by Samuel Shem
‘But the incubation period is four to six months.’
‘So? So in four months one of you will exchange-transfuse me.’
‘It’s all my fault,’ said Potts. ‘I shoulda hit him with steroids.’
After the others had left, the Runt turned to me and said he had a confession to make: ‘It’s about my third admission last night. In the middle of all this crap with the Yellow Man, this guy comes into the Emergency Room and I . . . I couldn’t handle it. I offered him five dollars if he’d go home. He took it and left.’
Prodded by my fear of its arrival, my time to be left alone on call arrived. Potts signed out his patients to me and went home to Otis. Scared, I sat at the nursing station, watching the sad sun die. I thought of Berry, and wished I was with her, doing things that young ones like us were supposed to be doing, while we still had our health. My fear mushroomed. Chuck came up, signed out his patients and asked me, ‘Hey, man, notice anything different?’
I did not.
‘My beeper, man, it’s off. They can’t get me now.’
I watched him walk down the long corridor. I wanted to call out to him, ‘Don’t go, don’t leave me alone here,’ but I did not. I felt so lonesome I wanted to cry. The Fat Man, earlier in the afternoon, as I’d gotten more and more nervous, had tried to reassure me, telling me that I was lucky, that he’d be on call with me all night.
‘Besides,’ he’d said, ‘tonight’s a great night, it’s The Wizard of Oz and blintzes.’
‘The Wizard of Oz and Blintzes?’ I asked. ‘What’s that?’
‘You know, the tornado, the yellow brick road, and that terrific Tin Man trying to get into Dorothy’s pants. Great flick. And at the ten-o’clock meal, blintzes. We’ll have a ball.’
That hadn’t helped me much. As I tended to the chaos of the ward, handling the now-hydrated and violent Ina Goober and tending to the feverish Sophie, who by now was so out of it from the LP that she’d attacked Putzel, I almost trembled with fear of what was to come. And then, when my time came, I choked. I was on the toilet and from six flights down, in her communications bunker, the page operator scored a direct hit:
DR. BASCH CALL EMERGENCY WARD FOR AN ADMISSION, DR. BASCH . . . Someone was dying in the E.W and they wanted me? Didn’t they know not to come into a teaching hospital in the first week of July? They wouldn’t see a doctor, they would see me. What did I know? I panicked. Olaf’s Potato started to zing through my mind again, and, heart pounding, I sought out the Fat Man, who was in the TV room immersed in The Wizard of Oz. Nibbling at a salami, he was singing along with the flick: ‘Because because because because because of the wonderful things he does. We’re off to see the Wizard, the wonderful Wizard of Ozzz . . .’
It was difficult to interrupt him. I thought it peculiar that he’d take an interest in something as playful as Oz, but I soon found out that his interest was, like many of his interests, perverted:
‘Do it,’ Fats muttered, ‘do it to Dorothy with the oil can. Spin her around on your hat, Ray, spin her around on your hat.’
‘I’ve got something to tell you,’ I said.
‘Shoot.’
‘There’s a patient, an admission, in the Emergency Ward.’
‘Good. Go see her. You’re a doctor now, remember? Doctors see patients. Do it. Ray Bolger, do it to her STAT!’
‘Yeah, I know,’ I squeaked, ‘but I . . . you see, someone’s going to be dying down there, and I . . .’
Taking his eyes off the tube, Fats looked at me and said in a kind voice, ‘Oh, I see. Scared, huh?’
I nodded and told him that all I could think of was Olaf’s big potato.
‘Right. OK, so you’re scared. Who isn’t, his first night on call? Even I was scared too. Let’s go. We gotta hurry. We’ve only got half an hour till the ten-o’clock meal. What nursing home is she from?’
‘I don’t know,’ I said as we walked to the elevator.
‘You don’t know? Damn. They’ve probably already sold her bed, so we won’t be able to TURF her back there. One of the true medical emergencies, when the nursing home sells the gomere’s bed.’
‘How do you know it will be a gomere?’
‘The odds, just playing the odds.’
The elevator opened, and there was the 6-North tern, Eat My Dust Eddie, standing with a stretcher on which was piled his very own first E.W. admission: three hundred pounds of flesh, naked but for dirty underpants, huge herniations of his abdominal wall, a great medicine ball of a head with little slots for eyes, nose, and mouth, and a bald skull covered with purplish criss-crossing neurosurgical scars so it looked like a box of Purina dog chow. And all of it was convulsing.
