by Samuel Shem
"I think she's got appendicitis"
"Damn! Would you listen to this? Get me my scalpal, honey."
Hearing the word "scalpel," Gath was at my elbow. Eager yet skeptical, he listened to my diagnosis, and walked into the room. Nervous about my reputation, I retreated to the toilet. After a few minutes an Alabama?cracker voice outside the door yelled:
"Basch, boah? Hey, boah, you in theah?"
"Yes"
"Can we'all come in theah, boah?"
"What for?"
"To congratulate you. In the opinion of Dr. Dwayne Gath, surgical resident in this E.W., we got a keeper. Hotcha!"
"What's a keeper?"
"Keeper? 'Pendix. You go in theah with the steel blade, find 'er, and keep 'er. Listen heah: THE ONLY WAY TO HEAL IS WITH COLD STEEL. Basch , you gave some hungry surgeon a chance to cut, and A CHANCE TO CUT IS A CHANCE TO CURE. We gunner cut on ole Princess, quicker'n yesterday."
Wiping the sweat off my brow, I opened the bathroom door to the beaming eyes of a Good Ole Boy who'd just given a surgical buddy of his a chance to cut on human flesh.
Feeling better, I began to see other patients. I began to get bogged down with the lonely horrendomas, the LOLs in NAD and the gomers with multisystem disease, often the severity of which, according to textbooks, was "incompatible with life." I began poring over them, doing things I'd done on the wards?taking a history, doing a physical, putting in IVs, feeding tubes, Foley catheters, beginning to treat, to start them on their way back to dementia. After I'd seen about three of them, I came back to the nursing station to find the clipboards wrist?deep on my desk. I was overcome with a sense of futility. I saw no way that I would be able to dent the collection of bodies. How could I take care of all of them? How could I survive?
"You wanna survive here?" asked Dini, pulling me aside.
"Yes."
"Good. Two rules: one, treat only the life?threatening emergencies; two, everything else, TURF. You know TURF?"
"Yes, the Fat Man taught me."
"Oh? Great. So you're all set. Like he says, BUFF 'n' TURF.' It's not easy to separate emergencies from turkeys, especially in the Holiday Season, and it's even harder to TURF so they don't BOUNCE. It's an art. If they're not emergencies, we don't handle 'em. Now, get back in there and BUFF 'n' TURF like crazy!"
What a relief. Familiar Fat Man ground. These bodies, seeking rest, would get none here: They'd either get TURFED back out to the street, TURFED up into the wards, or, if dead, TURFED down to the morgue. The most grotesque screaming gomer might arrive, and I could attack the case with the calm assurance that soon he would be TURFED elsewhere. A mind?boggling thought: the delivery of medical care consisted of BUFFING and TURFING the seeker of care somewhere else. The revolving door, with that eternally revolving door always waiting in the end.
The task was to separate disease from hypochondria. With the waiting room jammed with lonely, hungry bodies seeking a warm place to spend the winter night, complete with clean linen, good food, and attention of a spanking fresh round?assed nurse and a real doctor, to MEET 'EM AND STREET 'EM was not easy. Having had years of experience with the House of God, many of the alleged ill had developed sophisticated methods to get in. I'd been a tern for less than six months; they'd been getting admitted to the House for up to ninety years. All it would take, often, was to have fooled one tern, years before, and thus to have documentation in the old chart, for with the increased threat of litigation, none of us could ignore documented disease. Using the local library, these people had BUFFED their own charts, and knew more about their diseases than me. A particular symptom of a given documented old disease could be revved up on any given night, and the sufferer admitted to be hugged and suckled at the bazooms of the House of God.
I began to work through the multiglomerate experienced ill. At one point, as I was BUFFING a gomer, I felt a tap on the back of my leg, low down. I turned and saw Chuck and the Runt, kneeling on the tile floor, looking up at me like cockerspaniel pups in the window of a pet shop. The Fat Man stood behind them:
"Don't tell me," I said, "let me guess what you're on."
They told me anyway. They were on their knees.
"Man, do you know why?" asked Chuck.
"Because the last twelve weeks," said the Runt, "Howard has been in the E.W., and he's so scared of missing something by sending the patient back home that he admits them all. He's a SIEVE."
