by Samuel Shem
"TBC? What's TBC?"
"Total Bowel Control. Part of the Research Project at the VA."
"Excuse me, Fish." said Eddie, "but maybe you could tell us the answer to that question about the enzyme?"
"Oh? Why, I don't know"
"You don't know either?" asked Eddie.
"Why, no, and I'm proud to say it. I was hoping one of you would. But I'll say one thing: I'll know by tomorrow on rounds."
Since the placement of the gomers was hot stuff in Gomer City, so was the Sociable Cervix. Soon after our sexual carnival in the fall, my thing with Premarin Selma had cooled. On Social Service rounds that first day, both Selma and Rosalie Cohen were cordial but wary. I didn't mind. I was preoccupied by what I'd already seen of "the worst" ward, and I had a hard time concentrating on the meeting. I caught Eddie muttering something about "I looked up, and all I saw was gomers," and the nurses demanding we go over the three?part placement form, poring over questions like "Anointed: Yes No Date" and "Incontinence: Bladder Bowel Date of Last Enema." By the end of rounds I found myself zeroed in on a young blond; guy with a terrific tan, sitting in a corner giving hid forelock an occasional flick up out of his baby?blue eyes.
Later Hooper and Eddie and I were sitting in the on?call room, finding new ways to play with our stethoscopes without sucking on them outright. I raised question: "Why are there only gomers on this ward?" Hooper and Eddie looked at each other, puzzled. No one knew.
"Why don't you dial HELP and find out?" Hooper suggested.
"Dial what?"
"H?E?L?P. The guy in the Blue Blazer., It's a new House concept: if you need help with anything, dial HELP."
I dialed HELP and said, "Hello, I need help . . . No, I'm not a patient, I'm on the opposing team, the doctors, and I need one of those Blue Blazers . . . Which? Damn! Yeah, floor four . . . 'Bye." I turned to the others and said, "Each floor has a Blazer of its very own, and ours is named Lionel."
"Amazing," said Eddie. "I wonder how much those jokers get paid?"
The Blue Blazer arrived. He was the same Blazer as in rounds, and he looked just as terrific as before. We welcomed him and invited him to sit down. Witha dynamite aristocratic flick of the wrist and forelock, he did. He crossed his legs in a slick way that showed that here was a guy, finally, who really knew how to sit down and cross his legs.
A strange thing happened. We asked the Blazer all kinds of questions about what he and HELP was and did and how much HELP got paid, and "Why are there only gomers here on this ward?" Lionel answered each question in a sincere and soothing voice, and seemed to be a storehouse of information that he was glad to disseminate to us hardworking terns "without whom the House of God would fall like a house of cards." Yet each soothing answer was cotton candy, 'cause after it was, it wasn't. Lionel had said nothing. It was crucial to our survival in Gomer City that we get answers, since even if we TURFED every gomer out, if somehow each TURFED?out gomer was to be replaced with a fresh one, why the hell bother at all? We got angry, and our questions turned nasty. This did even less good, and just as the three of us were beginning to boil, in walked Fats. Sizing up the situation, he said a few soothing things to Lionel, who scurried out, and then Fats turned to us and asked, "What are you guys doing?"
We told him.
"So?" asked Fats, sitting down and smiling. "So what?"
"So the prick never did tell us what HELP did or how much they get paid. Where I come from, they pay help what they're worth, they pay 'em shit," said Eddie.
"Take it easy," said Fats. "Go with it. Getting pissed at jerks like that is useless"
"I want to know how come there are only gomers in here," I said.
"Yeah? Well, so do I and so does everyone else, and you know what? You'll never find out. Why get angry, eh?"
"I'm not getting angry," I said. "I am angry."
"So? So what good does that do? Finesse, Basch, finesse."
Gracie from Dietary and Food poked her head into the room, carrying an IV bottle filled with yellow liquid, and holding it up, announced, "The extract is ready, dear."
"Hey, great," said Fats, "let's try her out."
We followed Fats and Gracie down the corridor and we watched Gracie replace Jane Doe's IV bot with the bottle of "the extract." Fats, using the reverse stethoscope technique, shouted into Jane's ears: "THIS WILL MAKE YOUR BOWELS STOP RUNNIN JANIE. THIS WILL BIND YOU UP!"