‘Roy,’ said Eat My Dust, ‘meet Max.’
‘Hi, Max,’ I said.
‘HI JON HI JON HI JON,’ said Max.
‘Max perseverates,’ said E.M.D. ‘They unhooked his frontal lobe.’
‘Parkinson’s disease for sixty-three years,’ said Fats, ‘a House record. Max comes in when his bowels get blocked. See that intestine pushing its way out through the scars in his belly? Those lumps?’
We did.
‘If you X-ray it, you’ll find it’s feces. Last time Max was here, it took nine weeks to clean him out, and the only thing that finally worked was a small-handed female Japanese cellist who was also a BMS student, equipped with special long-armed gynecological gloves, and promised the internship of her choice if she would disimpact Max manually. Wanna hear “Fix the lump”?’
We did.
‘Max,’ said Fats, ‘what do you want us to do?’
‘FIX THE LUMP FIX THE LUMP FIX THE LUMP,’ said Max.
Eat My Dust Eddie and his BMS put their shoulders to the wheels of the stretcher, and Max, gathering momentum, rolled off into the neon sunset. Yoked together, the three looked like they were trudging around a ring of the mountain of Purgatory. Coming back to my senses as we rode the elevator down, I asked the Fat Man how come he seemed to know all the patients, like Max, Ina, and Mr. Rokitansky.
‘There is a finite number of House gomers,’ said Fats, ‘and since GOMERS DON’T DIE, they rotate through the House several times a year. It’s almost as if they get their yearly schedules in July, just like us. You get to know them by their particular shrieks. But what diseases does your gomere have?’
‘I don’t know. I haven’t seen her yet.’
‘Doesn’t matter. Pick an organ, any organ.’
I fell silent, so scared that I was having trouble thinking of an organ.
‘What is this? Where did they get you from? On quota? Is there affirmative action for Jews? What lies inside the chest cavity and beats?’
‘The heart.’
‘Good. So the gomere has congestive heart failure. What else?’
‘The lungs.’
‘Terrific. You’re really cooking now. Pneumonia. Your gomere has CHF and pneumonia, she’s septic from her indwelling catheter, refuses to eat, wants to die, is demented, and has an unobtainable BP. What’s the first thing—the crucial thing—to do?’
I thought of the diagnosis of septic shock, and suggested an LP.
‘Nope. That’s BMS textbook. Forget textbook. I am your textbook. Nothing you learned at the BMS will help you tonight. Listen—key concept—LAW NUMBER FIVE: PLACEMENT COMES FIRST.’
‘I think that’s going a little too far. I mean, you’re making all kinds of assumptions about this person. You’re treating a human being like a piece of baggage.’
‘Oh? I’m crass, cruel, and cynical again, am I? I don’t feel anything for the ill. Well, I do. I cry at movies, I’ve spent twenty-seven Passovers being pampered by the sweetest grandma any Brooklyn boy ever had. But a gomere in the House of God is something else. You’ll find out for yourself tonight.’
We stood at the nursing station of the E.W. Several others were sitting there: Howard Grinspoon, who was the new tern on call in the E.W.; and two policemen. Howard I’d known from the BMS. He was blessed with two traits which were to
prove to be so useful to him in medicine: unawareness of self, and unawareness of others. Not smart, Howard had slurped his way through BMS and into the House by doing something with urine, either putting urine through computers or running computers on urine. This had endeared him to that other man of little urine, the Leggo. A plodder and a planner, Howard was also into using IBM computer cards to aid in medical decision-making. By the start of the ternship, he already had developed a terrific bedside manner, to hide his rampant indecisiveness. Although Howard wanted to ‘present the case’ to Fats and me, Fats ignored him, focusing on the policemen. One policeman was huge, barrel-shaped, with red hair growing out of and into most of the slitty features on his fat red face. The other policeman was a matchstick, decked out, facially, in white of skin and black of hair, with vigilant eyes and a large and worrisome mouth filled with many disparate teeth.
‘I’m Sergeant Gilheeny,’ said the red, barrel-shaped one, ‘Finton Gilheeny, and this is Officer Quick. Dr. Roy G. Basch, we wish you hello and Shalom.’
‘You don’t look Jewish,’ I said.
