAY GO AVAY . . . and took a swing at him with her left fist. Enraged, Potts?gentle Moliere?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 perfused. "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."

  Potts and I looked at each other. We felt sad that someone our age who'd been playing ball with his six?year?old son on one of the super twilights of summer was now a vegetable with a head full of blood, about to have his skull cracked by the surgeons.

  "Sure it's sad," said Fats, "but there's nothing we can do. The ones our age are the ones who die. Period. The kind of diseases we get, no medico?surgicobullshitology can cure. Next?"

  "Well, the next is the worst," said Potts in a husky voice.

  "What's that?"

  "The Czech, the Yellow Man, Lazlow. Last night about ten o'clock he had a convulsion, and no matter what I did, he wouldn't stop convulsing. I tried everything. His liver function tests late last night were off the scale. He . . ." Potts looked at Chuck and me, and then, ashamed, looked down into his lap and said, "He's got fulminant necrotic hepatitis. I transferred him to the isolation ward on the other service. He's not my patient?our patient?anymore."

  Fats asked Potts in a kind voice if he'd given the Yellow Man steroids. Potts said that he'd thought about it, but had not.

  "Why didn't you tell me the lab results? Why didn't you ask me for help?" asked Fats.

  "Well I . . . I thought I ought to be able to make the decision alone."

  A somber quiet floated down over us, the quiet of sadness and grief. Fats reached over and put his thick arm around Potts's shoulder and said, "I know how shitty you feel. There's no feeling like it in the world. If you don't feel it at least once, Potts, you'll never be a good doc. It's all right. Steroids never help anyway. So he's TURFED to 6?North, eh? Tell you what: after breakfast, since we've got so many TURFS, I'll demonstrate the electric gomer bed."

  On the way to the electric gomer bed, whatever that was, Potts, despondent, turned to Chuck and said, "You were right, I should have given him the roids. He's gonna die for sure."

  "Wouldn't have helped him none," said Chuck, "he was too far gone."

  "I feel so bad," said Potts, "I want Otis."

  "Who's Otis?" I asked.

  "My dog. I want my dog."

&nb
sp; The Fat Man gathered us around the electric gomer bed containing my patient, Mr. Rokitansky. Fats explained how the goal of the tern was to have as few patients as possible. This was opposite the goal of the Privates, the Slurpers, and the House Administration: Since, according to LAW NUMBER ONE: GOMERS DON'T DIE, the gomers would not be leaving the tern's service by way of death, the tern had to find other ways to TURF them. The delivery of medical care consisted of a patient coming in and being TURFED out. It was the concept of the revolving door. The problem with the TURF was that the patient might BOUNCE, i.e., get TURFED back. For example, a gomer who was TURFED TO UROLOGY because he couldn't urinate past his swollen prostate might BOUNCE back to medicine after the urology intern with his filiform probes and flexible followers had managed to produce a total body septicemia, requiring medical care. The secret of the professional TURF that did not BOUNCE, said the Fat Man, was the BUFF.

  We asked what was a BUFF.

  "Like BUFFING a car," said Fats. "You gotta BUFF the gomers, so that when you TURF them elsewhere, they don't BOUNCE back. Because you gotta always remember: you're not the only one trying to TURF. Every tern and resident in the House of God is lying awake at night thinking about how to BUFF and TURF these gomers somewhere else. Gath, the surgical resident downstairs, is probably giving his terns the same lecture at this very moment, about how to produce heart attacks in gomers to TURF TO MEDICINE. But one of the key medical tools to TURF gomers elsewhere is the electric gomer bed. I'll demonstrate on Mr. Rokitansky. Mr. R., how you doing today?"

  PURRTY GUD.

  "Good. We're going on a little trip, OK?"

  PURRTY GUD.

  "Good. Now, the first thing to notice is that the electric gomer bed has side rails. They don't matter. LAW NUMBER TWO:?repeat after me?GOMERS GO TO GROUND."

  Responsively, we repeated: GOMERS GO TO GROUND.

