by Samuel Shem
Despite my newfound penchant for viewing all persons as sick and despite their newfound penchant for viewing all persons as defendants, things went well for a while. Walking through the echoing marble Court we laughed at various farces making the gossip columns, the choicest being the rumor that a reporter, using high?powered binoculars from a hidden vantage point on the bluffs over San Clemente, while watching Nixon and Bebe Rebozo walking along the beach in their dark suits, had seen the President stop, turn, and kiss Bebe squarely an the lips.
And yet neither friendship nor a weekend away from the House could contain my rage. Feeling free, like a person, made the contrast even more painful. I carried my suspicion and contempt with me. At one point Jerry and Phil were surprised at my vehemence, and at how far I'd moved, from English Socialist to Alabama Right A la Dwayne Gath. For some reason my friends' cynicism did not extend into the realms of paranoia. The trip turned sour, and on the plane back, Berry said, "You've got to be socialized all over again, Roy. No one can be that angry and be in this world with anyone else. Your friends are really worried about you."
"You're right," I said, thinking how every part of my life had suffered from my experience in the House of God, and how, from all the awful venerealia, even my sex life had curdled and quit.
Things got only worse. At the New Year's Eve party which I had to leave early because I had to report, for the last time, to the House E.W. at midnight, and at which I got pretty drunk, Berry blew up at me: "I hardly know you anymore, Roy. You're not like you were before."
"You were right about this time of year," I said, leaving. "It's sick, and it's crazy, and it sucks. So long."
I walked out the door into the bitter cold, through the frozen snow and over a snowbank turned black from the city dirt, to my car. That terrifying empty space between what was love and what is no more loomed large. I sat there disgusted, alone, the blue mercury arc lamps adding to the surreal night. Berry appeared, trying to pull me back to the human. She leaned in through the window, hugged me, kissed me, and wished me a Happy New Year, and said, "Look at it this way, the New Year means you're halfway through."
Feeling that I'd been cheated, promised a life and then saddled with death, I went into the E.W., drunk, searching for whoever it was who had cheated me. At precisely midnight, as the old year rolled over and showed its white underbelly and the new year starting sucking at its first black morning, a naked drunk celebrated by vomiting something awful into his lap. I sat at the nursing station surrounded by the futile attempts of the nurses to make a party out of the place. As I watched Elihu do a hip?swinging, clog?clacking campy rendition of the horah with Flash, I thought of "The Follies" at Treblinka. And then I thought about the pictures of the camps, taken by the Allies at liberation. The pictures showed emaciated men peering through the barbed wire, all eyes. Those eyes, those eyes. Hard blank disks. My eyes had become hard blank disks. Yet there was something in back of them, and, yes, that was the worst. The worst was that I had to live with what was in back of them, and what I had to live with, the rest of the world must never see, for it separated me from them, as it had just done with my former best friends and with my one long love, Berry. There was rage and rage and rage, coating all like crude oil coating gulls. They had hurt me, bad. For now, I had no faith in the others of the world. And the delivery of medical care? Farce. BUFF 'n TURF. Revolving door. I wasn't sitting at the end of the ambulance ride, no. There was no glamour in this. My first patient of the New Year was a five?year?old found in a clothes dryer, face bloodied. She had been hit by her pregnant mother, hit over and over with a bludgeon of pantyhose stuffed with shards of broken glass.
How could I survive?
14
I had high hopes that the Fat Man would save me.
Chubby, pumped up, bubbling with all the fresh optimism of a baby rocking in the cradle of the New Year, the Fat Man was back, ward resident in the House of God. During his long swing through the various Mt. St. Elsewheres and the Veterans Administration Hospital, I had missed him. Of course he had loomed large always, and in frantic times, his teachings had pulled me through. For months we had been in touch mostly through rumor. According to Fats, things were going great. Yet, the more I got to know him, the more contradictions there seemed to be. While laughing at a system that cherished Jo and the Fish and Little Otto and the Leggo, Fats seemed not only to be able to survive but also to use it for himself and even to enjoy it.