‘You don’t have to be Jewish to love a hot pumpernickel bagel, and besides, the Jews and the Irish are similar in one respect.’
‘What respect is that?’
‘In their respect for the family unit, and the concomitant fucked-up nature of their lives.’
Howard, irritated at being ignored, tried to tell us again about my admission. The Fat Man silenced him at once.
‘But you don’t know anything about her,’ said Howard.
‘Tell me her shriek, and I’ll know it all.’
‘Her what?’
‘Her shriek. Whatever sounds she makes.’
‘Well,’ said Howard, ‘she does shriek. She makes a ROODLE.’
‘Anna O.,’ said Fats. ‘Hebrew House for the Incurables. This admission will be approximately number eighty-six. You start with a hundred sixty milligrams of the diuretic Lasix and you go up from there.’
‘How’d you know all that?’ asked Howard.
Ignoring him, Fats turned to the policemen and said, ‘It’s obvious that Howard has failed to do the most important things in the case. I trust that you two gentlemen have?’
‘Even in our role as policemen who patrol the city and environs of the House of God and often sit and chat and drink coffee with the brilliant young medicos,’ said Gilheeny, ‘we do sometimes intervene in emergency patient care.’
‘We are men of the law,’ said Quick, ‘and we followed the house LAW: PLACEMENT COMES FIRST, and called the Hebrew House. Alas, during the ambulance ride here, Anna O.’s bed was sold.’
‘Too bad,’ said the Fat Man. ‘Well, at least Anna O. is a great one to learn on. She’s taught countless House terns medicine. Roy, go see her. You’ve got twenty minutes till the ten o’clock meal. I’ll wait here and jabber with our friends the cops.’
‘Magnificent!’ said the redheaded policeman, beaming a grand sunny smile, ‘for twenty minutes of Fat Man chat is a gift horse we shall look everywhere but in the mouth.’
I asked Gilheeny why he and Quick were so well-informed about this medical emergency, and his reply puzzled me:
‘Would we be policemen if we were not?’
I left the Fat Man and the two policemen huddling together, intensifying their chatter. I went to the door of room 116, and once again I felt alone and afraid. Taking a deep breath, I went in. The walls were covered with green tile, and the bright neon light glittered off the stainless-steel equipment. It was as if I had stepped into a tomb, for there was no doubt that here, somehow, I was in touch with that poor thing, death. In the center of the room was a stretcher. In the center of the stretcher was Anna O. She lay motionless, her knees bent up toward the ceiling, her shoulders curved around toward her knees, so that her head, unsupported and rigid, almost touched her thighs. From the side she looked like the letter W. Was she dead? I called to her. No answer. I felt for a pulse. Heartbeat? None. Breath? No. She was dead. How fitting, that in her death her entire body should have hooked around in mimicry of her persecuted Jewish nose. I felt relieved that she was dead, that the pressure to care for her was off. I saw her little tuft of white hair, and I remembered my grandmother lying in her coffin, and I was filled with sadness for that loss. A lump formed in my midsection, tugged at the tip of my heart, and pulled itself up into my throat. I felt that strange sensation of gritty warmth that comes just before tears. My lower lip curled down. To control myself, I sat.
The Fat Man rushed in and said. ‘All right, Basch, blintzes and . . . hey, what’s the matter with you?’
‘She’s dead.’
‘Who’s dead?’
‘This poor woman. Anna O.’
‘Baloney. Have you lost your mind?’
I said nothing to this. Perhaps I had lost my mind and the strange policemen and the gomere were all a hallucination. Sensing my sadness, the Fat Man sat down next to me.
‘Have I steered you wrong so far?’
‘You’re too cynical, but whatever you say seems to be true. Even though it’s crazy.’
‘Exactly. So listen to me, and I’ll tell you when to cry, ’cause there are times during this ternship when you’ll have to cry, and if you don’t cry then, you’ll jump off this building and they’ll scrape you up from the parking lot and drip you into a plastic bag. You’ll wind up a bagful of goo. Get it?’
I said I did.
‘But I’m telling you that now is not the time, ‘cause this Anna O. is a true gomere, and LAW NUMBER ONE: GOMERS DON’T DIE.’
‘But she’s dead. Just look at her.’
‘Oh, she looks dead, sure. I’ll give you that.’
‘She is dead. I called to her and felt for a pulse and listened for a heartbeat and looked for a breath. Nothing. Dead.’