  "Side rails up, side rails down," Fats said, "no matter how securely restrained, no matter how demented, no matter how seemingly incapacitated, GOMERS GO TO GROUND. The next thing about the gomer bed is this foot pedal. Gomers don't have good blood pressures, and when, like Ina, they stop perfusing the newer parts of their brains, they go crazy, start yelling, and try to GO TO GROUND. In the middle of the night, when you get called for the fact that your gomer now has a blood pressure the same as an amoeba, you kick this pedal. Basic, like knowing C major. OK, Maxine, take the blood pressure for a baseline reading."

  "Seventy over forty," said Maxine.

  "Good," said Fats, and kicked the pedal. The electric gomer bed roared into action. In less than thirty seconds Mr. Rokitansky was virtually upside down on his noggin, his feet pointing at forty?five degrees and his head jammed against the headboard, down below at the other end.

  "Blood pressure, Max? Mr. Rokitansky, how ya doin'?"

  Although Mr. Rokitansky didn't look like he was doing too good, as Maxine tried to read his BP?blood pressure?from his nearly vertical arm, he said:

  PURRTY GUD.

  A trouper.

  "One hundred and ninety over one hundred," said Maxine.

  "This position," said Fats, "is called Trendelenberg. You can get any blood pressure you want out of your gomer, depending on how much Trendelenberg you order. The reverse of Trendelenberg is what?"

  Nobody knew.

  "Reverse Trendelenberg," said Fats. "Since most gomers have trouble making a BP, you don't put a gomer in reverse too often."

  Next the Fat Man showed us how to get just the head of the bed up, for pulmonary edema; the foot of the bed up, for stasis ulcers of the foot; the middle of the bed up, for disorders of the middle. Finally, after he'd done everything with the gomer bed but twist it into a pretzel, using Rokitansky for the holes, he became solemn and said in an excited voice, "I've saved the most important control for last. This button controls the height. Mr. Rokitansky, are you ready?"

  PURRTY GUD.

  "Good, 'cause here we go," and pushing the button, which sent the bed going down, Fats said, "This is the up?down button and we are going down. Given LAW NUMBER TWO, which is . . ."

  "GOMERS GO TO GROUND," we said automatically.

  ". . . the only way to prevent them from hurting themselves is to have the mattresses on the floor. The nurses hate this position 'cause they have to go around searching for the bedpans on their hands and knees. We tried it last year and it didn't work?the traffic in bedpans went down and the place started to smell like the cattle yards in Topeka. However, now we are going up." Fats shouted out, "Going up!" pushed the button, and Rokitansky began to rise. During the smooth journey Fats called out, "Vacuum cleaners, ladies' lingerie, appliances, toys," and finally, when Rokitansky was five feet off the ground chest?level with us all, the Fat Man said, "This is one of the most important positions. From this height, if a gomer goes to ground it is an automatic intertrochanteric fracture of a hip, and a TURF TO ORTHOPEDICS. This height," said Fats, beaming, "is called "The Orthopedic.' The penultimate. And now, the ultimate." Again Fats hit the button, and Mr. Rokitansky floated on up, coming to rest at the level of our heads. "This height is called 'The Neurosurgical.' Going to ground from here results in the TURF TO NEUROSURGERY. And from there, they rarely BOUNCE back. Thank you, gentlemen, see you at lunch."

  "Wait," said Levy, the BMS. "You're being cruel to Mr. Rokitansky."

  "Whaddaya mean? Mr. Rokitansky, how are you doin'?"

  PURRTY GUD.

  "But he always says that."

  "Oh, yeah? Hey, Mr. Rokitansky, hey, you up there, you got anything else you want to tell us?"

  We waited with bated breath. From the Neurosurgical Height the word floated down to us: YEAH.

  "What?"

  KEEP THE LOWDOWN LOW.

  "Gentlemen, thank you again. You will find that if you push the down button, Mr. Rokitansky will come down. Lunch."

  "Of course he wasn't serious," said Potts. "No one could be that sadistic. It was a perverted way to try to cheer me up."