Among the rumors that had floated in from Fats's long road trip were several about Dr. Jung's Anal Mirror, including one that allegedly had Esquire publishing its listing of "The Ten Most Beautiful Assholes of the World." Yet whenever the Fat Man talked about his invention, it was always in the subjunctive tense, "would" and "could," not "will" and "can." Gregarious inside the House, when Fats left it, he disappeared. In spite of my offers, I never saw him outside. Although inside the House he was doing something erotic with Gracie from Dietary and Food, there was no word of female relationships outside. Ambitious, Fats wouldn't let women stand in his way. Even his goal in life, to "make a big fortoona," was complicated: whenever I'd ask him how it was going, he'd get a wistful look in his eye and say, "I'm just not crooked enough," and tell me that he'd passed up opportunities that would have made ten fortoonas in the past year alone. "If only I had the hearts and minds of the Watergate Boys," he'd sigh, "if only I was G. Gordon Liddy."
I knew for sure that he was going into a GI Fellowship, that he was the only graduate of Brooklyn College ever to make it to the House of God, and that he was the only true genius I'd ever met. Now, fat and snappy and with a small gold ring on a fat finger of a fat hand and a sparkling gold chain around a huge rubbery neck that barely existed at all, given the way the fat, sleek, black?haired head seemed to rest entirely upon the rolling mound of shoulder, now the Fat Man's good cheer seemed a strange contrast to the searing winter that held the city in its frozen tongs from January until the thaw. I knew from what other terns had said that this ward?ward 4?North?would be the worst. With Fats as our resident, I hoped that it would not be the worst.
"This ward will be the worst," said Fats, chalk in chubby fingers scrawling THE WORST on the blackboard of the on?call room. "This ward has taken fine young men and broken them." BROKEN THEM went up. "And yet, last year, I made it through, and this year, with me for these three months, you guys will make it through OK."
Hyper Hooper one of the other terns, asked, "What makes this ward the worst?"
"Name it," said Fats.
"The patients?"
"The worst."
"The nurses?"
"Salli and Bonni?they both wear caps and tin nursing?school badges like meter maids?who say to the gomers like, 'Now we eat our custard, sport.' The worst."
"The Visit?"
"The Fish."
The third tern, Eat My Dust Eddie, let out a long slow groan of despair. "I can't stand it," he said, "I can't stand having the Fish. He's a gastroenterologist and I can't stand anymore talk of shit."
"To hear you," said Fats, "you'd think no one ever shits in California." Then, getting serious, he leaned forward and said, "That reminds me?my Fellowship Application. I'm trying to get my GI Fellowship for July the first. The Leggo still hasn't written the crucial letter of recommendation. He says he's waiting to see how I run this ward. Don't screw me on that letter, hear? This is a 'Protect the Fat Man's Fellowship' ward rotation, see?"
"Where do you want to go for your fellowship?" asked Hooper.
"Where? L.A. Hollywood."
Eat My Dust groaned and covered his face with his hands.
"The Bowel Run of the Stars," said Fats, stars sparkling in his dark eyes.
Fats was into money. He'd grown up poor. His mother, during the High Holy Days, even though there wasn't anything to make soup from, had put pots of water on the stove to boil, so that if anyone dropped in, the illusion of soup would be there. Nourished by his family as being a true genius, he'd shot up like a Flatbush meteor, barre
led through Brooklyn College in science, cutthroated through Einstein Med, and arrived at the best internship of the Best Medical School, the House of God. Now, as he said, he was "going all the way to the top," and it seemed that from Flatbush, the top was Hollywood: "Imagine doing a sigmoidoscopy on Groucho Marx?" he'd said, "on Mae West, on Fay Wray, on Kong! On all those stars who think that the colon is filled with cologne."
I tuned back in as Fats was saying, "This ward is a GI Man's Heaven, and even for a GI man, it's Hell. How are you terns going to survive?"
"By killing ourselves," said Eddie.
"Wrong," said Fats seriously, "you are not going to kill yourselves. You are my A Team, you all know what you're doing by now. You will survive by going with it."
"Going with it?" I asked.