‘With Anna, you need the reverse stethoscope technique. Watch.’
The Fat Man took off his stethoscope, plugged the earpiece into Anna O.’s ears, and then, using the bell like a megaphone, shouted into it: ‘Cochlea come in, cochlea come in, do you read me, cochlea come . . .’
Suddenly the room exploded. Anna O. was rocketing up and down on the stretcher, shrieking at great pitch and intensity: ROODLE ROODLE ROOOOOO . . . DLE!
The Fat Man plucked his stethoscope from her ears, snatched my hand, and pulled me out of the room. The shrieks echoed through the E.W., and Howard, at the nursing station, stared at us. Seeing him, Fats yelled: ‘Cardiac arrest! Room 116!’ and as Howard jumped up and came running, the Fat Man, laughing, pulled me into the elevator and punched the cafeteria button. Beaming, he said, ‘Repeat after me: GOMERS DON’T DIE.’
‘GOMERS DON’T DIE.’
‘You betcha. Let’s eat.’
Few things could have been more disgusting than watching the Fat Man shovel day-old blintzes into his mouth, talking all the time about things as different as the porno motif in Oz, the virtues of the foul food we were eating, and finally, when he and I were left alone, his prospects in what he still would refer to only as the Great American Medical Invention. I drifted off, and was soon with Berry on a June beach, filled with love’s excitement, of possibility shared. Capability Brown. English landscapes. Eye within eye, sea salt on our caressing lips—
‘Basch, cut it out. You stay there much longer, and when you come back to this shithole, you’ll snap.’
How had he known? What had they done to me, putting me with this madman?
‘I’m not crazy,’ said Fats, ‘it’s just that I spell out what every other doc feels, but most squash down and let eat away at their guts. Last year I lost weight. Me! So I said to myself, “Not your gastric mucosa, Fats baby, not for what they’re paying you. No ulcer for you.” And here I am.’ Sated, he mellowed, and went on, ‘Look, Roy, these gomers have a terrific talent: they teach us medicine. You and I are going down there and, with my help, Anna O. is going to teach you more useful medical procedures in one hour than you could learn from a fragile young patient in a week. LAW NUMBER
SIX: THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A NUMBER-FOURTEEN NEEDLE AND A GOOD STRONG ARM. You learn on the gomers, so that when some young person comes in to the House of God dying . . .’
My heart skipped a beat.
‘. . . you know what to do, you do good, and you save them. That part of it’s exciting. Wait’ll you feel the thrill of sticking a needle blindly into a chest to make a diagnosis, to save someone young. I’m telling you, it’s fantastic. Let’s go.’
We did. With the Fat Man’s guidance, I learned how to tap a chest, tap a knee, put in lines, do an LP properly, and many other invasive procedures. He was right. As I got better with the needle, I began to feel good, more confident, and the possibility that I might become a competent doc glowed inside me. Fear began to leave me, and when I realized what was happening, I felt, deep inside, a blush, a rush, a thrill.
‘All right,’ said Fats, ‘so much for diagnosis. Now, treatment. What do we do for her heart failure? How much Lasix?’
Who knew? BMS had taught me nothing about the empirics of treatment.
‘LAW NUMBER SEVEN: AGE + BUN = LASIX DOSE.’
This was nonsense. Although the BUN—Blood Urea Nitrogen—was an indirect measure of heart failure, it was clear that Fats was playing another joke, and I said, ‘That equation is nonsense.’
‘Of course it is. And it works every time. Anna is ninety-five and her BUN is eighty. A hundred and seventy-five milligrams. Twenty-five to grow on, and it’s an even two hundred. Do what you like, but she’ll start to piss only when you get to two hundred. Oh, and remember, Basch, BUFF her chart. Litigation is nasty, so put a good shiny BUFF on Anna O.’s chart.’
‘OK,’ I said, ‘but do I have to get her out of heart failure before I start her bowel run?’
‘Bowel run? Are you nuts? She’s not a private patient, she’s our patient. There’s no bowel run on her.’
Feeling grateful, feeling glad that this medical wizard was with me, I said, ‘You know what you are, Fats?’
‘What?’
‘You’re a great American.’
‘And with luck, soon a rich one. Bedtime for Fats. Remember, Roy, primum non nocere, and hasta la vista muthafucka.’