"What is this extract?" I asked.
"Oh, it's something I invented and Gracie prepared and it's part of the TBC, part of the VA Research that's gonna make the fortoona."
"Fresh fruit is God's own cathartic," said Gra "and we hope that this is the opposite. It's completely organic. Like laetrile."
I asked Fats about this research at the VA, and he told me that some "shyster" there had gotten "a government grant" to try out a new antibiotic on eternal guinea pigs, the shell?shocked derelict vets. The Fat Man had contracted with the shyster to get a percentage for every vet he'd put on the antibiotic, so Fats had put them all on it.
"How'd it work?" I asked, realizing as soon said it that it was a dumb question, since it hadn't been given to work on anything.
"Great," said Fats, "except for one thing: the side effect."
"Side effect?"
"Yeah, see, it wiped out the intestinal flora, and one of the latent intestinal viruses took over and produced an incredible diarrhea that nothing can control. Nothing yet, that is. So we've got high hopes for this extract, see?"
"Yeah, but what's a little diarrhea?" Hooper asked.
"A little diarrhea?" said Fats, eyes widening. "A little . . ." And he dissolved into laughter, jolly chubby gusts of laughter that got bigger and bigger until he was holding onto his gut as if it would break apart and slop all over the tile floor, and Gracie and I and Eddie and Hooper laughed, and with tears in his eyes Fats finally took us aside and said, "Not a little diarrhea, men, a big diarrhea. A big contagious diarrhea. This first half of TBC, this VA antibiotic, can produce a diarrhea in anyone's bowels. If I had known how bad the side effect would be, I never would have done it. That's why I gotta find the second half, the cure. You see, this diarrhea's the most contagious and uncontrollable son of a bitch in the whole wide GI world."
At the end of the day I went to sign out to EMD, who was on call. I asked how it was going.
"Compared to California, it sucks. My third admission is on her way. I'm already on my knees."
Why?"
"She's on her way from Albany. Three hundred miles. In a taxi."
"In a taxi?"
"In a taxi. A totally demented wiped?out gomere who, according to the scouting report, has not urinated in weeks and is too demented to sign her informed consent for dialysis, who tormented her family to the point where they surreptitiously TURFED her into a slow?moving cab in Albany and who's been making her way here since noon. She's being sent here for dialysis."
"If she won't sign there, what makes them think she'd sign here?"
"'Cause like you said: 'Sweetheart, here it's Gomer City.' She's gonna be a special private patient of the Leggo's. It's the greatest day of her life."
On my drive home, the sun wore that harsh steely look of tired midwinter, slashing and aslant, enraged at the gray of the ice. I felt cold, unsheltered, perplexed. I had high hopes that the Fat Man would save me, and yet here he was telling me not to get angry at the Blazer.
"He told me to cool it, and I don't feel like cooling it," I told Berry. "I mean, you're always telling me to express my feelings, and I worry that if I cool it I'll it I'll go nuts. How can I listen to both of you?"
"Maybe there's some common ground," said Berry, "But I can see how you'd be scared to try and survive there if you and he are at odds. What does he say about all the gomers?"
Realizing with sadness that now even Berry had sucked into calling these pitiful old ones "gomers," said, "He says he loves 'em."
"That's just being counterphobic. Secondary narcissism."
"What's a
ll that?"
"Counterphobic is when you do what you're most scared of doing, the guy who's afraid of heights becoming a bridge painter. Primary narcissism, like with Narcissus at the Pool, is when he tries to love himself but he can't embrace his own refection, and he fails. Secondary narcissism is where he embraces others; they love him for it, and he loves himself even more. The Fat Man is embracing the gomers:"
"He's embracing the gomers?"
"And everybody loves him for it."
. . . Everybody loves the doctor and I'm by now your patients do love you. Hope you busy and know you are doing a terrific job. Watched the Knicks on cable TV and they prove that basketball is essentially a team game . . .
Fats had called us his "A Team." And yet what kind of team would it be if its ***MVI*** began questioning its coach?