  "I think he was," I said. "I think he meant it."

  "That's crazy," said Potts. "You mean he wants us to use that bed to get old people to break their hips? That's sick."

  "What do you think, Chuck?"

  "Who knows, man, who knows?"

  Potts and I sat at lunch, watching the Fat Man shovel food into his mouth. Chuck, on call that night, had been called away to admit his first patients. All Potts could talk about was how he should have hit the Yellow Man with steroids, and how he wanted to be with Otis, his dog. I felt more confused than scared, puzzled by the Fat Man's version of "the delivery of medical care." We were joined by the three terns on another ward, 6?North. Supported by Eat My Dust Eddie and Hyper Hooper was the Runt, with that same shot?out?of?a?cannon look as Potts. Chuck had seen the Runt earlier in the day and had told me how nervous the Runt was: "Man, he's goin' around with a big gigantic box of Vay?li?um tablets, and about every five minutes he's walkin' around and poppin' one into his mouth." Harold "the Runt" Runtsky had been a friend of mine through the four years at the BMS. A short, stocky product of two red?hot psychoanalysts, the Runt seemed to have had something analyzed out of him, and although he was as smart as anyone in the class, he'd been left shy and quiet, with a little too much slack in his strings, a reactive rather than an active guy, his raucous laugh usually being at someone else's jokes. The Runt had trouble standing up to women sexually. Saddled all through BMS with a roommate who was the most promiscuous guy in the class and who allowed him at times to peek through the keyhole at what was going on, the Runt had gotten into "two?dimensional" sex, magazines and movies. After much prodding, shortly before the internship he'd begun a relationship with an intellectual poet named June. The poems were sexless, asensual, bonedry.

  The Runt looked defused. His mustache drooped. As he sat down, he took out a pillbox, put a pill on his hamburger, and munched it down. When I asked what it was, he said, "Valium, Vitamin V. I've never been so nervous in my life."

  "Were you on call last night?"

&
nbsp; "Nape. Tonight. Hooper was on call last night."

  When I asked Hooper how it had been, he got that same gleam in his eye that he'd gotten at the B?M Deli when the Pearl told the story about doing the autopsy in secret, and he giggled and said, "Great, just great. Two deaths. One permission for the postmortem. Watched it myself this morning. Fantastic"

  "Does the Valium help?" Potts asked the Runt.

  "It makes me feel kinds sleepy, but I feel pretty unflappable. I'm writing orders for it for all my patients."

  "What?" I asked. "You're putting them on Valium too?"

  "Why not? They're all very nervous, having me as their doc. By the way, Potts, thanks a lot for that transfer last night, the Yellow Man," said the Runt sarcastically. "Terrific."

  "I'm sorry," said Potts, "I should have given him the steroids. Has he stopped convulsing?"

  "Nope. Not yet."

  I got beeped to go back to the ward, and as I left I asked Eat My Dust how it was going for him.

  "How's it going? Compared to California, it sucks."

  When the Rokitansky girls asked to speak with me again, I felt grand. Their hearing aids turned up full blast, they asked for the latest bulletin from "our brother's doctor." I felt like I was in command, like I had something to give. They hung on my every word. When my beeper called me away, they said they were sorry they'd bothered me and that I must have more important things to do, and as I left them to go down to my first Outpatient Clinic, I felt a real thrill. When I stepped into the elevator, people looked at me, tried to read my name tag, knowing I was a doc. I was proud of my stethoscope, of the blood on my sleeve. The Fat Man was a burnt?out case. Being a doc was a thrill. You could do things for people. They had faith in you. You couldn't let them down. Rokitansky would get well.

  Cocky, seduced by the illusion of somehow getting Rokitansky to regenerate his brain, I entered the Outpatient Clinic. Chuck and I had our Clinics on the same day, and, side by side, listened as the Clinic was explained. We'd be functioning just like General Practitioners, except we wouldn't get paid. We each were given an office, to use once every two weeks. The final seduction was when they presented each of us with our cards: