House of God

by Samuel Shem

  The token humanitarian statement having been made, we turned to computers, the Fish passing out our day-by-day schedules for the year. A large-breasted adolescent stood up to guide us through the maze of paperwork. She spoke of ‘the major problem you will face in your internship: parking.’ After going over several complex diagrams of the parking in the House, she passed out parking stickers and said, ‘Remember: we do tow, and we love it. With the Wing of Zock going up, you’d better put your stickers on the inside of your windshield, because the past few months the construction workers have ripped off all the stickers they could find. And if you’re thinking of riding your bikes, forget it. Every night the teen gangs rip through this place with bolt cutters. No bike is safe. Now we fill in our computer forms, so we can get paid. You all brought your number-two pencils, right?’

  Damn. I’d forgot. My whole life has been trying to remember to bring those two number-two pencils. I couldn’t remember when I’d ever remembered. And yet someone else always did. I filled in the circles of the forms.

  The meeting ended with the Fish suggesting ‘you might want to go to your respective wards to get acquainted with your patients before tomorrow.’ Although this sent a shiver through me, since I wanted to continue to deny that it exists, I filed out of the room with the others. Lagging behind, I found myself on the fourth floor walking from one end of the corridor to the other. Ten yards down the corridor were two armchair recliners, in which sat two patients. One, a woman with bright yellow skin signifying severe liver disease, sat with her mouth open to the fluorescent lights, her legs spread apart, her ankles puffed and her cheeks gaunt. There was a bow in her hair. Next to her was a decrepit old man with a frantic thatch of white hair spilling over his veined skull, who was yelling over and over:

  HEY DOC WAIT HEY DOC WAIT HEY DOC . . .

  An intravenous bottle was running yellow stuff into his arm, and a Foley catheter was running yellow stuff out of his vermilion-tipped schlong, which lay across his lap like a pet snake. The caravan of new terns had to wend its way single file past these two lost ones, and by the time I got to them there was a traffic jam and I had to stop and wait. The black guy and the black motorcycle guy waited with me. The man, whose name tag said ‘Harry the Horse,’ kept yelling: HEY DOC WAIT HEY DOC WAIT HEY DOC . . .

  I turned to the woman, whose name tag said ‘Jane Doe.’ She was singing, a chromatic phonetic scale of increasing intensity:

  OOOO—AYYY—EEEE—IYYYY—UUUUU . . .

  In response to our attention Jane Doe made motions as if to touch us, and I thought. ‘No don’t touch me!’ and she didn’t but what she did do was squeeze out a long liquid fart. Smells had always gotten to me, and that smell did then, and I felt like vomiting. Nope, they weren’t going to get me to see my patients yet. I turned around. The black guy, whose name was Chuck, looked at me.

  ‘What do you think of this?’ I asked.

  ‘Man, it’s pitiful.’

  Looming over us was the giant with the black motorcycle gear. He put on his black jacket again and said to us: ‘Guys, in my medical school in California, I never saw anyone as old as this. I’m going home to my wife.’

  He turned, walked back down the corridor, and disappeared into the down elevator. On the back of his black motorcycle jacket was spelled out in shiny brass studs.

  * * *

  * * * EAT MY DUST * * *

  * * * EDDIE* * *

  * * *

  Jane Doe farted again.

  ‘Do you have a wife?’ I asked Chuck.

  ‘Nope.’

  ‘Me neither. But I can’t take this yet. No way.’

  ‘Well, man, let’s go have a drink.’

  Chuck and I had poured a good deal of bourbon and beer into our bodies, and had gotten to the point of laughing at the farting Jane Doe and the insistent Harry the Horse asking us to HEY DOC WAIT. Having started by sharing our disgust, we proceeded through sharing our fear, and were in the process of sharing our pasts. Chuck had grown up dirt-poor in Memphis. I inquired as to how from this humble beginning he’d gotten to the pinnacle of academic medicine, the BMS-affiliated House of God.

  ‘Well, man, you see, it was like this. One day when I was a senior in high school in Memphis, I got this postcard from Oberlin College, and it said: WANT TO GO TO COLLEGE AT OBERLIN? IF SO, FILL OUT AND RETURN THIS CARD. That was it, man, that was all. No College Board tests, no application, no nothin’. And so I did it. Next thing I know, I get this letter saying I’d been accepted, full scholarship, four years. And here the white guys in my class were all trying like crazy to get in. Now, I’d never been out of Tennessee in my life, I didn’t know anything about this Oberlin, ‘cept I asked somebody and he told me they had a music school there.’

  ‘Did you play a musical instrument?’