15
"I want to eat," said Tina, the woman sent in the taxi.
"You can't eat," said Eat My Dust Eddie.
"I want to eat."
"You can't eat."
"Why can't I eat?"
"Your kidneys don't work."
"They do."
"They don't."
"They do."
"They don't. When was the last time you peed?"
"I don't remember."
"See? They don't."
"I want to eat."
"If your kidneys don't work, you can't eat! You're gonna sign up for dialysis and have a rotten life."
"Then I want to die."
"Now you are talkin', lady, now you are talkin'!" said EMD, and slipping past the Albany cabbie, who was trying to collect his two?hundred?dollar?plus?tip fare, Eddie and I left Tina and sat down to the Fat Man's cardflip.
"Card one," said Fats, "Golda M.?"
"Great case," said Eddie, "the Lady of the Lice. Seventy?nine?year?old admitted from the floor of her room; found grimacing like The Exorcist version of a Barbie Doll. Plum?sized lymph nodes all over her body, thinks she's on the T?line in St. Louis, and has lice."
"Lice?"
"Right. The creeping cooties. Nurses refuse to enter her room."
"OK," said Fats, "no problem. The way to TURF her is to find the cancer or find the allergy. We need skin tests: TB, monilia, strep, flyshit, egg foo yong, the works. One positive skin test explains the nodes, and it's a TURF back to the floor of her room."
"Putzel, her Private, says he won't let this poor old lady go back there. He demands that we find placement."
"Swell," said Fats, "I'll call Selma. Next? Sam Levin?"
"By the way," said EMD, "I didn't have a chance to tell Putzel about the cooties. He's in there now."
A creeping coup.
"Sam's an eighty?two?year?old demented derelict living alone in a rooming house, picked up by the police for loitering. When the cops asked him where he lived, he said 'Jerusalem,' and then he pretended to faint, so they TURFED him here. Severe diabetes. He's a well-known pervert. Chief complaint is, 'I'm hungry."'
"Of course he's hungry," said Fats, "his diabetes is burning his own body for fuel. Lice and perversion? What are the Jews coming to?"
"To the Black Crow," said Hooper.
"Insulin City," said Fats. "Rough TURF. Next?"
"You should know," said Eddie, "that Sam Levin is a man who eats everything. Watch your food, Fats."
Fats got up and locked his locker, in which he kept a stash of food, including several prized Hebrew National salamis.
"Next is Fast Tina the Taxi Woman," said Eddie, "a private patient of the Leggo's." At that the cabbie started yelling about his fare, and Fats TURFED him to HELP. He left, cursing, and in walked Bonni and said to Eddie: "Your patient Tina Tokerman's IV bottle has run out. What do you want me to hang next?"
"Tina," said Eddie.
"That's inappropriate. Now, about the lice: it's not our job to delouse, it is the intern's:"
"Crap," said EMD, "it's a nursing job, 'cause nurses already got lice."
"What?! Well! I'm calling my supervisor! And as for the lice, I'm dialing HELP! We're having problems in communication, good?bye."
"Anyway," Eddie went on, "there was Tina, and I thought, Hmm dementia, I'll go right for the money and invade. So first I did the LP."
"You did the LP first? Did you ask the Leggo before you did it?"
"Nope."
"A private patient of the Leggo's sent three hundred miles in a cab and you started with a painful invasive procedure without asking him first? Why?"
"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.' " j
"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 necks' 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 Eddies 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 dad 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. Arachnodaotyly, 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 Lumm?poore' and that's where you go. I don't want my Fellowship in the Gulag, get it?"
"Yours?" asked Eddie. "And what abo
ut mine? In Oncology." i'
"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 truck driver 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 call cryoglobulinemia, where with cold the blood clots small vessels, and Moe's big toe had turned as cold an white as a corpse on a slab in the morgue.
"What a great case!" cried the Leggo. "Let me ask 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 it. To the next question,.not a toughie, to Eddie, Ed answered, "I don't know." The Leggo gave him benefit of the doubt and gave a little lecture none 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 turn to me and asked me an easy one that any klutz who read Time could answer. I paused, knit my brow, 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 upT»