"Right. Like in the card game: finesse, men, finesse." Finesse? I drifted off, thinking that this was a little bit different from what Fats had said before. How could this ward be the worst? There would be no hiding our doing nothing from Fats, and after what I'd been through on the wards and in the E.W., there would be no doubts about my ability to handle just about anything. I guessed it would be the worst because the gomers would try to torment us by holding up their end of the delivery of medical care by camping in the House, and the Slurpers and the Privates; would try to torment us as well, each in his own failsafe way. It would be the worst precisely because them would be no duplicity or pretense, but only the eternal, almost ecological struggle to do revolving?door medicine the House of God way.
"Remember," said Fats, finishing, "if you don't anything, they can't do anything to you. Believe it not, guys, we're gonna have a ball. OK, now we're ready to go on out there. Let's break!"
We broke with all the enthusiasm of a high?school football team breaking from the locker room knowing they were going to get creamed and leaving their guts in the toilet bowls behind. Ward 4?North was yellow-tiled, smelly, and contorted like a gomer. We went from room to room, and in each there were four beds and on each bed was a horizontal human being who showed few signs of being a human being except being on a bed: No longer did I think it crazy or cruel to call these sad ones gomers. Yet part of me thought it was both crazy and cruel that I no longer thought so.
In one male room a gomer was spasmodically tugging at his catheter and moaning something like PAZTRAMI PAZTRAMI PAZTRAAAH?MI and at that, Eat My Dust began making dog?vomiting noises in my ear. We went into the hallway and saw two more males, side by side, the only difference being their mouths, which were:
[one gaping open, the other gaping open with the tongue hanging out of the lower corner]
The Fat Man asked the BMSs?the terrified, eager, and idealistic BMSs?what the inspection of these two men would produce as diagnoses, and they had no idea. Fats said, "These are classic signs: the O SIGN on the left and the Q SIGN on the right. The O SIGN is reversible, but once they get to the Q SIGN, they never come back."
We proceeded down the corridor. Suddenly there they were: side by side in armchair recliners sat two patients, the same two patients Chuck and I had turned back from that first day, Harry the Horse (HEY DOC WAIT HEY DOC WAIT) and Jane Doe (OOOO?AYYY?EEEE?IYYY?UUUU). Still there! We stood in front of them, mesmerized.
"Come on, come on," said Fats, dragging us away down the corridor. "This is the worst, the Rose Room. This room has taken fine young men and broken them. There should be an antidepressant dispenser at the door. Always remember, when you leave the Rose Room and feel like killing yourself, remember that it is they of the Rose Room, and not you, who are ill. THE PATIENT IS THE ONE WITH THE DISEASE."
"Why is it called the Rose Room?" we asked.
"It is called the Rose Room because it invariably happens that the four female beds contain gomeres named Rose."
In hushed silence we stood in the middle of the dimly lit Rose Room. All was still, spectral, the four Roses horizontal, at peace, barely dimpling their swaddling sheets. It was all very nice, until the smell hit, and then it was disgusting. The smell was shit. I couldn't stand it. I left. From the corridor I could hear Fats continue to lecture. Out came EMD, gagging. Still Fats talked on. Out came Hyper Hooper, snorting. On and on Fats talked. The three fresh BMSs, holding to the fantasy that if they left the Rose Room before the Fat Man, their grade would plunge down toward that deadhouse, middle C, stayed. Fats droned on. Yelping and retching, handkerchiefs to their mouths, out ran the BMSs As Fats rattled on to himself and to the gomertose Roses, the BMSs threw open a window and hung out their heads, and the burly construction workers who were riveting together the Wing of Zock pointed, to them and laughed, and the laughter seemed to come, from far away. I wished I could have been a robust hardhat, far from the smell of shit. Fats droned on to himself. The next one out, I mused, would be a Rose. Finally, out came our leader, asking, "What's the matter, guys?"
We told him the matter was the aroma.
"Yeah, well, you can learn a lot from that aroma. With luck, in three months you'll be able to stand the middle of that room and give the four diagnoses as the different bowel odors smack your olfactory lobes. Why, just today there was a steatorrheac malabsorbtion, a bowel carcinoma, a superior mesenteric insufficiency giving rise to bowel ischemia and diarrhea, and last? . . . yes! Little packets of gas. slipping past a long?standing fecal impaction."
"Hey, Fats," said Hooper, "how about having a box with postmortem permission slips here at the doorway of the Rose Room?"
"LAW NUMBER ONE: GOMERS DON'T DIE," said Fats.