"A SIEVE?" I asked.
"Right," said Fats, "he lets everyone through. At Bellevue half the ones Howie admitted would have been TURFED out by the receptionist. Or they would have been too embarrassed to come in. New Yorkers have some pride, especially when it comes to degradation. Howie's been letting through six admissions per tern per day. These poor boys are on their knees. They were your friends, remember?"
"They still are," I said. "What can I do?"
"Man," said Chuck, "be a WALL. Don't let anyone in."
"In New York once," said Fats, "we had a contest to see how long the medical service could go without an admission. Thirty?seven hours. You shoulda seen what we sent outta there. Roy, help them. Be a WALL."
"You can count on me," I said, and watched them leave.
Later that afternoon I was sitting at the nursing station, 'musing on SIEVES AND WALLS .
"There's a cardiac case in the car!"
A woman stood inside the automatic doors, screaming. My first thought was that she was crazy, my second was why would a cardiac case be in a car and not an ambulance and that she was joking, and then I panicked. Before I could move, Gath and the nurses were running out the door to the car, wheeling a crash-cart. By the time I was standing, they had slammed the guy on the chest, were breathing him and pumping his chest, Gath was sticking an IV into the big vessels in his neck, and all were barreling into the major?medfr ical emergency room. Shaking, I flashed on a LAW … AT A CARDIAC ARREST THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE. That helped, and I went into the room. He was a youngish man, coated with the pale blue?white skin of the dead. Gath was threading the line into the heart, Dini was taking a blood pressure, Flash was breathing him, any Sylvia was starting the EKG. I was standing there with my, finger up my ass, woozy. And then the concept of the EKG saved me. As soon as I saw the little pink strip of paper with its blue?lined grid, I started function. He no longer was a man five years older me who was going to die, he was "a patient with anterior MI having runs of V Tach which were compromising his pulmonary circulation and extending his MI." He became a series of concepts and that might just respond to the right treatment. His rhythm fed into my head and CLICK out came a slogan LIVE BETTER ELECTRICALLY and I said, "Let's defibrillate him," arid we did. He went into normal sinus rhythm, the deathly blue of his lips turned pink, he regained consciousness, the MICU resident came down, he was TURFED there, and I sat down again, shaking all over.
"Not bad for your first," said Dini clinically.
"I was panicked," I said, "and I don't understand it. I mean, I've been at lots of arrests before."
"On the wards," she said, "it's different. Up there, you have information about the patient and you know what to expect. Down here, all you've got is the body barreling through those doors. It's all fresh, not preprocessed. That's why I love it."
"You love it?"
"Yeah. It's a real thrill to have anything at all come through those doors and to be able to handle it. You better go talk to his wife. It's easier when they make it. Talk to her, and then you'll be all set."
Covered in vomit and blood, I walked out of the room into which the wife had seen her husband disappear, dying. She had a hungry, pleading look in her eyes, trying to read what I was about to say. Alive or dead? When I told her he was alive and in the MICU, she burst into tears. She grabbed my shoulders and hugged me and sobbed, thanking me for saving his life. Choked up, I looked past her and saw Abe, who'd stopped rocking and was staring at us with a lasersharp buzzing beam in his eye. I went back through the automatic doors, imagining those
times I'd have to say, "He's dead." I didn't tell her that if she waited another five minutes I'd have had to say that. End of the ambulance ride was exactly what it was.
Things were going well. I continued to wade through the unprocessed nonemergent, trying to be a good WALL. In the early evening, Gath sat down next to me and said, "Hey, boah, got sumpin' for ya. A soo?prise. Close your eyes and hold out youah hand. Want ya to guess what it is"
I felt a wet, soft, smooth, wormy thing nestled in the palm of my hand, and guessed, "A skinny hot dog?"
"Nope. A keeper."
I opened my eyes, and sure enough it was nothing but, and Gath said, "A hot one, ready to pop. OPERATIONS ARE GOOD FOR PEOPLE, heah? And for he'pin' me, dahlia, I'm gonna he'p you. Jes call, y'heah?"
This was new. To have a good time in the House of God? To look forward to whatever flowed through the doors. To save a life? Two lives? I felt proud. The burden of treating the intractable, untreatable, unplaceable, unwanted, had been replaced by the fantasy of being a real doctor, dealing with real disease. Before midnight, waiting for my replacement, Eat My Dust Eddie, I was sitting in the nursing station talking to the two policemen, who'd stopped in for their first cup of coffee before braving the terror of the night.
"You have been vomited upon," said Gilheeny.
"Your baptism under fire," said Quick, "if you will I excuse a metaphor from Roman Catholicism."
"It's been enough to snap my socks, that's for sure."
The night nurse came up with a final request. Pointing to a worried couple standing inside the doors, she said that they had been told that their daughter had been brought to the House, an overdose…
"There was no overdose who came in here," I said.
"I know, I checked, but you'd better go talk to them."
I did. Well?off, Jewish, he an engineer and she a housewife, they were concerned about their daughter, a student at the women's college across the street. I told them I'd call MBH?Man's Best Hospital?to check if she'd been taken there. I did so. MBH: checked. Yes, she had been brought in: dead on arrival.
The two policemen looked at me. Again I felt choked up. I went back to the parents, not knowing what to say. "She was taken to the MBH. You'd better go there."
"Thank God," said the woman. "Sheldon, let's go"
"OK. Thanks, doe. Maybe, when she's better, they can transfer her back here. This is our hospital, if you know what I mean."
"Yeah," I said, unable to tell it to them straight, "maybe they can."
I went back to the nursing station and sat, feeling guilty about my cowardice, and thinking of the people I'd known who'd been alive and who now were dead, whatever that was.
"How hard to deal honestly with death," said Gilheeny.
"Harder than the hard elbow of a gomere," said Quick.
"And yet that hardness brings out the softness in us all," said the redhead, "the soul in us that makes us cry at births and weddings and wakes and those sad times when the pebbles of the gravedigger dance upon the coffin lid. Sure, and it makes us more human. Yes, this emergency room is not a mean bad place, now, is it?" '
"Not a mean bad place at all," said Quick.
Eat My Dust arrived, to the policeman's booming "Welcome!" I said good night and walked out through the waiting room. Crazy Abe stopped rocking and pinned me with his gaze, buzzing with electric current.
"Are you Jewish?" he asked.
"Yes, I am."
"So far you did good. Watch out driving it's slippery with rain good night."
He was right, about the good job, the Jewishness, the rain, the slipperiness. How could I not be glad? I felt human. For the first time I had spent a human sixteen hours in the House of God.
11
Pitch?black, sweat?wet and foaming, the two matched horses struggled in the mire of the coal mine, searching for firm footing on the ramp leading out. I jumps down into the pool and unhitched them, and as the scrambled up and out, gobs, of wet black muck sprays down all around me, one landing with a SMACK on the exposed portion of my neck. Disgusted, I reached to wipe it away?
"OWW! Roy, you hit me in the eye. I was kissin you awake."
Berry. I'd hit her in the eye. Where were we? In her car, in my hometown. I said, "I'm sorry. I didn't know where I was."
"We're here. I came as far as I could on your directions. You've got to show me how to get to your house. Look??it's snowed here. Isn't it terrific? The first snowfall of the year:'
It was terrific. Black of tree limb snuggling up white of snow, all clouded in the gray of moist November. Thanksgiving. That was it. Despite our growing ROR, Berry and I were going to my house for Thanksgiving. She'd picked me up that morning at the door of the House E.W., after I'd worked all night and had driven us to my home, in the Siberian Provinces of upper New York State. The tundra. Whaling town, whoretown, bartown, churchtown, it had reached its peak in population just before the American Revolution, and was now supported by two cement plants that nightly covered it in cement dust, the cement workers supporting the whores, bars, churches, Lions, Elks, Mooses, and all the other remnants of man's bestiality to man.
"Your town is so quaint," said Berry.
"Buying condoms wasn't easy"
"What made your farther move up here from the city?"
I remembered my father telling me how he'd struggled to make it as a dentist in the City after the war, he and my mother sleeping on the rollaway that doubled, during the day, as the waiting?room couch, and I remembered my mother telling me how pleased he was, after the first day in his office in this small town, when he came home like a kid with a new toy holding eighty?five dollars in cash in his hand and, remembering how he loved golf, I said, "Money, fear, and golf."