  ‘You gotta be kiddin’. My old man read cowboy novels as a night janitor, and my old lady cleaned floors. Only thing I played was roundball. The day I was supposed to leave, my old man says, “Son, you’d be better off joinin’ the army.” So I take the bus to Cleveland and then I was supposed to change for Oberlin, and I didn’t know if I was in the right place but then I see all these dudes with musical instruments and I say yup this must be the right bus. So I went to Oberlin. Majored in premed ‘cause you didn’t have to do nothing, read two books—the Illiad, which I didn’t dig, and then this great book about these red killer ants. See, there was this dude trapped, tied down, and this army of red killer ants came marchin’ and marchin’. Great.’

  ‘What made you decide to go to medical school?’

  ‘Same thing, man, same ezact thing. In my senior year, I got this postcard from the University of Chicago: WANT TO GO TO MEDICAL SCHOOL AT CHICAGO? IF SO, FILL OUT AND RETURN THIS CARD. That was all. No Medical Board tests, no application, no nothing. Full scholarship, four years. So there it is, and here I am.’

  ‘And what about the House of God?’

  ‘Same thing, man, same ezact thing. Senior year, postcard: WANT TO BE AN INTERN AT THE HOUSE OF GOD? IF SO, FILL OUT AND RETURN THIS CARD. There it is. Sumthin’ else huh?’

  ‘Well, you sure put one over on them.’

  ‘I thought I did, but you know, seeing these pitiful patients and all, I think those guys sending me the postcards knew all along I was trying’ to fool them by gettin’ all this, so they fooled my by givin’ it all to me. My old man was right: that first postcard was my downfall. I shoulda joined the army.’

  ‘Well, you got to read a good story about the killer ants.’

  ‘Yeah, I can’t deny that. What about you?’

  ‘Me? I look great on paper. For three years after college I was on a Rhodes Scholarship to England.’

  ‘Damn! You must be some ath-a-lete. What’s your sport?’

  ‘Golf.’

  ‘You gotta be kiddin’. With those little white balls?’

  ‘Right. Oxford got fed up with the dumb Rhodes jocks, so they went in more for brains my year. One guy’s sport was bridge.’

  ‘Well, man, how old are you, anyway?’

  ‘I’ll be thirty on the fourth of July.’

  ‘Damn, you’re older than all of us. You’re as old as dirt.’

  ‘I should have known better than to come to the House. My whole life has been those goddamn number-two pencils. You’d think I’d learn.’

  ‘Well, man, what I really want to be is a singer. I got a great voice. Listen to this.’

  In falsetto, shaping the tones and words with his hands, Chuck sang. ‘There’s a . . . moone out too-night, wo-o-o-ooow, and I know . . . if you held me tight, wo-o-o-owww . . .’

  It was a lovely song and he had a lovely voice and it was lovely, all of it, and I told him so. We both were real happy. In the face of what faced us, it was almost like falling in love. After a few more drinks we decided we were happy enough to leave. I reached into my pocket to pay, and came out with Berry’s note.

  ‘Oh, shit,’ I said, ‘I’m late. Let’s go.’

  We paid
and walked out. The heat had disappeared under an umbrella of summer rain. Soaking wet, with the thunder blasting and the lightning rattling, Chuck and I sang through the car window to Berry. He kissed her good-bye, and as we left him, walking toward his car, I yelled out: ‘Hey I forgot to ask you—where are you starting tomorrow?’

  ‘Who knows, man, who knows?’

  ‘Wait—I’ll look,’ and I fished out my computer schedule and saw that Chuck and I would be together for our first ward rotation. ‘Hey, we’re gonna work together.’

  ‘That’s cool, man, that’s cool. So long.’

  I liked him. He was black and he had endured. With him I would endure. July the first seemed less frightening than before.

  Berry was concerned about my lacing my denial with bourbon. I was silly and she was serious, and she said that this first forgetting to meet her was an example of the problems we might have during the year. I tried to tell her something about the B-M Deli, and could not. When I, laughing, told her about Harry the Horse and the farting Jane Doe, she didn’t laugh.

  ‘How can you laugh at that? They sound pathetic.’

  ‘They are. I guess denial didn’t work.’

  ‘It did. That’s what your laughter’s about.’

  In my mailbox was a letter from my father. An optimist, he was a master of the conjunction, his letters patterned in the grammar of: [phrase] conjunction [phrase]:

  . . . I know there is so much to learn about medicine and it is all new. It is fascinating all the time and there is nothing more amazing than the human body. The hard physical part of the job will soon become usual and you must watch your health. I had an eighty on Wednesday afternoon and am putting better . . .