"Hooper, what the hell is it with you and those posts?" I asked.
"The Black Crow Award," said Hooper.
"That was a joke," I said.
"It was not. The postmortem is the flower?no, the red rose?of medicine."
As Hooper went on down the corridor, I thought how happy he'd gotten, now that he'd lodged his M firmly OR, and now that he had his Israeli Path Resident doing autopsies for him on a "same?day" basis. Racing for the Black Crow, Hooper hated the seemingly immortal gomers, and sought out younger patients, the ones who could die. In particular, he cherished the upper socioeconomic young, who, according to a recent J. Path. article, were most likely to sign for their own posts. Occasionally someone would mention to Hooper that maybe he was a little too heavy into death, but he'd just smile his boyish California smile, hop up and down like a Mouseketeer, and say, "Hey, it's where we're all headed, right?" Death had become a lifeline for the perky little Sausalitan.
Fats had gone straight from the stench of the Rose Room to breakfast, and Eddie and I were left alone. He turned his tense eyes to me and said, "I can't take it?they're all gomers."
"It's a tremendous opportunity to utilize your twenty-six years of education and maturity to procure the delivery of medical care for a needy geriatric population."
Neck and neck for the Black Crow with Hooper, Eddie had gotten deep into sadomasochism, in particular grooving on patients "hurting" him or on he "hurting" them. I tried to change the subject, and said "Say, I hear your wife's having a baby."
"A what?"
"A baby. Your wife. Sarah, remember?"
"Yeah, the wife is having her baby. Soon."
"It's not just hers, it's yours too!" I shouted.
"Yeah. Say, did you see 'em? All gomers. If three of them were seen in California they'd close up the state. They smell, and I hate smells. Gomers and gomers and more gomers. And"?he looked at me with puzzled and almost pleading expression and said, " and gomers. I mean, do you know what I mean?"
"Yeah, I do." I said. "Don't worry, we'll help each other through."
"I mean . . . gomers is all there is here is gomers."
"Sweetheart," I said, giving up, "it's Gomer City:
The Fish was remarkable. Hands in his pool; head in the clouds, he was so bananas in his own way that almost every time you had a conversation with him you wanted to run and tell someone about it, because it did strange things to your brain, as if someone had unrolled a few convolutions, and if it hadn't come from t
he Chief Resident you'd swear it had come from a lunatic. That first day as our Visit, he strolled up and was greeted by Fats in between Harry the Horse and Jane Doe and said, "Hi, guys, how's it going?" and avoided our eyes and didn't wait to hear how it had been going and said, "Let's see the patients, huh?"
"Welcome, Fish," said Fats. "We're both GI, and is there ever good GI material here, eh?"
Jane Doe cut a long, drawn?out, liquid fart.
"What'd I tell you, Fish?" said Fats. "The Gee Eye tract!"
"The GI tract is a special interest of mine," said the Fish," as is flatulence. I've recently had the opportunity to review the world literature on flatulence in liver disease. Why, flatulence in liver disease would make a very interesting research project. Perhaps the House Staff would be interested in undertaking such a research project?"
No one said he was interested.
"Let me ask you this," said the Fish, looking at Hooper. "What enzyme is missing in liver disease to produce flatulence?"
"I don't know," said Hooper.
"Good," said the Fish. "You know, it's so easy to answer a question. Why, quite often it's harder, here on rounds, to say frankly 'I don't know.' In some hospitals like the MBH, it would be frowned on to say 'I don't know.' But I want the House of God to be the kind of place where an intern can be proud to say 'I don't know.' Good, Hooper. Eddie? What's the enzyme?"
"I don't know," said Eat My Dust.
"Roy?"
"I don't know," I said.
"Fats?" asked the Fish, with trepididation.
After a tense pause Fats said, "I don’t know."
The Fish looked a little perturbed that everyone had said "I don't know," Jane Doe broke wind again, and the Fish, irritated, said, "I love the GI Tract as much as anyone, but it's not professional to have someone with that kind of looseness of bowel control sitting in the middle of the corridor. Too loose. Put her in her room."
"Oh, we can't do that," said Fats, "she gets real violent in her room. But don't worry, I'm working on something special to stop the farting. Part of the TBC."