"Fear?"
"Yeah. Of being a nothing in the City."
Halfway up the main street, as I struggled with the confusion brought on by the Chamber of Commerce desecrating the memories of my youth by switching the buildings around so I didn't know what went with what anymore or which place I'd had my first beer or my first kiss or the first time I'd gotten the shit beat outta me by the Italians for going out with their sister even though their sister had wanted to go out with me, I saw a sign in the second?floor window of an old building, the snow failing to hide the peeling paint:
DENTIST.
My father's sign. Twenty?seven years there. Wanted to be a medical doctor, and the Jewish quota in the thirties in the City med schools had fucked him over. He and his generation had built the Houses of Gods, to ensure to assure. Sad to see, that little sign. Tears came to my eyes. How much easier it was for me to feel sad, and show it, when I wasn't with them, with him cheerily whistling "Some Enchanted Evening" and restlessly swinging his arms back and forth and trying to live his dreams through me.
And so no tears came to my eyes when I saw them at home. Seeing me with Berry immediately raised everyone's hopes for my marriage. Despite my mother's reputation for breaking up relationships?the most blatant example being a Thanksgiving years before when, after dinner, she'd announced to my spinster cousin's beau that "Now it's time for you and me to talk turkey, Roger," and she'd stayed locked up in they den with him for an hour, and after she got through with him no one ever saw Roger again?she started right in on me. I was forced by fatigue to take a nap, and I excused myself from all their questions and lapsed into vivid daytime dreams. I awoke from that deep sleep that has you cheek to cheek with your owns drool on the pillow, and at dinner my mind was soil coated with sleep. I'd been up all night in the E.W. too often the past several nights, trying to deal with the ocean of humanity rolling and surging under my eyes. My mother resented my having taken a nap and my being tired, but Berry's being there diluted my mother's raging attention, and the yell level stayed at mezzo .
After dinner, things began looking up. The 18 1/2 minute gap on the latest White House tape had just been revealed, and what pleasure it gave us all! Four generations of Baschs buzzed with the news of the Rose Mary Reach. Spurred on by
the news photos Rose Mary Woods spread?eagled between the foot pedal of her tape recorder and the phone behind h as if awaiting a quick roll in the hay with Nixon, we laughed and chortled together that now, finally, Nixon was going to get his. Good for us! Good for America! From the very tiniest Basch, my brother's four?year-old daughter, who was learning to play with her toy phone by picking it up and spread?eagling herself and screaming RO?MARY REACH RO?MARY REACH, my brother, who seemed to despise Nixon even more than the rest of us, past my father, who was interested in the technical aspects of the erasure, foreshadowing the panel of experts who would show, beyond shadow of a doubt, that "there were four to nine consecutive manual erasures" and who'd conclude that "the event could not have happened by accident," and finally, to my grandfather, the only one of his generation left, who smiled a wise smile and said only, "After all these years, to see this, is a wonderful thing."
During a lull in the conversation my grandfather stood up and said to me, "Well, now, Doctor, now I get free advice. Let's go."
We went into my room and sat down, and he said, "Nah, I don' wanna talk with you about advice," and he pulled his chair up opposite me and leaned over the way old men do, and I remembered his wife, perenially sitting in back of him, an echo over his shoulder, now dead.
"So you know," he said, "you're the oldest grandchild, and I remember the day you were born. I hoid the news in Saratoga. I was president of the Italian American Grocers of Manhattan. We had our convention dere dat year."
"A Jew as president of the Italian American?Grocers?"
"Yeh. The whole t'ing was Jews. You're an educated man, I'm asking you?would you buy from an Italian? They bought their spaghetti from us. After Polish and Yiddish, next I Joined Italian. Den English. Basch's Italian American Grocery, that was me, then. I got 'black hand' letters from the Mafia, the works. Even in Kolomea in Poland, we were grocers. My father made all his money during the war with Japan: he bought up hides, and people said to him you're crazy what you buying these hides for, and he said never mind, and when war came, they needed them hides."