  Berry put me to bed and went back to her place, and I was soon wrapped in the velvet robe of sleep, heading toward the kaleidoscope of dream. Pleased, happy, no longer scared, with a smile I murmured ‘Hiya, dream,’ and I was soon in Oxford, England, at lunch in the Senior Common Room of Balliol College, a Septcentenary Fellow at each elbow, eating dull food off bone china, discussing how the screwy Germans, after fifty years’ work on their vast Dictionary compiling all the Latin words ever used, had gotten only up to the letter K, and then I was a kid running out into the summer dusk after supper, baseball mitt in my hand, leaping up and up in the warm twilight, and then, in a whirlwind of dread, I sighted a traveling circus falling from a cliff into the sea, the sharks savaging the succulent marsupials as the drowned clown’s painted face dissolved in the cold inhuman pickling brine. . . .

  3

  It must have been the Fat Man who first showed me what a gomer was. The Fat Man was my first resident, easing my transition from BMS student to intern in the House of God. He was wonderful, and a wonder. Brooklyn-born, New York City-trained, expansive, impervious, brilliant, efficient, from his sleek black hair and sharp black eyes and bulging chins through his enormous middle that forced his belt buckle to roll over on its belly like a shiny fish, to his wide black shoes, the Fat Man was fantastic. Only New York City could have bounced back from his birth to nourish him. In return, the Fat Man was skeptical of whatever wild country existed to the west of that great frontier, Riverside Drive. The only exception to this urbane provincialism was, of course, Hollywood, the Hollywood of the Stars.

  At six-thirty in the morning of July the first, I was swallowed by the House of God and found myself walking down an endless bile-colored corridor on the sixth floor. This was ward 6-South, where I was to begin. A nurse with magnificently hairy forearms pointed me to the House Officer’s On-Call Room, where rounds were in progress. I opened the door and went in. I felt pure terror. As Freud had said via Berry, my terror was ‘a straight shot from the id.’

  Around the table were five people: the Fat Man; an intern named Wayne Potts, a Southerner whom I’d known at BMS, a nice guy but depressed, repressed, and kind of compressed, dressed in crisp white, pockets bulging with instruments; the three others seemed eager, and this told me they were BMS students doing their medicine clerkship. Each intern was to be saddled with a BMS, each day of the year.

  ‘It’s about time,’ said the Fat Man, biting a bagel, ‘where’s the other turkey?’

  Assuming he meant Chuck, I said, ‘I don’t know.’

  ‘Turkeys,’ said Fats, ‘he’ll make me late for breakfast.’

  A beeper went off, and Potts and I froze. It was the Fat Man’s: FAT MAN CALL THE OPERATOR FOR AN OUTSIDE CALL, THE OPERATOR FOR AN OUTSIDE CALL, FAT MAN, RIGHT AWAY.

  ‘Hi, Murray, what’s new?’ said Fats into the phone. ‘Hey, great. What? A name? Sure sure yeah no problem hang on.’ Turning to us, Fats asked, ‘OK, you turkeys, what’s a catchy doctor’s name?’

  Thinking of Berry, I said, ‘Freud.’

  ‘Freud? Nah. Gimmee another. Stat.’

  ‘Jung.’

  ‘Jung? Jung. Murray? I got it. Call it Dr. Jung’s. Great. Remember, Murray, we’re gonna be rich. Millions. Bye-bye.’ Turning back to us with a pleased smile, Fats said, ‘A fortoona. Ha. OK, we’ll start rounds without the other tern.’

  ‘Great,’ said one of the BMSs, leaping to his feet. ‘I’ll get the chart rack. Which end of the ward do we start on?’

  ‘Sit down!’ said Fats. ‘What are you talking about, chart rack?’

  ‘Aren’t we going on work rounds?’ asked the BMS.

  ‘We are, right here.’

  ‘But . . . but we’re not going to see the patients?’

  ‘In internal medicine, there is virtually no need to see patients. Almost all patients are better off unseen. See these fingers?’

  We looked carefully at the Fat Man’s stubby fingers.

  ‘These fingers do not touch bodies unless they have to. You want to see bodies, go see bodies. I’ve seen enough bodies, and especially bodies of gomers to last me the rest of my life.’

  ‘What’s a gomer?’ I asked.

  ‘What’s a gomer?’ said the Fat Man. With a little smile he spelled out ‘G-O . . .’

  He stopped, his mouth still set in the ‘O,’ and stared at the doorway. There stood Chuck, wearing a collar-to-toes-length brown leather coat with tan fur ruffles at the edges, sunglasses, and a brown leather hat with a broad rim and a red feather. He walked clumsily on platform heels, and looked as if he’d been up dancing the night away.

  ‘Hey, man, what’s happenin’?’ said Chuck, and slid into the nearest chair, slouching down, covering his eyes with a weary hand. As a token gesture, he unbuttoned his coat and threw his stethoscope on the table. It was broken. He looked at it and said, ‘Well, I guess I broke my scope, eh? Rough day.’

  ‘You look like some kind of mugger,’ said a BMS.

  ‘That’s right, man, ‘cause you see, in Chicago where I come from, there are only two kinds of dudes—the muggers and the mugged. Now, if you don’t dress like a mugger, man, you automatically gets youseff mugged. You dig?’

  ‘Never mind dig,’ said the Fat Man, ‘pay attention. I was not supposed to be your resident today. A woman named Jo was, but her father jumped off a bridge and killed himself yesterday. The House switched our assignments, and I’ll be your resident for the first three weeks. After what I did as an intern last year, they didn’t want to expose the fresh terns to me today, but they had no choice. Why didn’t they want you to meet me, your first day as a doctor? Because I tell things as they are—no bullshitology—and the Fish and the Leggo don’t want you to get discouraged too soon. They’re right—if you start to get as depressed now as you’ll be in February, in February you’ll jump off a bridge like Jo’s pop. The Leggo and the Fish want you to cuddle with your illusions, so you don’t give in to your panic. ‘Cause I know how scared you three new terns are today.’

  I loved him. He was the first person to tell us he knew about our terror.

  ‘What’s there to be depressed about?’ asked Potts.

  ‘The gomers,’ said the Fat Man.

  ‘What’s a gomer?’

  From outside the room there came a high-pit
ched, insistent cry: GO AVAY GO AVAY GO AVAY . . .

  ‘Who’s on call today? You three interns rotate days on call, and you only admit patients on your on-call day. Who’s admitting today?’

  ‘I am,’ said Potts.

  ‘Good, ‘cause that awful sound comes from a gomer. If I’m not mistaken, it’s from one Ina Goober, whom I admitted six times last year. A gomer, or rather, the feminine, gomere. Gomer is an acronym: Get Out of My Emergency Room—it’s what you want to say when one’s sent in from the nursing home at three A.M.’

  ‘I think that’s kind of crass,’ said Potts. ‘Some of us don’t feel that way about old people.’

  ‘You think I don’t have a grandmother?’ asked Fats indignantly. ‘I do, and she’s the cutest, dearest, most wonderful old lady. Her matzoh balls float—you have to pin them down to eat them up. Under their force the soup levitates. We eat on ladders, scraping the food off the ceiling. I love . . .’ The Fat Man had to stop, and dabbed the tears from his eyes, and then went on in a soft voice, ‘I love her very much.’

  I thought of my grandfather. I loved him too.

  ‘But gomers are not just dear old people,’ said Fats. ‘Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them. We’re cruel to the gomers, by saving them, and they’re cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them.’

  ‘I don’t get it,’ said Potts.

  ‘After Ina you’ll get it. But listen—even though I said I don’t see patients, when you need me, I’m here with you. If you’re smart, you’ll use me. Like those dolled-up jets that cargo the gomers to Miami: “I’m Fats, fly me”. Now, let’s get on to the cardflip.’

  The efficiency of the Fat Man’s world rested on the concept of the three-by-five index card. He loved three-by-five cards. Announcing that ‘there is no human being whose medical characteristics cannot be listed on a three-by-five index card,’ he laid out two thick decks on the table. The one on the right was his. The duplicate deck on the left he split in three, and handed a stack to each of the new terns. On each card was a patient, our patients, my patients. The Fat Man explained how on his work rounds he would flip a card, pause, and expect that tern to comment on the progress being made. Not that he expected progress to have been made, but he had to have some data, so that at the next cardflip, a condensed version later in the morning with the Fish and the Leggo, he could relate ‘some bullshit or other’ to them. The first cards flipped every day would be the new admissions from the tern who’d been on call the night before. The Fat Man made it clear that he was not interested in fancy elaborations of academic theories of disease. Not that he was antiacademic. To the contrary, he was the only resident to have his own reference file on every disease there was, on three-by-five cards. He loved references on three-by-five cards. He loved everything that was on a three-by-five card. But the Fat Man had strict priorities, and at the top was food. Until that awesome tank of a mind had been fueled via that eager nozzle of a mouth, Fats had a low tolerance for medicine, academic or otherwise, and for anything else.